title: Endoscopic endonasal orbital transposition to expand the frontal sinus approaches.
abstract: BACKGROUND
  The management of frontal sinus disease still remains a challenging issue for rhinologists. Although endoscopic frontal sinus surgery has significantly advanced over the past years, there are some conditions in which the external approaches are still necessary. Recently, the increasing experience in endoscopic sinus surgery together with important technologic advancements have allowed expansion of the indications for selected lesions localized more and more lateral into the frontal sinus.
  
  
  OBJECTIVE
  The aim of this study was to describe the endoscopic endonasal approach to the far lateral portion of the frontal sinus and to evaluate the outcomes of this technique.
  
  
  METHODS
  A retrospective evaluation was carried out with patients at a single institution, who, from 2004 to 2012, underwent an exclusive endoscopic transnasal approach to the far lateral portion of the frontal sinus at a single institution. The surgical technique included the Draf IIb procedure, a modified Lothrop procedure (Draf III), and endoscopic lateralization of the orbit, differently associated according to the needs of each case.
  
  
  RESULTS
  Twenty-four patients were eligible for the present study. The lesions included were mucoceles in 9 cases, fibro-osseous lesions in 10 cases, and inverted papillomas in 5 cases. The overall follow-up ranged from 12 to 120 months (mean, 40.6 months). At the time of the last follow-up, no recurrence of disease was observed in the patients treated; in one case of osteoma, a small and stable in size (1 mm) persistent lesion was observed in an asymptomatic patient. One scheduled and one accidental cerebrospinal fluid leak with immediate skull base reconstruction occurred. No intraoperative or postoperative early or late orbital complication was observed in any case.
  
  
  CONCLUSIONS
  The endoscopic endonasal orbital transposition seems to facilitate the endoscopic management of selected far-lateral frontal sinus lesions. However, it is a demanding procedure that requires experience and skill to avoid intraoperative skull base and orbital complications.
authors.affiliation: Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Karligkiotis
authors.forename: Andrea
authors.initials: A
authors.lastname: Pistochini
authors.forename: Mario
authors.initials: M
authors.lastname: Turri-Zanoni
authors.forename: Paola
authors.initials: P
authors.lastname: Terranova
authors.forename: Luca
authors.initials: L
authors.lastname: Volpi
authors.forename: Paolo
authors.initials: P
authors.lastname: Battaglia
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bignami
authors.forename: Paolo
authors.initials: P
authors.lastname: Castelnuovo
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005626:Frontal Sinus / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D009915:Orbit; D010027:Osteotomy / Q000379:methods*; D010254:Paranasal Sinus Diseases / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult