e. Frontal Sinus Operation.
(1) General. This procedure involves making an incision through the
eyebrow of the affected side and through the anterior wall and floor of the frontal sinus
for removal of the diseased tissue, cleansing of the sinus cavity, and drainage. It may
be made necessary in acute frontal sinusitis with persistent headaches and edema of
the upper lid when other modes of therapy have failed.
(a) An incision is made over the affected frontal sinus, extending from
the base of the nose through the eyebrow as far as the supraorbital notch. A
self-retaining retractor, hook retractor, knife, sponges, fine hemostats, fine ligatures, and
suction set are needed.
(b) Either the anterior wall of the frontal sinus or the floor of the sinus is
opened by means of dental burrs, chisel, mallet, gouges, septum-cutting forceps,
curettes, and nasal forceps. Drainage is established by either the nasofrontal duct or
the insertion of drains.
(c) An ethmoidal incision is made behind the nasal process of the
superior maxillary bone with a chisel and mallet. The lacrimal duct is identified and
preserved. Ethmoid cells are curetted.
(d) A Penrose drain is introduced; the external wound is approximated
with fine silk sutures and dressing applied. The patient's face is cleaned and dried.
(1) General. This is for removal of the diseased portion of the middle
turbinate, opening and removal of ethmoid cells, and removal of diseased tissue in the
nasal fossa through a nasal approach or external approach. It reduces the many celled
ethmoid labyrinth into one large cavity to ensure adequate drainage and aeration.
(2) Operative procedure. For the nasal route, the procedure is similar to
intranasal antrostomy described previously. For the external route, the procedure is
similar to the frontal sinus operation.
(1) General. This involves making an opening into one or both of the
sphenoid sinuses by the intranasal or external ethmoidectomy approach. It is difficult to
visualize the cavity of the sphenoid sinus because of its depth. Surgery of the sphenoid
sinus is usually done intranasally or through an external ethmoidectomy approach.
Operative procedure. This is the same as for intranasal antrostomy.