Management of Lateral Frontal Sinus Pathology in the Endoscopic Era.
Considerable advances in endoscopic technique and experience have allowed an increasing number of patients with complex frontal sinus disease to be treated with endoscopic surgery. The objective of the current study was to evaluate management strategies and outcomes regarding treatment of lateral frontal sinus disease.



Prospective case series.



Academic tertiary medical center.



Prospectively collected data concerning frontal sinus pathology located lateral to the plane of the lamina papyracea (lateral disease) were reviewed. Data were collected regarding demographics, etiology, surgical technique, revision rate, anatomic considerations, and clinical follow-up. Only patients with at least 24 weeks of clinical follow-up and pathology who required removal and dissection in this region were included in the study.



Over 5 years, 156 patients (mean age, 47.9 years; range, 14-84 years) with 183 lateral frontal sinus pathologies and an average clinical follow up of 76 weeks (range, 24-237 weeks) were evaluated. Endoscopic or open surgery was attempted in 84 patients (54%) prior to intervention at our institution. Primary pathologies included inflammatory/obstructive diseases (n = 119), skull base defects (n = 33), and tumors (n = 31). Initial interventions included endoscopic (Draf IIA, n = 76; Draf IIB, n = 52; Draf III, n = 23), extended (IIA + trephine, n = 1; III + trephine, n = 2; III + osteoplastic flap, n = 2), and open (osteoplastic flap, n = 3; Reidel, n = 1; cranialization, n = 1) procedures. Seven patients (4%) required a subsequent revision procedure.



The vast majority of lateral frontal sinus pathology was managed using endoscopic techniques with excellent outcomes and a low revision rate in the current study.
Department of Surgery/Division of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Bryant T
BT
Conger
Department of Surgery/Division of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Elisa
E
Illing
Department of Surgery/Division of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Benjamin
B
Bush
Department of Surgery/Division of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA bwoodwo@hotmail.com.
Bradford A
BA
Woodworth
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005626:Frontal Sinus / Q000473:pathology / Q000601:surgery*; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D059747:Nasal Surgical Procedures / Q000379:methods; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome
CSF rhinorrhea; chronic rhinosinusitis; endoscopic sinus surgery; endoscopic skull base surgery; extended frontal sinusotomy; frontal sinus; sinus surgery; sinusitis; sinusotomy; skull base