Indications

• This is done for isolated anterior ethmoid and or maxillary sinus/frontal sinus disease that has not responded to maximum medical treatment.

• It is worth limiting surgery to the anterior ethmoid sinuses before entering the frontal recess, because this is often all that is necessary. As soon as you instrument the frontal recess you greatly increase the risk of causing iatrogenic disease (Kennedy, 1992).

• If surgical treatment to the anterior ethmoid sinuses is followed by medical treatment, the frontal sinus usually clears without any further intervention.

Surgery can be limited to the anterior ethmoid air cells when disease is localized to this area, such as in limited inflammatory polyps, inverted papilloma, or fungal disease (Fig. 5.30).

Inverting Papilloma Ethmoid Sinus
Fig. 5.30 Very localized inverted papilloma, localized to the anterior ethmoid sinuses.
Anterior Ethmoid Sinus Diagram

Fig. 5.31 a, b The green wire lies in the hiatus semilunaris; the above the uncinate process—type A. The white wire marks the blue wire is in a bulla frontalis whose roof has been opened in suprabullar recess area, and behind the bulla lie the retrobullar the specimen in b. The red wire is in the frontal sinus that drains recess and the basal lamella.

Fig. 5.31 a, b The green wire lies in the hiatus semilunaris; the above the uncinate process—type A. The white wire marks the blue wire is in a bulla frontalis whose roof has been opened in suprabullar recess area, and behind the bulla lie the retrobullar the specimen in b. The red wire is in the frontal sinus that drains recess and the basal lamella.

Suprabullar Recess

b a A line diagram of an agger nasi cell (1) with a bulla frontalis (2) extending into the frontal sinus. b The uncinate process and middle turbinate have been removed to reveal an agger nasi cell (arrow) as the most anterior cell in lateral nasal wall.

a A line diagram of an agger nasi cell (1) with a bulla frontalis (2) extending into the frontal sinus. b The uncinate process and middle turbinate have been removed to reveal an agger nasi cell (arrow) as the most anterior cell in lateral nasal wall.

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