Frontal sinus rescue

Abstract

Since the late 1980's, endoscopic frontal sinusotomy has emerged as the preferred technique for the surgical management of chronic frontal sinusitis that is refractory to routine medical treatment [9]. During endoscopic frontal sinusotomy, the partitions of the cells that pneumatize the frontal recess are carefully identified and removed under endoscopic visualization. Throughout the procedure, mucosa is preserved, and the boundaries of the frontal recess are not disturbed.Thus, after endoscopic frontal sinusotomy, the frontal recess should be a widely patent,mucosa-lined structure with rigid walls. If a frontal recess boundary is not fixed, then it may collapse into the frontal recess and cause secondary frontal recess/ostium stenosis. Today, this most commonly occurs after resection of the middle turbinate (which forms the medial boundary of the frontal recess). Because the middle turbinate remnant that remains after middle turbinate resection is often destabilized, it may fall laterally and compromise frontal recess patency. Simply stated, standard endoscopic frontal sinusotomy is often inadequate for the surgical treatment of chronic frontal sinusitis after middle turbinate resection, since the technique cannot compensate for frontal recess stenosis due to collapse of the middle turbinate. Revision endoscopic frontal sinusotomy with mucoperiosteal flap advancement, termed the frontal sinus rescue procedure (FSR), has been developed as a modification of the standard endoscopic frontal sinusotomy technique [5, 10]. The important principles of FSR are: FSR is not the creation of a simple hole to drain an obstructed frontal sinus In FSR, bony and soft tissue obstruction caused by the destabilized middle turbinate remnant is removed, and then a mucosal flap is advanced across the denuded bone at the medial aspect of the frontal ostium Critical lateral frontal recess mucosa is preserved; thus mucociliary clearance is restored, since the normal drainage pattern is down the lateral aspect of the frontal recess Of course, the entire FSR procedure is performed under endoscopic visualization. © Springer-Verlag Berlin Heidelberg 2005.