Frontal Sinusotomy & Frontal Recess
The drainage segment of the frontal sinus, contrary to other sinuses, is long, has an hour glass configuration and influenced by the degree of pneumatization of nearby ethmoidal cells such as agger nasi cells, frontal cells, suprabullar cells and ethmoidal bulla.
The superior attachment of the uncinate process also determines the drainage of the frontal sinus into the ethmoidal infundibulum or directly into the middle meatus.
The recognition of the need to preserve normal nasal anatomy and to preserve nasal mucosa in order to have postoperative normal nasal functions is more demanding in frontal sinus surgery than other sinuses. The importance of mucosal preservation and avoidance of bone drilling is essential to leave behind intact mucosa-lined cavities essential for proper postoperative healing. Experience has shown that when mucosa is stripped or bones are drilled, healing is slow, intensive postoperative care is required, and scarring is formidable. Indeed regenerated mucosa may never redevelop normal ciliary density. New bone growth may occur in areas of stripped mucosa and provide a nidus for chronic infection. This becomes even more critical in the all-important area of the frontal recess, where mucosal scarring and new bone growth can lead to complete stenosis and persistent infection.
It is a personal preference to clean the frontal recess before the dealing with the ethmoidal bulla so as to preserve anatomical landmarks. The entrance to frontal recess is just above the superior border of the bulla. If the bulla is entered first, one should preserve its superior border as a landmark for entrance to the frontal recess. The best landmark to the frontal sinus ostium is to follow the uncinate process remnant up to its superior attachment.
The following videos demonstrate Stammberger’s technique for “uncapping the egg” in an anterior and lateral direction with emphasis on the significant development offered by the 450 endoscope, thru-cutting curved instruments and powered instrumentation.
Video 20 illustrates Frontal Recess Clearance with cold instruments.
Video 20 "FRC with Cold Instruments"
Video 21 & Video 22 illustrate Frontal Sinusotomy with cold instruments.
Video 21 "Frontal Sinusotomy with Cold Instruments 1" Video 22 "Frontal Sinusotomy with Cold Instruments 2"
Video 23 illustrates Recess Clearance with powered instruments.
Video 23 "FRC with Powered Instruments"
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