"By doing the surgery over and over again, I've learned to look at the (computerized tomography) scan and check to see if I had room for my instruments to go through," says Dr. Kountakis, senior author of the recently released first textbook on the frontal sinuses.
He wondered if guidelines could be developed to help others do the same.
He and colleagues Dr. Ramon E. Figueroa, MCG neuroradiologist, and Dr. Firas T. Farhat, MCG sinus fellow who is now the first fellowship-trained rhinologist practicing in Lebanon, determined those measurements by studying the CT scans and anatomy of seven cadavers.
They identified the critical measurements as the thickness of the nasal beak, the boney structure between the eyes where the nose and forehead meet, as well as the "accessible dimension," a term Dr. Kountakis coined for available working space inside the frontal drainage area.
"Even with the smallest instruments that are available today, this dimension should be at least 5 mm (about .2 inches) to allow for safe drill insertion," the study authors write of the accessible dimension.
"The smaller it is, the harder it is," says Dr. Kountakis. "You need to have some space that will admit all these instruments going up into the forehead."
Researchers also measured the distance between the nasal beak and the front of the nearby skull base as well as the widest front-to-back depth of the frontal sinuses.
By their new measurements, four of the seven cadavers qualified for the sinus-saving modified Lothrop procedure. The researchers suggest long-term clinical studies to further assess the efficacy of the measurements.
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Contact: Toni Baker
tbaker@mcg.edu
706-721-4421
Medical College of Georgia
30-Jun-2005