Endoscopic view of frontal sinus polyps.
A 25-year-old man complained of nasal congestion and frontal pain of approximately 2 years' duration. He had used numerous medications. He had no previous allergy or surgical treatment. Of note was that he worked as a spray painter in an auto body shop. In addition, he also was taking flying lessons and was having difficulty with pressurization Pressurization generally refers to the application of pressure in a given situation or environment; and more specifically refers to the process by which atmospheric pressure is maintained in an isolated or semi-isolated atmospheric environment (for instance, in an aircraft, or in a small plane, as he would experience increasing facial pain and frontal headaches.
Nasal endoscopy revealed a pale, boggy, watery nasal mucosa with multiple polyps. His condition was more marked on the left side than on the right. Computed tomography (CT) of the sinuses showed bilateral ethmoid ethmoid /eth·moid/ (eth´moid)
1. sievelike; cribriform.
2. the ethmoid bone; see Table of Bones. .ethmoi´dal
eth·moid or eth·moi·dal
adj. and maxillary max·il·lar·y
Of or relating to a jaw or jawbone, especially the upper one.
A maxillar; a jawbone.
adj sinusitis sinusitis
Inflammation of the sinuses. Acute sinusitis, usually due to infections such as the common cold, causes localized pain and tenderness, nasal obstruction and discharge, and malaise. with polypoid tissue. CT also revealed a polypoid mass in the right frontal sinus.
The patient underwent bilateral functional endoscopic sinus surgery functional endoscopic sinus surgery Functional endonasal endoscopic sinus surgery ENT A procedure that removes diseased nasal cavity and paranasal sinus tissue and restores mucociliary clearance Applications Chronic and/or recurrent sinusitis in Pts who fail under general anesthesia. Multiple polyps were removed from both nasal cavities with a microdebrider. The right frontal sinus was explored via the frontal recess, and a polyp on the floor of the sinus was removed (figure).
The right lateral nasal wall was examined with a 0[degrees] telescope (figure, A). It showed the middle meatus, frontal recess, and middle turbinate turbinate /tur·bi·nate/ (-nat)
1. shaped like a top.
2. any of the nasal conchae.
tur·bi·nate or tur·bi·nat·ed
1. Shaped like a top.
2. . The polyp was pulled out from the frontal recess with a suction tip. The region of the frontal sinus ostium ostium /os·ti·um/ (os´te-um) pl. os´tia [L.] an opening or orifice.os´tial
ostium abdomina´le tu´bae uteri´nae was examined with a 30[degrees] telescopic view of the frontal sinus lumen (figure, B). It is important for the endoscopic surgeon to know that in most cases there is no anatomically defined "nasal frontal duct," but rather a frontal recess, which is the area of the junction of the frontal and anterior ethmoid sinuses.  As described by Kuhn, the frontal recess is an inverted funnel-shaped space.  It has a narrow upper portion in the internal frontal ostium and a lower bell-shaped end in continuity with the anterior ethmoid sinus wall.
A 30[degrees] telescopy te·les·co·py
The art or study of making and operating telescopes.
Noun 1. (figure, C) of the enlarged frontal sinus ostium revealed a small cyst and a medium-sized polyp on the floor of the frontal sinus. The opening was enlarged with Kuhn-Bolger frontal recess curettes and a microdebrider with a curved cutting blade. A KuhnBolger frontal sinus probe was used to explore and palpate pal·pate
To examine by feeling and pressing with the palms of the hands and the fingers.
pal·pation n. the interior of the frontal sinus. As the tip of the 30[degrees] telescope was advanced, a closer view of the cyst and the polyp was obtained (figure, D). These lesions were removed with a Kuhn-Bolger giraffe frontal sinus cup forceps. The patient's facial pain and nasal congestion resolved after surgery, and 2 years later he was still asymptomatic.
Endoscopic excision of a polyp in a frontal sinus is much more difficult than that in other paranasal sinuses. The location and size of the polyp should be carefully studied by preoperative CT. The surgeon should be familiar with the anatomy of the frontal recess and the frontal sinus. Computer-guided surgical systems are useful during endoscopic frontal sinus surgery in difficult cases.
From the Department of Otolaryngology, University of South Florida College of Medicine As of Fall 2006, there were 477 students in the M.D. program; 78 students in the M.S. and 83 students in the Ph.D. program in the School of Basic Biomedical Sciences; and 55 students in the DPT program in the School of Physical Therapy. , Tampa (Dr. Christmas), and the Southern New England Ear, Nose, Throat, and Facial Plastic Surgery Group, New Haven, Conn.; the Section of Otolaryngology, Hospital of St. Raphael, New Haven; and the Section of Otolaryngology, Yale University School of Medicine, New Haven (Dr. Yanagisawa).
(1.) Rains BM. Powered instrumentation in the management of chronic frontal Sinusitis. In: Krouse JH, Christmas DA, eds. Powered Endoscopic Sinus Surgery. Baltimore: Williams and Wilkins, 1997. Ch. 8.
(2.) Kuhn FA. Chronic frontal sinusitis: The endoscopic frontal recess approach. Operative Techniques in Osolaryngology--Head and Neck Surgery 1996;7:222-9.