Management of Frontal Sinusitis

Revision endoscopic frontal sinus surgery remains a great challenge to all who practice sinus surgery. The last decade has brought about a specialization of instruments and techniques aimed at treating frontal sinus disease endoscopically and avoiding frontal sinus obliteration. Surgical technique aside, the most important decisions are still made in the office. These entail assessing whether or not the patient is a good surgical candidate, the appropriate choice of endoscopic procedure given the individual patient’s anatomy and disease process, and the institution of aggressive adjuvant medical therapy.Frontal sinusitis after middle turbinate resection is a serious surgical challenge, for which standard endoscopic frontal sinusotomy is poorly suited. The frontal sinus rescue procedure, more formally known as revision endoscopic frontal sinusotomy with mucoperiosteal flap advancement, is uniquely designed for the correction of frontal stenosis due to middle turbinate resection. In this procedure, the bone and soft-tissue stenosis is removed, and the surgically enlarged frontal neo-ostium is relined with a small mucoperiosteal flap. Mucosa of the lateral frontal recess is preserved. In this way, frontal sinus rescue procedure may restore appropriate mucociliary clearance to a frontal sinus obstructed due to previous middle turbinate resection.