History of Frontal Sinus Surgery

The in the beginning frontal sinus surgical procedure was in the place described in 1750. Despite more than 2 centuries as the description of the procedure forward frontal sinus, the optimal procedure is nevertheless not clear. Sinus disease could have existence highly morbid with the danger of life impending complications, because of its anatomic nearness to anterior skull base and orb.

"Surgical treatment of chronic frontal sinusitis is herculean, often unsatisfactory and sometimes disastrous" Ellis 1954.

Aims of chimerical treatment modality of this disease are:

Eradication of underlying sickness process

Preservation of function of the cavity

To cause least morbidity and cosmetic inelegance.

Historically the ideal surgical procedure has been flip flopping from External to intranasal. With the recent advancement in imaging techniques and nasal endoscopes, Endoscopic frontlet sinus surgery is becoming really received these days. Resolution and details granted by modern imaging modalities have gone a dilatory way in reducing the potential surgical complications of endoscopic surgery.

History of surgical procedures involving this yard can be divided into following era:

Era of trephination (1750):

Frontal bay surgery was first described in 1750. It was in 1884 Alexander Ogstun described a trephination operation where an opening was made in the preceding table of frontal sinus to clean out the sinus cavity. He also dilated the naso frontal duct and curetted its mucosa. He believed this action could facilitate better drainage from the brow-band sinus. He advocated placement of drainage tube inside the naso frontal duct to obviate stenosis.

It was about the similar time Luc described a similar proceeding. This procedure was aptly known taken in the character of Ogstun Luc procedure. This procedure failed commonly for the reason that of increased incidence of nasofrontal duct stenosis.

Era of radical ablation procedures (1895):

Kuhnt in 1895 described a action where in he removed the anterior wall of this sinus in one attempt to clear the frontal recess of the diseased mucosa. He stripped the mucosa up to the brow-band recess and stented the frontonasal channel to improve the drainage. In 1898 Riedel performed extinction of the sinus. He advocated without fault removal of anterior table and pose of FS with stripping of mucosa. He performed this conduct in a patient with osteomyelitis of brow-band bone. This procedure caused an deformed deformity of skull. Killian in 1903 advocated keeping of 1 cm bar of supraorbital b. Killian was able to avoid ugliness by retaining this bar of bone. Killian moreover advocated ethmoidectomy combined with rotation of mucosal hanging fold to cover the frontal recess circuit. Killian's procedure was fraught by complications like Restenosis, supraorbital rim necrosis, defame op meningitis, mucocele formation etc.

Era of preservative procedures (1905):

Major advantage of conservative procedure is avoidance of cosmetic defects. Conservative procedures involved intranasal approach to frontal sinus. It was Knapp in 1908 who performed from without Fronto ethmoid surgery. He approached the FS from one side its floor, removed the diseased mucosa and stented the Fronto nasal canal to prevent Restenosis.

In 1908 Halle chiseled to the end the frontal process of maxilla and used a burr to take out the floor of FS.

In 1914 Lothrop enlarged the drainage footway using intranasal approach. He combined intranasal ethmoidectomy by external ethmoidal approach. He managed to appoint a common frontal nasal communication dint of removing the frontal sinus floor, intersinus septum and the superior portion of nasal septum. He also said that resection of medial orbital wall caused prolapse of orbital topics into the ethmoid area causing interruption to sinus drainage.

External frontoethmoidectomy 1897 - 1921:

In 1897 Jenson performed the capital external Fronto ethmoidectomy in Germany. Lynch and Howarth in 1921 popularized resection of nonplus of the frontal sinus with expanding of the frontal sinus outlet by way of external approach. This approach is forth known as Lynch Howarth procedure. A curvilinear cut is made just below the medial end of eyebrow. It is curved mean to the medial canthus. The frontal process of maxilla and lamina papyracea is sequestered. The sinus is entered via its knock down and the lining mucosa is curetted. A stent is placed in the frontal sinus ostium to prevent stenosis. The stent is left in office for a period of 4 weeks. Boyden used silicone tube to prevent stenosis.

Osteoplastic anterior wall advance (1058):

This procedure became popular during 1960's. Backer introduced radiographic engraving to outline the sinus. This action was fraught with the risk of hemorrhage.

Endoscopic intranasal draw near:

With the advent of nasal endoscopes (angled) come nearly up to the sinus outflow tract has get to be easy.