Frontal Recess Stenosis

Most frontal sinus disease is the result of previous surgery, and it is important not to instrument this area unless there is a good reason. The frontal sinus is often opaque on CT in nasal polyposis, but this is not a reason to operate on the frontal recess as it is normally due to retained mucus. It is rare to find polyps within the frontal sinus. Simply opening the middle meatus and debulking polyps in the region below the frontal recess with a shaver or through-cutting forceps, followed by douching and topical nasal steroids, will often be enough to allow the patient's disease, and their symptoms, to be controlled.

The key point is not to denude the frontal recess of its mucosa since this runs the risk of causing stenosis (Fig. 12.27). If there is purulent disease within the frontal sinus causing symptoms, then it is best to open the recess, preserving as much mucosa as possible. This is best done by dissecting the mucosa off the agger nasi air cells with a ball probe and then pulling the probe down on the shell of the cell and removing the fragments of bone—being careful to preserve the mucosa. Any loose fragments of mucosa are best left alone, as to grab them and pull them will tear off the mucosa like tearing loose wallpaper from a wall, leaving bare bone that runs the risk of cicatrization. If there are large fragments of redundant mucosa that cannot be approximated to the walls around the frontal recess, these can be trimmed using a shaver or through-cutting forceps. If there is a bony partition between a supraorbital cell and the frontal recess or a high frontal cell, the partition between them should be removed submucosally, or a hanging partition can be punched with a through-cutting instrument. This will leave an almost intact covering of mucosa (Fig. 12.28a, b).

When operating in the frontal recess, a 45° endoscope is invaluable. If you cannot locate the frontal sinus with a probe by the methods described, it is best not to probe with any force or remove tissue in the hope that you will find the recess, as this is how CSF leaks, orbital damage, or frontal stenosis are produced. Because of this complication, always ask yourself why you need to be in the frontal recess. Does the patient have genuine frontal sinusitis, or do they have tensiontype headache? Frontal symptoms in nasal polyposis are uncommon and it is equally unusual for chronic frontal symptoms to be due to genuine rhinosinusitis.

Recess Stenose
Fig. 12.28 a Granulation tissue surrounds a stent in the frontal ing and preserving the mucosa of the frontal recess is less likely recess and this may stenose when the tube is removed. b Open- to result in stenosis.

Fig. 12.29 Postoperative views of a patient with ongoing infection a before and b after douching along with antibiotic ointment.

Fig. 12.29 Postoperative views of a patient with ongoing infection a before and b after douching along with antibiotic ointment.

Was this article helpful?

0 0
Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

Get My Free Ebook


  • Regina Egan
    WHAT IS frontal recess stenosis?
    11 months ago

Post a comment