"The frontal sinus is behind the forehead and it has a very tortuous drainage," says Dr. Stil E. Kountakis, vice chair of the Medical College of Georgia Department of Otolaryngology-Head and Neck Surgery. "It's the most difficult sinus to work with."
The good news is the frontal sinuses, which run parallel to the eyebrows, are not the most common site for infection. The bad news is the sinuses between the eyes the ethmoids, into which the frontal sinuses drain are, says Dr. Kountakis.
"The general recommendation is to avoid frontal sinus surgery as much as possible," he says, citing potential hazards that come with their proximity to the skull base and the orbits.
But when chronic symptoms such as headache, cough, sore throat, nasal congestion and drip don't respond to medical therapy, miserable patients may opt for surgery that effectively obliterates their frontal sinuses. Surgeons crack open the skull, open the frontal sinuses, remove the lining and fill the empty cavity with abdominal fat. "A better solution is to perform functional endoscopic surgery that provides a large area for the sinuses to drain while preserving sinus function," says Dr. Kountakis, who directs the Georgia Sinus and Allergy Center.
He is corresponding author on a study published in the May/June issue of the American Journal of Rhinology that should help surgeons determine if patients are instead candidates for a sinus-saving modified Lothrop procedure.
The procedure enables sinus surgeons to work through the nose to create a larger drainage pathway for the frontal sinuses by removing the floor of the sinuses between the eyes and creating a hole in the septum that separates the nose. "This opens up the sinuses so they drain without obstruction," says Dr. Kountakis. 'This is a last
Contact: Toni Baker
Medical College of Georgia