Endoscopic view of obstructing frontal recess polyps.A 53-year-old man was evaluated for frontal headaches of 2 years' duration that would resolve intermittently with the use of antibiotics and decongestants Decongestants Definition Decongestants are medicines used to relieve nasal congestion (stuffy nose). Purpose A congested or stuffy nose is a common symptom of colds and allergies. . He had been treated by several family practitioners prior to referral to our office. Nasal endoscopy nasal endoscopy Rhinolaryngoscopy, rhinopharyngoscopy, rhinoscopy The use of a flexible fiberoptic endoscope to evaluate upper airways–nasal passages, nasopharynx, oropharynx, and larynx, a procedure usually carried out by ENTs or allergists Indications detected polyps Polyps A tumor with a small flap that attaches itself to the wall of various vascular organs such as the nose, uterus and rectum. Polyps bleed easily, and if they are suspected to be cancerous they should be surgically removed. arising bilaterally from the middle meatus and the frontal recess areas (figure 1). Computed tomography (CT) of the paranasal sinuses identified bilateral 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. involving the frontal and ethmoid sinuses (figure 1). [FIGURE 1 OMITTED] Endoscopic en·do·scope n. An instrument for examining visually the interior of a bodily canal or a hollow organ such as the colon, bladder, or stomach. en sinus surgery was performed with a microdebrider. The frontal recess polyps were removed bilaterally and the obstruction was eliminated (figure 2). The patient's frontal headaches resolved completely, and sinus infections became infrequent. [FIGURE 2 OMITTED] The frontal recess is a pre-chamber to the frontal sinus, and any disease in the frontal recess can affect the frontal sinus. (1) Any obstructing entity of the frontal recess can cause an infection in the frontal sinus and an accompanying frontal headache. (2) In the case described herein, the polyps in the frontal recess were approached through the middle meatus. Polypectomies were carried out with a microdebrider, which allowed for the precise and meticulous removal of the polyps. Mucosal preservation, which is of extreme importance, can be accomplished with powered instrumentation. (3) Aggressive surgical intervention in the frontal recess can cause scarring and stenosis and result in an iatrogenic iatrogenic /iat·ro·gen·ic/ (i-a´tro-jen´ik) resulting from the activity of physicians; said of any adverse condition in a patient resulting from treatment by a physician or surgeon. obstruction of the frontal recess and frontal sinus. This problem can be avoided by using meticulous technique with the microdebrider. Dewey A. Christmas, MD; Joseph P. Mirante, MD; Eiji Yanagisawa, MD References (1.) Stammberger H, Wolf G. Headaches and sinus disease: The endoscopic approach. Ann Otol Rhinol Laryngol Suppl 1988;134:3-23. (2.) Wolf G, Christmas DA Jr, Mirante JP. Powered endoscopic frontal recess surgery: A functional approach. In: Yanagisawa E, Christmas DA Jr, Mirante JP. Powered Instrumentation in Otolaryngology--Head and Neck Surgery. San Diego: Singular Thompson Learning, 2001:105-14. (3.) Christmas DA Jr, Krouse JH. Powered instrumentation in dissection of the frontal recess. Ear Nose Throat J 1996;75:359-60, 363-4. 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, and the Halifax Medical Center Halifax Medical Center (HMC) is a 764-bed hospital located in Daytona Beach, Florida. HMC is the largest hospital serving Volusia and Flagler counties and provides the area's only trauma center, pediatric emergency department, neonatal intensive care unit and pediatric intensive , Daytona Beach, Fla. (Dr. Christmas and Dr. Mirante); and the Southern New England Ear, Nose, Throat, and Facial Plastic Surgery Group; the Section of Otolaryngology, Hospital of St. Raphael; and the Section of Otolaryngology, Yale University School of Medicine, New Haven, Conn. (Dr. Yanagisawa). |
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