Atlas of Frontal Sinus Surgery: A Comprehensive Surgical Guide

Foreword
Preface
Acknowledgments
Contents
Part I: Preparations
	1: An Overview of Frontal Sinus Surgery. Past, Present and Future
		1.1	 Historical Perspective
		1.2	 Definition of Frontal Sinus Surgery and Main Indications
			1.2.1	 Definition
			1.2.2	 Indications
		1.3	 Epidemiology
			1.3.1	 Pediatric Population
			1.3.2	 Frontal Sinusitis Complications in Children
		1.4	 Risk Factors for Frontal Sinus Disease
		1.5	 Socioeconomic Importance
			1.5.1	 Socio-Economic Impact of Frontal Sinus Disease
			1.5.2	 Costs of Surgical Intervention
			1.5.3	 Medico-Legal Economic Burden
		1.6	 Safety Concerns
			1.6.1	 Skill-Oriented Risks
			1.6.2	 Informed Consent
		1.7	 Complications of Frontal Sinus Surgery
			1.7.1	 Pediatric Surgery
		1.8	 Conclusion
		References
	2: Training in Frontal Sinus Surgery
		2.1	 Introduction
		2.2	 Cadaver Dissections, 3D Models, and Virtual Reality
		2.3	 Factors Leading to Successful Training
		2.4	 Advanced and Lifelong Training
		References
	3: Frontal Sinus Classical and Endoscopic Anatomy
		3.1	 Introduction
		3.2	 Frontal Bone
		3.3	 Frontal Recess
		3.4	 Anatomical Structures
			3.4.1	 Agger Nasi Cell
			3.4.2	 Uncinate Process
			3.4.3	 Frontal Cells
			3.4.4	 Frontobullar, Suprabullar and Supraorbital Cells
		3.5	 Anatomical Landmarks
			3.5.1	 Lateral Lamella of the Cribriform Plate
			3.5.2	 Anterior Ethmoidal Artery (AEA)
			3.5.3	 First Olfactory Fiber and Nasal Branch of the Anterior Ethmoidal Artery
			3.5.4	 Frontal Beak (FB)
			3.5.5	 Posterior Table of the Frontal Sinus
		3.6	 Conclusions
		References
	4: Indications of Frontal Sinus Surgery
		4.1	 Introduction
		4.2	 Inflammatory Diseases
			4.2.1	 Chronic Rhinosinusitis (CRS)
				4.2.1.1	 Localized Frontal CRS
				4.2.1.2	 Diffuse CRS
			4.2.2	 Complications of Rhinosinusitis
			4.2.3	 Mucocele
		4.3	 Sinonasal Tumors
			4.3.1	 Benign Lesions of the Frontal Sinus
				4.3.1.1	 Osteomas
				4.3.1.2	 Fibrous Dysplasia (FD)
				4.3.1.3	 Inverted Papilloma (IP)
			4.3.2	 Malignant Neoplasm
		4.4	 Skull Base Defects
			4.4.1	 Frontal Sinus Cerebrospinal Fluid (CSF) Leak
			4.4.2	 Fractures of the Frontal Sinus
		References
	5: Pre-operative Medical Management
		5.1	 Management of Co-morbidities
		5.2	 Corticosteroids
			5.2.1	 Intranasal Corticosteroids
			5.2.2	 Systemic Corticosteroids
		5.3	 Patient Positioning
		5.4	 Local Anesthesia
			5.4.1	 Injected
		5.5	 Topical Agents
		5.6	 Anesthetic Agents
		5.7	 Airway Choices
		5.8	 Summary
		References
	6: Classification of the Frontal Sinus Anatomy, the Extent, and Complexity of the Frontal Sinus Endoscopic Surgery
		6.1	 Introduction
		6.2	 International Frontal Sinus Anatomy Classification (IFAC) [1]
			6.2.1	 Anterior Cells
				6.2.1.1	 Agger Nasi Cell (ANC)
				6.2.1.2	 Supra-Agger Cell (SAC)
				6.2.1.3	 Supra-Agger Frontal Cell (SAFC)
			6.2.2	 Posterior Cells
				6.2.2.1	 Supra-Bulla Cell (SBC)
				6.2.2.2	 Supra-Bulla Frontal Cell (SBFC)
				6.2.2.3	 Supraorbital Ethmoid Cell (SOEC)
			6.2.3	 Medial Cells
				6.2.3.1	 Frontal Septal Cell (FSC)
		6.3	 Classification of the Extent of Endoscopic Frontal Sinus Surgery (EFSS) [1]
			6.3.1	 No Tissue Removal
			6.3.2	 Frontal Recess Clearance Procedures
			6.3.3	 Frontal Ostium Enlargement Procedures by Removal of Bone from the Frontal Beak
		6.4	 The International Classification of the Radiological Complexity (ICC) of Frontal Recess and Frontal Sinus [17]
		References
	7: Surgical Planning: Three-Dimensional Imaging, Stereolithography, and Virtual Surgery
		7.1	 Introduction
		7.2	 Multiplanar Reconstruction
		7.3	 Volume Rendering
		7.4	 Surface Rendering
		7.5	 Augmented Reality
		7.6	 Stereolithography
		7.7	 Virtual Endoscopy
		7.8	 Virtual Surgery
		References
	8: Ergonomic Aspects and Instrumentation in Frontal Sinus Surgery
		8.1	 Introduction
		8.2	 Surgical Ergonomics
			8.2.1	 Operating Theater Layout
			8.2.2	 Surgeon Position (Standing Vs Sitting)
			8.2.3	 Instruments and Equipment
			8.2.4	 Robotics
				8.2.4.1	 Endoscope Holders
			8.2.5	 Additional Considerations
		8.3	 Cognitive Ergonomics
			8.3.1	 Surgical Safety Checklist
			8.3.2	 Surgical Field
			8.3.3	 Image-Guided Navigation System
			8.3.4	 Augmented Real-Time Image Guidance
			8.3.5	 Additional Considerations
		References
Part II: Step by Step Procedures
	9: Frontal Balloon Sinuplasty: Frontal Sinus Surgery Without Tissue Removal
		9.1	 Introduction
		9.2	 Indications
		9.3	 Schematic Description
		9.4	 Pearls and Potential Pitfalls
		9.5	 Surgical Procedure Step by Step
		9.6	 Postoperative Tips
		9.7	 Summary/Conclusion
		References
	10: Cells Removal: Draf Type I and IIA
		10.1	 Introduction
		10.2	 Indications
		10.3	 Schematic Description (Anatomy-Expected Result)
		10.4	 Preoperative Tips (Individual Risk Factors, Radiology, Instrumentation)
			10.4.1	 Individual Risk Factors
			10.4.2	 Radiology
			10.4.3	 Instrumentation
		10.5	 Pearls and Potential Pitfalls
			10.5.1	 Pearls
			10.5.2	 Pitfalls
		10.6	 Surgical Procedure Step by Step
			10.6.1	 Access
			10.6.2	 Uncinectomy, Anterior and Posterior Ethmoidectomy
			10.6.3	 Performing an Axillectomy (Optional)
			10.6.4	 Understanding the 3D Anatomy of the Frontal Recess Cell
			10.6.5	 Localizing the Fontal Sinus Outflow Tract
			10.6.6	 Removing the Cells of the Frontal Recess
			10.6.7	 Removing the Cells of the Anterior Skull Base (Tunnel Vs Funnel)
			10.6.8	 Irrigation of the Sinus
			10.6.9	 Preventing Lateralization of the Middle Turbinate
		10.7	 Postoperative Tips
		References
	11: The Vertical Bar Concept in Frontal Recess and Frontal Sinus Surgery
		11.1	 Introduction
		11.2	 Indications
		11.3	 Schematic Description
		11.4	 Pre-operative Tips
		11.5	 Pearls and Potential Pitfalls
		11.6	 Surgical Procedure Step-by-Step
			11.6.1	 Initial Endoscopic Examination
			11.6.2	 Uncinectomy
			11.6.3	 Identification of the Frontal Sinus Drainage Pathway
			11.6.4	 Intact Bulla Technique
		11.7	 Post-operative Tips
		References
	12: Bone Removal. Grade 4-5: Partial Removal of Frontal Sinus Floor. Draf II B
		12.1	 Introduction
		12.2	 Indications
		12.3	 Instrumentation
		12.4	 Pearls and Potential Pitfalls
		12.5	 Surgical Procedure Step by Step
		12.6	 Postoperative Tips
		References
	13: Bone Removal Grade 5 (Complete Removal of Unilateral Frontal Sinus Floor) Including Eloy IIC, IID, IIE, IIF
		13.1	 Introduction
		13.2	 Indications
		13.3	 Preoperative Tips
		13.4	 Pearls and Potential Pitfalls
		13.5	 Surgical Procedure and Schematic Descriptions
			13.5.1	 Modified Hemi-Lothrop Procedure/Eloy IIC (Fig. 13.2)
			13.5.2	 Modified Mini-Lothrop Procedure/Eloy IID (Fig. 13.3)
			13.5.3	 Modified Subtotal-Lothrop Procedure/Eloy IIE (Fig. 13.4)
			13.5.4	 Modified Central-Lothrop Procedure/Eloy IIF (Fig. 13.5)
		13.6	 Postoperative Tips
		References
	14: Bone Removal. Grade 6: Draf III
		14.1	 Introduction
		14.2	 Indications
		14.3	 Anatomy
		14.4	 Preoperative Tips
		14.5	 Pearls and Potential Pitfalls
		14.6	 Surgical Technique
			14.6.1	 Location of the Anterior Margin of the Cribriform Plate
			14.6.2	 Identification of the Frontal Sinus Ostium
			14.6.3	 Septectomy
			14.6.4	 Frontal Floor Resection
			14.6.5	 Posterior Enlargement
			14.6.6	 Outside-in
		14.7	 Postoperative Treatment
		References
	15: Frontal Sinus Surgery (Draf III) as a Previous Step to a more Complex Technique Part 1
		15.1	 Introduction
		15.2	 Indications and Particular Tumor Specifics
			15.2.1	 Osteomas
			15.2.2	 Inverted Papillomas (IPs)
			15.2.3	 Malignant Sinonasal Tumors
			15.2.4	 Intracranial Malignancies
		15.3	 Preoperative Tips
		15.4	 Pearls and Potential Pitfalls
		15.5	 Surgical Procedure Step by Step
		15.6	 Postoperative Tips
		References
	16: Frontal Sinus Surgery (Draf III) as a Previous Step to More Complex Techniques Part 2
		16.1	 Introduction
		16.2	 Indications
		16.3	 Schematic Description
			16.3.1	 Blood Supply [14, 15]
		16.4	 Preoperative Tips
		16.5	 Pearls and Potential Pitfalls
		16.6	 Surgical Procedure Step by Step
		16.7	 Postoperative Tips
		16.8	 Conclusion
		References
	17: External Approaches to the Frontal Sinus. Osteoplastic Flaps With or Without Frontal Sinus Obliteration
		17.1	 Historical Review
		17.2	 Indications
		17.3	 Preoperative Tips
			17.3.1	 Anatomy
			17.3.2	 Imaging Pre-op
			17.3.3	 Instrumentation
		17.4	 Pearls and Potential Pitfalls
		17.5	 Surgical Procedure Step by Step
		17.6	 Postoperative Tips
		References
	18: Indication of Frontal Sinus Trephination Procedure
		18.1	 Introduction
		18.2	 Indications
		18.3	 Schematic Description (Anatomy—Expected Result)
		18.4	 Preoperative Tips (Individual Risk Factors, Radiology, Instrumentation)
		18.5	 Pearls and Potential Pitfalls
		18.6	 Surgical Procedure Step by Step
		18.7	 Postoperative Tips
		References
	19: The Place of Riedel–Mosher’s Procedure in Contemporary Sinus Surgery
		19.1	 Introduction
		19.2	 Indications
		19.3	 Schematic Description (Anatomy—Expected Result)
		19.4	 Preoperative Tips (Individual Risk Factors, Radiology, Instrumentation)
		19.5	 Pearls and Potential Pitfalls
		19.6	 Surgical Procedure Step by Step
			19.6.1	 Scalp and Pericranial Flap
			19.6.2	 Anterior Frontal Wall Removal
			19.6.3	 Posterior Frontal Wall and Frontal Floor Removal
			19.6.4	 Pericranial Reconstruction and Closure
		19.7	 Postoperative Tips
			19.7.1	 Reconstruction
		References
	20: The Importance of Frontal Sinus Surgery in Craniofacial Resection. Endoscopic, Open, and Combined Approaches
		20.1	 Introduction
		20.2	 Indications
		20.3	 Anatomy
		20.4	 Preoperative Tips
			20.4.1	 Instrumentation
		20.5	 Pearls and Potential Pitfalls
		20.6	 Surgical Procedure Step by Step
			20.6.1	 Open Transfrontal Craniofacial Approach
			20.6.2	 Craniofacial Endoscopic Approach
			20.6.3	 Combined Cranionasal Approach
		20.7	 Postoperative Tips
		References
	21: Frontal Sinus Tumours
		21.1	 Introduction
		21.2	 Benign Lesions of the Frontal Sinus
			21.2.1	 Osteoma
			21.2.2	 Mucocele
			21.2.3	 Fibro-Osseus Lesions
			21.2.4	 Inverted Papilloma
		21.3	 Malignant Tumors of the Frontal Sinus
			21.3.1	 Squamous Cell Carcinoma
			21.3.2	 Adenocarcinoma
			21.3.3	 Sinonasal Undifferentiated Carcinoma
			21.3.4	 Esthesioneuroblastoma
			21.3.5	 Sinonasal Neuroendocrine Carcinoma
			21.3.6	 Sinonasal Sarcomas
			21.3.7	 Mature B-Cell Non-Hodgkin Lymphoma
			21.3.8	 Adenoid Cystic Carcinoma
			21.3.9	 Other Malignant Tumors
		References
	22: Transorbital Approach to the Frontal Sinus
		22.1	 Introduction
		22.2	 Indications
		22.3	 Schematic Description. Anatomical Landmarks
		22.4	 Preoperative Tips (Individual Risk Factors, Radiology, Instrumentation)
			22.4.1	 Radiology
			22.4.2	 Instrumentation
		22.5	 Pearls and Potential Pitfalls
		22.6	 Surgical Procedure
		22.7	 Postoperative Tips
		References
	23: Revision Surgery of the Frontal Sinus
		23.1	 Introduction
		23.2	 Indications
		23.3	 Schematic Description (Anatomy: Expected Result)
		23.4	 Preoperative Tips (Individual Risk Factors, Radiology, Instrumentation)
			23.4.1	 Individual Risk Factors
			23.4.2	 Radiology
			23.4.3	 Instrumentation
		23.5	 Pearls and Potential Pitfalls
		23.6	 Surgical Procedure: Key Steps
			23.6.1	 Meticulous Endoscopic Examination and Identification of Remaining Anatomical Landmarks
			23.6.2	 Wide Exposure of the Middle Turbinate Axilla
			23.6.3	 Complete Ethmoidectomy
			23.6.4	 Sharp Frontal Recess Dissection
			23.6.5	 Possible (Partial) Resection of Frontonasal Beak
			23.6.6	 Maintain Postoperative Patency
			23.6.7	 Stenting Techniques
				23.6.7.1	 Steroid-Eluting Stents
			23.6.8	 Mucosal Graft Transplants and Local Mucoperiosteal Flaps
		23.7	 Postoperative Tips
		References
	24: Treatment of Frontal Sinus Trauma and CSF Leaks
		24.1	 Introduction
		24.2	 Indications
			24.2.1	 Frontal Sinus Fractures
				24.2.1.1	 Isolated Anterior Table Fractures
				24.2.1.2	 Posterior Table Fractures
				24.2.1.3	 Frontal Fractures Involving Nasofrontal Duct
			24.2.2	 Frontal Sinus CSF Leak
		24.3	 Schematic Description (Anatomy and Expected Result)
		24.4	 Preoperative Tips
			24.4.1	 Frontal Sinus Fractures
				24.4.1.1	 Preexisting Lacerations
				24.4.1.2	 Supraciliary Incision
				24.4.1.3	 Closed Approach: Percutaneous Reduction
				24.4.1.4	 Bicoronal Approach
				24.4.1.5	 Endoscopic-Assisted External Approach
				24.4.1.6	 Endoscopic Endonasal Approach (EEA)
			24.4.2	 Frontal Sinus Cerebrospinal Fluid (CSF) Leaks
				24.4.2.1	 Biochemical Analysis
				24.4.2.2	 Diagnostic Imaging Tests
		24.5	 Pearls and Potential Pitfalls
			24.5.1	 Frontal Sinus Fractures
			24.5.2	 Frontal Sinus CSF Leak
		24.6	 Management and Surgical Procedure
			24.6.1	 Management of Frontal Sinus Fractures
				24.6.1.1	 Management of Isolated Anterior Table Fractures
					Traditional Management
					Endoscopic Endonasal Approach: Surgical Technique
				24.6.1.2	 Management of Posterior Table Fractures
					Traditional Management
					Endoscopic Endonasal Approach: Surgical Technique
				24.6.1.3	 Management of Frontal Fractures Involving Nasofrontal Duct
					Traditional Management
					Endoscopic Endonasal Approach
			24.6.2	 Management of Frontal Sinus CSF Leaks
				24.6.2.1	 Conservative Management
				24.6.2.2	 Traditional Surgical Management
				24.6.2.3	 Endoscopic Endonasal Approach: Surgical Technique
		24.7	 Postoperative Tips
			24.7.1	 Frontal Sinus Fractures
			24.7.2	 Frontal Sinus CSF Leak
		References
	25: Treatment of Frontal Sinus Mucoceles
		25.1	 Introduction
		25.2	 Schematic Description (Anatomy: Expected Results)
		25.3	 Preoperative Tips
			25.3.1	 Individual Risk Factors
			25.3.2	 Radiology
			25.3.3	 Instrumentation
		25.4	 Pearls and Potential Pitfalls
		25.5	 Step-by-Step Surgical Procedure
		25.6	 Postoperative Tips
		References
	26: Treatment of Frontal Sinus Osteomas
		26.1	 Introduction
		26.2	 Indications
		26.3	 Schematic Description (Anatomy: Expected Result)
		26.4	 Preoperative Tips
		26.5	 Pearls and Pitfalls
		26.6	 Step-by-Step Surgical Procedure
		26.7	 Postoperative Tips
		References
	27: Treatment of Frontal Sinus Inverted Papilloma
		27.1	 Introduction
		27.2	 Preoperative Tips: Patient Evaluation
			27.2.1	 Preoperative Imaging
		27.3	 Pearls and Potential Pitfalls
		27.4	 Step-by-Step Surgical Procedure
			27.4.1	 Classification and Surgical Procedure
			27.4.2	 Surgical Key Steps
		27.5	 Postoperative Tips
		27.6	 Conclusions
		References
	28: Mucosal Flaps in Frontal Sinus Surgery
		28.1	 Introduction
		28.2	 Indications
		28.3	 Preoperative Tips
		28.4	 Pearls and Potential Pitfalls
		28.5	 Step-by-Step Surgical Procedure
			28.5.1	 Free Grafts
			28.5.2	 Pedicled Flaps
		28.6	 Postoperative Tips
		References
Part III: Complications, Postoperative Management, and Open Issues
	29: Complications of Frontal Sinus Surgery
		29.1	 Introduction
		29.2	 Assessment
			29.2.1	 Preoperative Optimization
			29.2.2	 Intraoperative Optimization
		29.3	 Intraoperative Complications
			29.3.1	 Haemorrhage
			29.3.2	 Direct Orbital Injury
			29.3.3	 Revision Surgery
			29.3.4	 Skull Base Injury
			29.3.5	 Intraoperative Packing
			29.3.6	 Frontal Balloon Dilation
			29.3.7	 External Frontal Surgery
			29.3.8	 Postoperative Care
			29.3.9	 Postoperative Complications
		29.4	 Summary
		References
	30: Management of Orbital and CNS Complications of Frontal Sinusitis
		30.1	 Introduction
		30.2	 Orbital Complications
			30.2.1	 Treatment
			30.2.2	 Surgical Procedure
		30.3	 Central Nervous System (CNS) Complications of Frontal Sinusitis
			30.3.1	 Treatment
			30.3.2	 Surgical Procedures
		References
	31: Postoperative Management
		31.1	 Introduction
		31.2	 Packing and Spacers (Without Medication Impregnation)
		31.3	 Drug-Eluting Spacers and Stents
		31.4	 Frontal Sinus Stent
		31.5	 Postoperative Antibiotics
		31.6	 Postoperative Systemic Steroids
		31.7	 Saline Irrigation
		31.8	 Intra-Nasal Medications
		31.9	 Postoperative Debridement
		31.10	 Summary
		References
	32: Debates and Controversies in Frontal Sinus Surgery
		32.1	 Introduction
		32.2	 Management of the Middle Turbinate During Frontal Sinus Surgery
		32.3	 Use of Stents and Grafts During Frontal Sinus Surgery
		32.4	 Extent of Frontal Sinus Surgery
		32.5	 Outside-In Versus Inside-Out Draf III
		32.6	 Conclusion
		References
	33: Future of Frontal Sinus Surgery: Beyond Surgical Treatment
		33.1	 Introduction
			33.1.1	 Revision Rates for Specific Sinuses
			33.1.2	 Extension of Endonasal Endoscopic Surgery
		33.2	 From Phenotypes to Endotypes: Type 2 Inflammation
			33.2.1	 Th2 Inflammation Mechanisms in CRSwNP
		33.3	 Biological Drugs
			33.3.1	 Criteria
			33.3.2	 Dupilumab
			33.3.3	 Omalizumab
			33.3.4	 Mepolizumab
			33.3.5	 Reslizumab
			33.3.6	 Others Potential mAb: Benralizumab, Tezepelumab
		33.4	 Future Research
		33.5	 Conclusions
		References