Frontosphenoethmoidectomy

This is mainly reserved for those with persistent symptoms after anterior ethmoid surgery. In patients with severe recurrent polyposis, the best way to provide the patient with a longer symptom-free interval is to open up all the cells including the frontal recess (Fig. 5.79 a-c). A small proportion of patients with pol-yposis have frontal symptoms and in these patients we would open the frontal recess.

Frontal Ethmoid OsteomaSphenoethmoidectomy
Fig. 5.78 A frontosphenoethmoidectomy. In addition to a sphenoethmoidectomy, the frontal recess is opened.
Sphenoethmoidectomy

Fig. 5.79a, b Postoperative appearance after a frontosphenoethmoidectomy for severe polyposis. c A frontal sinusotomy type II in the same patient as in a and b. Note that there is residual mucosal inflammation that requires regular douching and topical nasal steroids to control it.

Frontosphenoethmoidectomy┬▒ Frontal Sinusotomy ┬▒ Maxillary Sinusotomy ┬▒ Sphenoid Sinusotomy 99

Patients with postoperative stenosis of the frontal recess and with symptoms require opening of the frontal recess (Fig. 5.80). Patients with pathology involving the frontal recess such as fungal disease and mucoceles need wide opening of the frontal recess area. (Fig. 5.81 a-c). Osteomas rarely cause symptoms except when they are large enough to cause a cosmetic deformity or a mucocele (Hehar and Jones, 1997). Beware if a patient has other symptoms, e.g., pain, as an osteoma rarely causes these symptoms and they are so common that they are likely to be a coincidental finding.

Be careful to review the patient's symptoms and endoscopic signs to make sure that you are addressing genuine frontal sinus pathology.

Frontosphenoethmoidectomy
Fig. 5.80 Frontosphenoethmoidectomy and median drainage procedure.
Paradoxical Turn Left Middle Turbinate

Fig. 5.81 a-c The pre- and postoperative appearance after a frontosphenoethmoidectomy and median drainage procedure for severe polyposis and a left mucocele.

Fig. 5.81 a-c The pre- and postoperative appearance after a frontosphenoethmoidectomy and median drainage procedure for severe polyposis and a left mucocele.

Sphenoidotomy Procedure
Fig. 5.82 A sphenoidotomy. The light green indicates when it is necessary to enlarge it into the posterior ethmoid sinuses.

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