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Quantifying Lateral Frontal Sinus Access: The Upper Blepharoplasty Approach.

Toby O Steele1,2, Oliver Y Chin1, Michael R Kinzinger1

  • 11 Department of Otolaryngology-Head and Neck Surgery. University of California Davis, Sacramento, California, USA.

The Annals of Otology, Rhinology, and Laryngology
|January 5, 2018
PubMed
Summary
This summary is machine-generated.

The upper blepharoplasty approach (UBA) offers excellent lateral frontal sinus access, while the modified endoscopic Lothrop procedure (MELP) excels medially. Combining both ensures complete frontal sinus surgical access.

Keywords:
cadaver studyendoscopic sinus surgeryextended frontal sinusotomyexternal sinus surgeryfrontal sinusotomylateral frontal sinus accessorbital/ocularparanasal sinusestrephinationupper blepharoplasty approach

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Area of Science:

  • Otolaryngology
  • Neurosurgery
  • Anatomy

Background:

  • Surgical access to the frontal sinus, particularly the lateral aspects, remains a significant challenge.
  • Advancements in surgical technology have not fully resolved limitations in accessing certain frontal sinus regions.

Purpose of the Study:

  • To anatomically quantify the surgical reach and applicability of the upper blepharoplasty approach (UBA) for accessing the frontal sinus.
  • To compare the efficacy of the UBA with the modified endoscopic Lothrop procedure (MELP) and a combined approach.

Main Methods:

  • Twelve cadaveric specimens were utilized for anatomical assessment.
  • Frontal sinuses were divided into three zones: medial (Zone 1), central (Zone 2), and lateral (Zone 3) relative to the supraorbital neurovascular bundle (SON).
  • Twenty-four UBAs and 12 MELPs were performed, assessing instrument access to each frontal sinus wall.

Main Results:

  • The UBA demonstrated high accessibility to the lateral frontal sinus (Zones 2 and 3: 89% and 100%).
  • The MELP showed improved medial access (Zone 1: 83%-100%) but limited lateral access (Zone 3: 67%).
  • The combined UBA and MELP approach achieved 100% access to all frontal sinus boundaries.

Conclusions:

  • A combined approach utilizing the MELP with UBA/lateral trephination provides comprehensive access to all frontal sinus boundaries.
  • The UBA is highly effective for lateral frontal sinus exposure but has limitations medially due to the SON.