OBJECTIVETo summarize the follow-up outcomes of Draf IIb frontal sinusotomy and it's modified procedures, and to discuss the surgical indications and prognostic factors.

METHODSThirty-two patients treated between 2004 and 2010 were enrolled in this study. There were 15 patients for recurrent frontal inverted papilloma (IP), 6 for mucocele, 4 for recurrent frontal sinusitis, 3 for osteoma, 2 for meningoencephalocele with cerebrospinal fluid rhinorrhea, 1 for meningoencephalocele alone and 1 for acute frontal sinusitis. All patients underwent preoperative paranasal sinus computed tomography (CT) scans. Patients with tumor accepted magnetic resonance imaging (MRI). The patients with meningoencephalocele and cerebrospinal fluid rhinorrhea received magnetic resonance cisternography (MRC). The Draf IIb frontal sinusotomy and it's modified Draf IIb-1-3 procedures were applied endoscopically under general anesthesia mainly by high speed bur and power system. The postoperative CT scan was obtained as a base line for follow-up 1 week after the operation. Postoperative follow-up was performed under endoscope.

RESULTSAmong 19 cases of Draf IIb, 12 were recurrent IP of frontal sinus, 4 were mucocele, 2 were recurrent frontal sinusitis and 1 were osteoma. Five cases received Draf IIb-1, 2 for each recurrent IP of frontal sinus and recurrent frontal sinusitis and 1 for osteoma. Six cases received Draf IIb-2, 3 for meningoencephalocele, 1 for each IP, acute frontal sinusitis and osteoma. Two cases received Draf IIb-3 were mucocele. The follow-up ranged from 8 to 73 months. Twenty-two cases of the frontal nepostium were widely opened, 7 were stenosis and 3 were closed. Revision surgery was seen in 2 cases with IP. All of them had no complications.

CONCLUSIONSThe Draf IIb frontal sinusotomy and it's modified procedures are suitable for complex frontal sinus disease, which can be selected according to pathological and anatomical features, and have a good prospect for clinical application.

Endoscopy ; methods ; Female ; Frontal Sinus ; surgery ; Humans ; Male ; Paranasal Sinus Diseases ; surgery ; Paranasal Sinus Neoplasms ; surgery ; Retrospective Studies ; Treatment Outcome

Cysts ; Humans ; Paranasal Sinus Diseases ; surgery ; Sphenoid Bone ; Sphenoid Sinus ; surgery

Aged ; Humans ; Male ; Maxillary Sinus ; Paranasal Sinus Diseases ; diagnosis ; etiology ; surgery ; Syndrome

Adult ; Endoscopy ; Female ; Humans ; Mucocele ; surgery ; Paranasal Sinus Diseases ; complications ; surgery ; Pituitary Apoplexy ; complications ; surgery ; Sphenoid Sinus

OBJECTIVE: To investigate the advantages and disadvantages between two surgical approaches of trans scalp coronary incision (TCI) and functional endoscopic sinus surgery (FESS) by which front-ethmoid-orbital masses being resected. METHOD: Thirty-four cases of front-ethmoid-orbital mass from 1995-2006 were retrospectively studied, among which lesions of 18 cases resected by FESS, lesions of 16 cases via TCI. The follow-up time varied from 2 to 4 years. RESULT: Five of 18 cases by FESS had residual dizziness or nasal pain, one case recurred 2 years after the operation. None of TCI cases experienced recurrence, whereas dizziness presented in 3 cases, regional dull sensation of the operative scalp in 12 cases. CONCLUSION FESS and TCI approach has its own benefits and shortcomings thus has its indications respectively.
Adolescent ; Adult ; Aged ; Cysts ; surgery ; Endoscopy ; Ethmoid Sinus ; surgery ; Female ; Frontal Sinus ; surgery ; Humans ; Male ; Middle Aged ; Orbit ; surgery ; Paranasal Sinus Diseases ; surgery ; Paranasal Sinus Neoplasms ; surgery ; Retrospective Studies ; Scalp ; surgery ; Young Adult

Adult ; Blindness ; etiology ; Cysts ; surgery ; Humans ; Infection ; complications ; etiology ; Male ; Paranasal Sinus Diseases ; surgery ; Postoperative Complications ; Sphenoid Sinus

OBJECTIVE: To investigate the diagnosis and management of non-pituitary lesions in sphenoidal sinus. METHOD: All cases with non-pituitary lesions in sphenoidal sinus were confirmed by CT scan. Eight cases with localized lesions underwent operation by trans-sphenoidal approach. Two cases with juvenile nasopharyngeal angiofibroma with invasion to the sphenoid sinus were treated by trans-septal approach. The rest received operation by trans-superior meatal or trans-ethmoidal approach. RESULT: Forty-five of these cases underwent complete or major resection of the lesion by endoscopic sphenoid sinus surgery, including 23 cyst and pus cyst of sphenoidal sinus, 8 fungal sphenoid sinusitis, 2 bleeding polyp of sphenoidal sinus, 1 post- hypophysectomy granulation hyperplasia of sphenoidal sinus , 5 papilloma of sphenoid sinus, 1 cerebrospinal rhinorrhea of sphenoid sinus, 2 ossified fibroma of sphenoid sinus,2 juvenile nasopharyngeal angiofibroma with invasion to the sphenoid sinus, 1 meningioma of ethmoid and sphenoid sinus. Three cases with hematoma in sphenoidal sinus and pseudoaneurysm in internal carotid artery underwent nasal endoscopic examination, and the diagnosis was established by DSA, and they received interventional therapy. Three cases with malignancy of sphenoidal sinus received major mass resection of sphenoidal sinus by trans-ethmoidal approach, and followed with radio therapy and chemotherapy. Two cases with NPC involving sphenoidal sinus were treated by radio therapy and chemotherapy after pathological examination. CONCLUSION Headache and visual loss were two common symptoms for the lesions in sphenoidal sinus. Imaging study including CT, MRI and DSA is very important for the diagnosis of the lesions in sphenoidal sinus. There are various surgical pathways to deal with sphenoidal sinus diseases under nasal endoscope. The operation will be direct, safe and minimal invasive if we choose the pathway properly.
Adolescent ; Adult ; Aged ; Child ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Paranasal Sinus Diseases ; surgery ; Sphenoid Sinus ; Sphenoid Sinusitis ; surgery

A 8-years-old male patient with a bulge of left eye ball for one mongth was hospitalized. The inspection of the patient showed the movement on the left side of the lateral nasal wall and a narrow nasal cavity. Orbital CT showed that the left orbital ethmoid sinus, maxillary sinus cyst, left orbital, sphenoid sinus, nasal cavity were damaged. A resection with the combination of approaches including the left maxillary sinus, the ethmoid sinus, and the sphenoid sinus osteofibroma was performed. 5 days after the operation, the nasal packing material was removed and 7 days after the operation the stiches were removed. The recovery of the patient was satisfied after the operation and no recurrence was observed during one and half years follow up.
Child ; Ethmoid Sinus ; pathology ; Humans ; Male ; Maxillary Sinus ; pathology ; Nasal Cavity ; pathology ; Nasal Surgical Procedures ; Ossification, Heterotopic ; diagnosis ; surgery ; Paranasal Sinus Diseases ; diagnosis ; surgery ; Sphenoid Sinus ; pathology

OBJECTIVETo explore the feasibility of the extended inferior meatal maxillary antrostomy through inferior turbinate reversing approach.

METHODSEight patients underwent extended inferior meatal maxillary antrostomy through inferior turbinate reversing approach for maxillary sinus lesions. The indications, surgical management and outcomes of the surgery were presented.

RESULTSThere were 2 cases of maxillary dentigerous cyst with oroantral fistula, 2 cases of antrochoanal polyp, 2 cases of maxillary sinus inverted papillomas, 1 case of odontogenic maxillary sinusitis with oroantral fistula, and 1 case of maxillary sinus mucocele. All patients underwent extended inferior meatal maxillary antrostomy through inferior turbinate reversing approach without intraoperative complication, with good access to the lesions. Complete resection could be achieved through this approach, no postoperative complications occurred except one patient had a delayed wound healing of inferior turbinate, all patients were free of recurrence with the average postoperative follow-up of 7.8 months (range 4-12 months).

CONCLUSIONThe extended inferior meatal maxillary antrostomy through inferior turbinate reversing approach is recommended for some maxillary pathology owing to its good access to the lesions and complete resection.

Cysts ; Dentigerous Cyst ; Humans ; Maxilla ; Maxillary Sinus ; surgery ; Maxillary Sinus Neoplasms ; Maxillary Sinusitis ; Mucocele ; Nasal Polyps ; Papilloma, Inverted ; Paranasal Sinus Diseases ; surgery ; Postoperative Complications ; Turbinates ; surgery

OBJECTIVE: To evaluate the efficacy of the endoscopic maxillary sinus surgery by lateral wall fenestration of the inferior nasal meatus (EMSLWF). METHOD: Based on traditional Messerklinger sinus surgery, we treat the 17 cases with maxillary sinus disorder by lateral wall fenestration of the inferior nasal meatus, removing the polyp, hemangioma, inverting papilloma, invasive sinus aspergillosis etc, trans aperture maxillary and intranasal window. RESULT: The maxillary sinuses of the 17 cases are clean. Mucosa are well recovered and drained of the mid dle and inferior nasal meatus. We did not find the nasal mucosa pathological changes like the fluid-filled blisters or edema etc. The intranasal windows are closed in only 2 cases (4.25%) after about 2 months. The maxillary sinuses of all cases are still clean with no recurrence of primary diseases. CONCLUSION The EMSLWF is well suitable for dealing with the maxillary sinus diseases. Meanwhile, before the function of the nasal mucociliary transportation system recovered in the perioperative period, the gravity drainage affection should be kept by the intranasal win dow in the inferior nasal meatus. The EMSLWF is worthy of more attention in clinic.
Adolescent ; Adult ; Aged ; Endoscopy ; Female ; Humans ; Male ; Maxillary Sinus ; surgery ; Middle Aged ; Nasal Cavity ; surgery ; Nasolacrimal Duct ; surgery ; Nose ; surgery ; Paranasal Sinus Diseases ; surgery ; Young Adult