3 types of endonasal frontal sinus drainage procedures
There are three types of endonasal frontal sinus drainage techniques: simple frontal sinus drainage (Type I), extended frontal sinus drainage (Type II) and median drainage (Type III).
Simple frontal sinus drainage (Type I)
This technique is indicated when the frontal sinus is opacified or unopacified in the patients suffering from pansinusitis. The patients neither have asthma nor aspirin hypersensitivity. They have not undergone a surgery. In terms of radiology and pathology, the frontal sinus disorder is mild. Other indications include orbital and endocranial complications due to a failed conservative surgery for acute sinusitis, and chronic sinusitis without polyposis.
The Type I operation is combined with endonasal pansinus operation or circumscribed ethmoidectomy.
Extended frontal sinus drainage (Type II)
The type II procedure is used to treat chronic pansinuistis if the large frontal sinus is opacified. If polyposis is not severe but more drainage is required, extended drainage procedure is recommended. The technique is also preferred in case of recurrent barotraumas and frontal sinus examination after circumscribed trauma that affected the ethmoid sinuses’ part located close to the infundibulium.
The type II operation coupled with an endonasal ethmoidectomy can remove small benign tumors like fibrous dysplasia, osteofinromas and osteomas.
Median drainage (Type III)
The technique is used to remove the frontal bone’s anterior beak, frontal intersinus septum and septum top. The removal opens the frontal recesses and facilitates a central drainage pathway. The type III drainage provides the maximum possible endonasal drainage to the nasal cavities from the frontal sinus.
The type III is recommended for pansinusitis that meets the following criteria:
- The frontal sinus is opacified.
- Symptoms of underlying diseases like Woakes syndrome, Kartagener syndrome and mucoviscidosis
- The patients have bronchial asthma and aspirin intolerance.
The operation is also useful if the frontal sinuses are very big, mucosal pathology of the sinus is severe, or all the sinuses feature polyposis. However, it should be avoided if the frontal sinuses are small.
Other indications include intracranial and orbital complications that originate in the frontal sinus mucoceles and the sinuses but without any bone damage. Small benign mid line tumors can also be removed during this type of surgery.
Which is the best procedure?
While selecting the most suitable sinus drainage procedure, keep in mind the following points:
- Extent and severity of pathology
- Patient specific anatomy
- Current outflow from the sinus
