title: A novel approach to frontal sinus surgery: treatment algorithm revisited.
abstract: BACKGROUND
  Access to the frontal sinus remains a challenging problem for the craniofacial surgeon. A wide array of techniques including minimally invasive endoscopic approaches have been described. Here we present our technique using medical modeling to gain fast and safe access for multiple indications.
  
  
  METHODS
  Computer-aided surgery involves several distinct phases: planning, modeling, surgery, and evaluation. Computer-aided, precise cutting guides are designed preoperatively and allowed to perfectly outline and then cut the anterior table of the frontal sinus at its junction to the surrounding frontal bone. The outcomes are evaluated by postoperative three-dimensional computed tomography scan.
  
  
  RESULTS
  Eight patients sustaining frontal sinus fractures were treated with the aid of medical modeling. Three patients (37.5%) had isolated anterior table fractures, and 4 (50%) had combined anterior and posterior table fractures, whereas 1 patient (12.5%) sustained isolated posterior table fractures. Operative times were significantly shorter using the cutting guides, and fracture reduction was more precise. There was no statistically significant difference in complication rates or overall patient satisfaction.
  
  
  CONCLUSIONS
  The surgical approach to the frontal sinus can be made more efficient, safe, and precise when using computer-aided medical modeling to create customized cutting guides.
authors.affiliation: Institute of Reconstructive Plastic Surgery, New York University, New York, New York, USA.
authors.forename: Peter Niclas
authors.initials: PN
authors.lastname: Broer
authors.forename: Steven M
authors.initials: SM
authors.lastname: Levine
authors.forename: Neil
authors.initials: N
authors.lastname: Tanna
authors.forename: Katie E
authors.initials: KE
authors.lastname: Weichman
authors.forename: Gabriel
authors.initials: G
authors.lastname: Hershman
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Caldroney
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Allen
authors.forename: David L
authors.initials: DL
authors.lastname: Hirsch
authors.forename: Pierre B
authors.initials: PB
authors.lastname: Saadeh
authors.forename: Jamie P
authors.initials: JP
authors.lastname: Levine
mesh_terms: D000328:Adult; D000465:Algorithms; D005260:Female; D005626:Frontal Sinus / Q000293:injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D017060:Patient Satisfaction; D012887:Skull Fractures / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed