Who Needs Extended Frontal Sinus Surgery?
Extended frontal sinus surgery may be needed for patients failing prior frontal sinus surgery, lesions or scarring in the frontal sinuses, and many other factors that might be identified on sinus imaging, such as osteomas or mucoceles. Our sinus surgery experts offer the full spectrum of extended frontal sinus procedures and are capable of addressing any challenges involving the frontal sinuses. In most cases, extended frontal sinus surgery can be performed endoscopically, similar to other sinus procedures. Only rarely are external incisions required to access the frontal sinuses, and this can often be determined by the findings on sinus imaging.
How Does Extended Frontal Sinus Surgery Work?
Similar to other sinus procedures, extended frontal sinus surgery aims to restore the drainage and function of the frontal sinuses on one or both sides.1 Due to factors such as unfortunate or abnormal anatomy impacting frontal sinus drainage, scarring or excessive bone growth, lesions affecting the frontal sinuses, and more, the usual sinus surgery instrumentation and approaches may fail to adequately address these challenges.2 Skilled Rhinologists with extra fellowship training in sinus surgery can utilize specialized instrumentation, including frontal sinus-specific instruments, endoscopic drills, and most importantly, a detailed understanding of the frontal anatomy to create larger openings than otherwise possible. Examples include drilling on one or both sides to enhance the size of the frontal openings (Draf IIb, Draf III, or modified Lothrop), external “burr-hole” access to reach portions of the frontal sinuses not accessible endoscopically via small incisions near the eyebrow(s), and a larger external approach through an incision that follows or hides within the hairline and involves opening the frontal sinus widely through the frontal bone followed by plate and screw closure.
Preparing For Extended Frontal Sinus Surgery
If you believe you may need extended frontal sinus surgery, the first step towards finding relief is a consultation with one of our fellowship-trained sinus experts. Bring any available CT Imaging demonstrating your condition and prior surgery reports when available, and provide the most accurate history possible during your visit to ensure that your physician can fully evaluate and plan for all aspects of your care. Your sinus surgeon will perform a comprehensive nasal examination, nasal endoscopy, and possibly obtain repeat CT imaging in the office in order to objectively define your condition. They will discuss your findings and treatment options and help you determine which approach is best for you.
Recovering After Extended Frontal Sinus Surgery
Recovery after extended frontal sinus surgery will vary based upon the procedure needed. Those patients undergoing full sinus procedures, including drilling to extend the frontal sinuses endoscopically, will notice only a slight increase in the external tenderness over the eyebrows and bridge of their nose compared to other sinus procedures. Slight bruising near the inside corners of the eyes is rare but noted occasionally. As with any endoscopic sinus procedure, it is recommended to refrain from exercise, lifting, blowing your nose, or any straining or strenuous activity for about 2 weeks after your surgery. Discomfort and nasal congestion with occasional visible facial swelling tend to peak about 3 to 4 days after surgery and slowly diminish over the following 1 to 2 weeks. Your surgeon may prescribe medications to limit inflammation and assist with pain control during this portion of your healing. You will require several post-operative visits with your surgeon to inspect the nose and sinuses for optimal healing.
Sources
1 Arch Otolaryngol Head Neck Surg.Extended Endoscopic Frontal Sinus Surgery to Interrupted Nasofrontal Communication Caused by Scarring of the Anterior Ethmoid. https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/508948. Accessed June 24, 2022.
2 Shen J, Chan N, Wrobe BB. The endoscopic modified lothrop procedure: Review of single institution experience and long‐term outcomes. Laryngoscope Investig Otolaryngol. 2018 Apr; 3(2): 105–109. Published online 2018 Mar 23. doi: 10.1002/lio2.145
