An explanation of the following type of surgery:
Elimination of the frontal sinuses by adding fat. Any
information on this type of surgery would appreciated.
Thank you.
Reply: ------------------
The surgery you refer to is known as a frontal sinus obliteration. The frontal sinuses are located in the forehead above the eyes. Occasionally chronic frontal sinusitis will fail to improve with long term medication, or will lead to complications such as extension of sinus infection into the eye or brain thus leading to the need for frontal sinus surgery. Until very recently, one of the most common frontal sinus surgerys performed was the frontal sinus obliteration. This operation involves making an incision in the scalp well above the forehead (a coronal incision) or an incision across the eyebrows. The former is the preferred approach since the incision can be camouflaged in the hair. Those with male pattern baldness usually are advised the brow incision. The bone overlying the frontal sinus is then lifted as a flap to expose the inside of the frontal sinus. The contents of the interior of the sinus are then removed (usually polyps and infection) and the bone inside the sinus is polished with a drill to remove all of the lining. The inside of the sinus is then packed with adipose tissue (fat) which is usually obtained through a small incision in the abdomen and the bone flap is then replaced and secured with thin plates or wire. The adipose tissue turns into scar which fills and obliterates the inside of the frontal sinus.
Very recently, newer frontal sinus surgical techniques have been described which involve the use of endoscopes placed through the nostrils. These newer techniques have the potential for surgically draining the frontal sinuses without the need for external approaches however they are highly sophisticated and require considerable experience in order to be successful and to avoid serious complications. Experienced endoscopic sinus surgeons will often attempt to treat chronic frontal sinus disease which fails medical therapy with an endoscopic approach initially. If the endoscopic approach fails to eliminate chronic frontal sinus disease, frontal sinus obliteration is then usually recommended. However, complications of chronic frontal sinus disease may make it necessary to proceed directly to frontal sinus obliteration.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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