title: Where endoscopy fails: indications and experience with the frontal sinus fat obliteration.
abstract: BACKGROUND
  With the event of angled endoscopes, image guidance and the rapidly improving endoscopic techniques the previously used osteoplastic frontal sinus fat obliteration (ISO) becomes more and more a second line treatment option. The objective of our study is to describe the up-to-date indications for FSO based on our own experience.
  
  
  METHODS
  Retrospective analysis including follow-up visits of 77 patients with frontal sinus fat obliteration at our clinic between 1991 and 2006 was undertaken and descriptive statistics were drawn.
  
  
  RESULTS
  Thirty-six cases were operated by FSO as a first-line treatment, 41 had previous surgery. Eighty percent of all patients showed no postoperative residual complaints. Two patients required revision surgery. General complication rate was 36.4%, however these consisted in the vast majority of cases (90%) of minor complications.
  
  
  CONCLUSIONS
  FSO still remains a valuable operation for specific indications. FSO is the gold standard for repeatedly failed endoscopic procedures. The operation should also target the following indications as a first-line treatment: large/lateral osteomas, malignant disease, lateral mucoeceles, most fractures of the posterior sinus wall with CSF-leak, osteomyelitis, pathologies in small underdeveloped sinuses with narrow floor. It is associated with minimal complications and a good outcome.
authors: Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich, Zurich, Switzerland.
authors: Michael B
authors: MB
authors: Soyka
authors: Alexandra
authors: A
authors: Annen
authors: David
authors: D
authors: Holzmann
mesh_terms: D000273:Adipose Tissue / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004724:Endoscopy; D005260:Female; D005626:Frontal Sinus / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010254:Paranasal Sinus Diseases / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies