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Georgalas, Christos et al.: 2022 The Frontal Sinus DOI: 10.1055/b-0042-184536
Section V Controversial Topics in Current Practice

37 Extreme Lateral Lesions: What Is the Limit of Endoscopic Surgery?

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Editors: Georgalas, Christos; Sama, Anshul

Authors: Abuzeid, Waleed M.; Adappa, Nithin D.; Ahmed, Shahzada; Alasousi, Fahad; Alobid, Isam; Al-Rasheed, Abdulaziz; Alt, Jeremiah A.; Avdeeva, Klementina; Banks, Catherine; Barnes, Martyn; Basak, Hazan; Batra, Pete S.; Battaglia, Paolo; Bernal-Sprekelsen, Manuel; Beton, Suha; Brand, Yves; Breedveld, Paul; Briner, Hans Rudolf; von Buchwald, Christian; Carrau, Ricardo L.; Carrie, Sean; Castelnuovo, Paolo; Chatzinakis, Vasileios; Chen, Philip A.; Chute, Deborah; Clarke, Caroline S.; Conley, David B.; Constable, James; Craig, John R.; Dadgostar, Anali; Dallan, Iacopo; DelGaudio, John M.; Diamantopoulos, Ioannis I.; Badawey, M Reda El; Eloy, Jean Anderson; Fakhri, Samer; Fastenberg, Judd H.; Fazio, Enrico; Felding, Ulrik A.; Fried, Marvin P.; Getz, Anne E.; Ghogomu, Nsangou; Gotlib, Tomasz; Gudis, David A.; Hadjihannas, Edward; Harvey, Richard J.; Herman, Philippe; Hettige, Roland; Hopkins, Claire; Husain, Qasim; Ioannidis, Dimitris; Jankowski, Roger; Javer, Amin; Jeyarajan, Hari; Kanumuri, Vivek V.; Karligkiotis, Apostolos; Kern, Robert C.; Khoueir, Nadim; Jankowski, Roger; Javer, Amin; Jeyarajan, Hari; Kanumuri, Vivek V.; Karligkiotis, Apostolos; Kern, Robert C.; Khoueir, Nadim; Maza, Guillermo; McHugh, Kelsey; Meço, Cem; Mencacci, Lodovica Cristofani; Morris, Stephen; Morrissey, David; Nair, Salil; Narayanan, Prepageran; Orlandi, Richard R.; Palmer, Charles F.; Palmer, James N.; Parasher, Arjun K.; Patel, Zara M.; Pfisterer, Michael J.; Philpott, Carl M.; Pietrobon, Giacomo; Polev, Georgiy A.; Prevedello, Daniel M.; Psaltis, Alkis J.; Ramakrishnan, Yujay; Rokade, Ashok; Roxbury, Christopher; Sacks, Raymond; Sansoni, E. Ritter; Santamaría-Gadea, Alfonso; Schlosser, Rodney J.; Seccia, Veronica; Sindwani, Raj; Smith, Kristine A.; Speleman, Kato; Subramaniam, Soma; Šurda, Pavol; Tajudeen, Bobby A.; Tan, Neil Cheng-Wen; Tang, Dennis; Tang, Ing Ping; Tarabichi, Osama; Tewfik, Marc A.; Tipirneni, Kiranya E.; Turri-Zanoni, Mario; Walters, Benjamin K.; Woodworth, Bradford A.; Wormald, Peter John; Youssef, Ahmed

Title: The Frontal Sinus

Subtitle: Surgical Approaches and Controversies

Print ISBN: 9783132400528; Online ISBN: 9783132437845; Book DOI: 10.1055/b-006-163737

1. Edition © 2022. Thieme. All rights reserved.
Georg Thieme Verlag KG, Stuttgart

Subjects: Otorhinolaryngology, Phoniatrics, Audiology

Thieme Clinical Collections (English Language)



 
Cem Meco, Suha Beton and Hazan Basak

Abstract

Continuous progress achieved in endoscopic techniques has dramatically changed the way we can approach extreme lateral lesions of the frontal sinuses. Driven by the eventual objective of causing less morbidity without compromising outcomes, endoscopic surgery nowadays can address most far lateral frontal sinus lesions even in large and well-pneumatized sinuses. An array of sophisticated endoscopic techniques added to Draf procedures can be used to achieve this goal. In order to adequately manipulate in the extreme lateral portion, orbital content needs to be suspended laterally with intact periorbita, after removing superomedial restricting orbital bones with appropriate instrumentation. At this moment, transection of the anterior ethmoidal artery, which is the only medial attachment of periorbita, plays a crucial role. This provides a wide access route to the most lateral portion of the frontal sinus, opening the area extensively for satisfactory visualization and manipulation around the lesions and their bony attachments. Thus, laterally located, especially benign frontal pathologies like mucoceles, fibro-osseous lesions, inverted papillomas, dura lesions, and others could be managed effectively. This evolution of divergence from established external surgical approaches is a result of achieving equal, if not better, outcomes with endoscopic surgery, while avoiding skin incisions and osteoplastic techniques that could cause problems. Nevertheless, one must not forget that external open approaches have withstood the test of time as elegant gold standard approaches and will always have their place for managing extreme lateral frontal lesions, especially for malignant neoplastic diseases or, if adequate instrumentation and expertise are not available to utilise endoscopic approaches.

Key words

frontal sinus - endoscopic surgery - extreme lateral pathology - Draf procedures - periorbital suspension - orbital transposition
 
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