A golden experience: Fifty years of experience managing the frontal sinus.

Objectives/hypothesis: The frontal sinus is one of the most anatomically complex and inaccessible of the paranasal sinuses. As a result, surgeons have continually tried to improve surgical management of the frontal sinus. The senior author (c.

Pediatric septoplasty.

This article discusses the importance of obtaining the correct anatomic location of a nasal obstruction in the pediatric patient, the relative and absolute indications for septoplasty, and surgical techniques. Because disruption of the developing nasal septum can alter craniofacial growth patterns, the current understanding of the effect of septoplasty on craniofacial growth is also discussed.

Endoscopic localization of the anterior and posterior ethmoid arteries.

Objectives: Understanding the endoscopic locations of the anterior and posterior ethmoid arteries is important during endoscopic sinus or endoscopic skull base procedures so that these arteries can be avoided. Therefore, the objective of this study was to define the endoscopic locations of the ethmoid arteries.

Methods: Twenty-four cadaver heads were used to identify the endoscopic location of the ethmoid arteries via an external incision.

Risk factors for recurrent sinus surgery in cystic fibrosis: review of a decade of experience.

Background: Patients with cystic fibrosis (CF) who undergo endoscopic sinus surgery often require multiple revision procedures. Our objective was to identify risk factors for revision sinus surgery in patients with CF, to better identify this subset of patients who might be better suited for alternative interventions at their initial procedure.

Methods: Patients with CF who presented to our academic tertiary care sinus clinic between 1994 and 2003 were reviewed.

Initial surgical treatment for chronic frontal sinusitis: a pilot study.

Objectives: The initial surgical treatment for chronic frontal sinusitis is not well defined. Our objective was to determine the effectiveness of anterior ethmoidectomy for chronic frontal sinusitis.

Methods: Patients with chronic frontal sinusitis who underwent anterior ethmoidectomy as initial surgical treatment were reviewed.

Tornwaldt's cyst: incidence and a case report.

Tornwaldt's cyst is an uncommon type of nasopharyngeal cyst that may cause clinically significant symptoms. We reviewed reports of 31,855 computed tomography (CT) scans and 21,158 magnetic resonance imaging (MRI) scans to ascertain how many Tornwaldt's cysts were discovered incidentally. These images had been obtained between Jan.

Steroid injection for sinonasal polyps: the University of Virginia experience.

Background: Sinonasal polyps are treated with topical steroids, systemic oral steroids, surgical excision, and intrapolyp steroid injection. Use of steroid injection is not widespread because of reported complications. The objective of this study was to evaluate the complications of intrapolyp steroid injections and compare it to the complications of surgical removal of polyps.

Limits of endoscopic visualization and instrumentation in the frontal sinus.

Background: Endoscopic limitations in the frontal sinus are poorly defined. We set out to define these limits.

Methods: Fifteen cadaveric heads underwent endoscopic frontal sinusotomies (Draf IIA, IIB, III).

Expression of leukotriene C4 synthase and plasminogen activator inhibitor 1 gene promoter polymorphisms in sinusitis.

Background: Studies have described polymorphisms in genes involved with both leukotriene synthesis and remodeling. Leukotriene C4 synthase (LTC4S) is the critical terminal pathway enzyme involved in regulation of cysteinyl leukotriene (CysLT) synthesis. An A-to-C base exchange in the promoter region of the LTC4S gene influences its expression.

FloSeal use in endoscopic sinus surgery: effect on postoperative bleeding and synechiae formation.

Purpose: The objective of this study is to evaluate the effect of the hemostatic agent, FloSeal (FS), on bleeding and healing after functional endoscopic sinus surgery.

Methods: We performed randomized, double-blinded, controlled study at a tertiary care center. Patient nasal sides were randomized to FS or control.

Endoscopic sinus surgery in patients older than sixty.

Objective: Rhinosinusitis is the sixth most common chronic condition of the elderly. Functional endoscopic sinus surgery (FESS) has developed over the last 20 to 30 years into a widely accepted treatment modality for chronic rhinosinusitis in adults who have failed maximal medical management. The aim of this study was investigate the safety and efficacy of FESS in the geriatric population as compared to that of the adult population.

Endoscopic management of cerebrospinal fluid rhinorrhea.

Purpose: Most anterior skull base defects causing cerebrospinal fluid (CSF) rhinorrhea can be readily approached using endoscopic techniques when surgical repair is necessary. We present our data from endoscopic repair of CSF rhinorrhea with long-term follow-up.

Methods: Retrospective data analysis of patients that were diagnosed with anterior skull base CSF rhinorrhea and underwent endoscopic repair at a tertiary institution.

Long-term results of the Lothrop operation.

With continued surgical instrument advancement, endoscopic sinus surgery techniques continue to evolve with an overall improvement of our ability to offer surgical treatment for a variety of surgical disorders of the sinuses and anterior skull base. Frontal sinusitis and the extent of surgery performed in the frontal recess once medical management fails are constantly debated in the literature. It seems that even though instrumentation has greatly improved, surgical management of frontal sinusitis remains a frustrating endeavor for otolaryngologists.

Endoscopic management of benign sinonasal tumors: a decade of experience.

Background: A variety of benign tumors present in the nasal and paranasal sinuses.

Methods: We review our experience over the last 10 years with endoscopic management of these tumors and discuss (presentation, diagnostic considerations, and therapeutic options.

Results: Eighteen patients with benign sinonasal tumors were managed with endoscopic techniques.

Three-dimensional computed tomography of congenital nasal anomalies.

Objective: To determine the utility of performing three-dimensional (3D) computed tomography (CT) of congenital naso-frontal anomalies for preoperative planning and counseling and compare it with standard two-dimensional (2D) imaging and intraoperative findings.

Study Design: Prospective case evaluation of imaging studies and medical records in cohort of patients with congenital nasal anomalies.

Methods: We performed 3D CT imaging of three different types of congenital nasal lesions.

Skull base erosion by sphenoid fungus balls: diagnosis and endoscopic treatment.

Background: Fungus balls typically are innocuous lesions found in immunocompetent hosts. They are located most commonly in the maxillary sinus but may be life-threatening when found in the sphenoid sinus.

Methods: We review our series offour sphenoid fungus balls with skull base erosion.

Pitfalls in the endoscopic drainage of subperiosteal orbital abscesses secondary to sinusitis.

Objective: To review the safety and efficacy of endoscopic drainage of subperiosteal orbital abscesses (SPOAs) secondary to sinusitis and to evaluate risk factors that may be associated with failure.

Study Design: Retrospective chart review.

Methods: All patients admitted to the University of the Virginia Health System with a diagnosis of SPOA between 1992 and 1999 were reviewed.

The endoscopic modified Lothrop: long-term follow-up on 44 patients.

Background: The gold standard for surgical treatment of chronic frontal sinusitis has been the osteoplastic flap with obliteration. In an attempt to preserve the frontal sinus, we have been performing the endoscopic modified Lothrop orfrontal drill-out.

Methods: Retrospective chart review.