The Frontal Sinus

 

Description:

"This book will be a valuable resource for novice surgeons approaching one of the most challenging anatomical subsites, since it provides a stepwise approach to understanding the anatomical background, the radiological aspects, and the broad spectrum of different surgical approaches to the frontal sinuses.The authors are to be congratulated for this masterpiece, which will become the gold standard for experts and beginners." —Paolo Castelnuovo

Edited by renowned rhinologists and skull base surgeons Christos Georgalas and Anshul Sama, this complete guide to frontal sinus surgery covers surgical anatomy and radiology, frontal-specific pathology, surgical techniques, technical advancements, and controversies. It focuses on those starting surgical practice and it is also of interest to well-established surgeons.

This book brings together some of the leading surgeons across the globe to provide varied and complementary perspectives. The content is organized in five sections: surgical anatomy, specific conditions of the frontal sinus, open surgical approaches, endoscopic surgical approaches, and controversies.

Key Features

More than 600 full-color images and diagrams illustrating surgical concepts and demonstrating detailed techniques

Stepwise descriptions of surgical techniques with a "tips and tricks" section in each chapter drawn from the authors' experience

Clinical case presentations in each chapter illustrating key concepts and techniques

A truly global and balanced perpective with world-leading authors from all continents

Controversial topics analyzed from evidence-based medicine (EBM) perspective

This is a must-have resource for otolaryngology–head and neck surgery residents, fellows, and specialists that may also benefit neurosurgeons, maxillofacial surgeons, plastic surgeons, and other clinicians who deal with this challenging and complex area.

 

Table of Contents:

 

Videos

Section I Anatomy of the Frontal Sinus and Frontal Recess

1 Developmental Bases of the Anatomy of the Frontal Sinus

1.1 Introduction

1.2 Frontal Sinuses and Ethmoid Lateral Masses have Different Evolutionary and Developmental Origins

1.2.1 The Ethmoid Develops from the Olfactory Cartilaginous Capsule

1.2.2 The Frontal Sinuses Pneumatize after Erythropoietic Bone Marrow Conversion into Fatty Marrow

1.3 The Nitric Oxide “Story” of the Paranasal Sinuses Makes them Play a Role in Blood Oxygenation on Demand

1.4 Pneumosinus Dilatans and Arrested Pneumatization Could Bear Witness to Sinus Development

1.4.1 Pneumosinus Dilatans

1.4.2 Arrested Pneumatization

1.5 Conclusion

2 Radiological Anatomy

2.1 Introduction

2.2 Lamina Papyracea

2.3 Uncinate Process

2.4 Floor of Olfactory Recess

2.5 Agger Nasi Air Cell

2.6 Accessory Air Cells

2.7 Anterior Ethmoidal Artery

2.8 Bulla Ethmoidalis

2.9 Middle Turbinate

2.10 Conclusion

3 Applied Surgical Anatomy

3.1 General Considerations

3.2 Applied Anatomy for Endonasal Approaches

3.3 Applied Anatomy for External Approaches

3.3.1 Coronal Approach

3.3.2 Transpalpebral Approach

3.4 Blood Supply

3.5 Innervation

3.6 Anatomical Variations and Surgical Considerations

3.7 Conclusions

Section II Endoscopic Surgical Approaches to Frontal Sinus Disease

4 Draf Frontal Sinusotomy I and IIa

4.1 Indications

4.2 Surgical Steps

4.3 Tips and Tricks

4.4 Case Examples

4.5 Complications Management

4.6 Conclusion

5 Draf Frontal Sinusotomy IIb

5.1 Indications

5.2 Anatomy

5.3 Surgical Steps

5.3.1 Lateral Approach

5.3.2 Median Approach

5.4 Tips and Tricks

5.5 Complications

6 Extended Draf IIb and Other Modifications of the Lothrop Procedure

6.1 Introduction

6.2 Indications

6.3 Surgical Steps

6.3.1 Overview of Standard Draf IIb

6.4 Modifications of the Standard Draf IIb Procedure

6.4.1 Modified Hemi-Lothrop Procedure (Eloy IIC)

6.4.2 Modified Mini-Lothrop Procedure (Eloy IID)

6.4.3 Modified Subtotal-Lothrop Procedure (Eloy IIE)

6.4.4 Modified Central-Lothrop Procedure (Eloy IIF)

6.5 Tips and Tricks

6.6 Case Examples

6.6.1 Example 1

6.6.2 Example 2

6.6.3 Example 3

6.7 Complications

6.7.1 Recurrence and Chronic Scarring

6.7.2 Cerebrospinal Fluid Leak

6.7.3 Orbital Injury

6.7.4 Anterior Ethmoid Artery Injury

7 The Frontal Sinus Rescue Procedure

7.1 Indications

7.2 Surgical Steps

7.2.1 Step 1

7.2.2 Step 2

7.2.3 Step 3

7.2.4 Step 4

7.3 Reverse Frontal Rescue Procedure

7.4 Complications

7.5 Tips and Tricks

7.6 Conclusion

8 Draf III (Endoscopic Modified Lothrop)— Inside-Out and Outside-In Approaches

8.1 Indications

8.1.1 Relative Contraindications

8.2 Surgical Steps

8.3 Lateral-to-Medial/Inside-Out Technique ▶ [168]

8.4 Outside-In/Medial-to-Lateral Technique

8.5 Tips and Tricks

8.6 Case Examples

8.6.1 A Case of Allergic Fungal Rhinosinusitis with Fronto-orbital Mucocele

8.6.2 A Case of Chronic Frontal Sinusitis with a High Posterior Frontal (Type 3) Cell

8.6.3 A Case of Chronic Frontal Sinusitis—Riedel’s Procedure Reversal

8.7 Postoperative Management

8.8 Complications and their Management

8.8.1 Skull Base Injury and Cerebrospinal Fluid Leak

8.8.2 Hemorrhage

8.8.3 Orbital Injury

8.8.4 Skin Injury

8.8.5 Stenosis of the Frontal Sinus Neo-ostium

9 Transseptal Approach

9.1 Background and CT Review

9.2 Indications and Contraindications

9.3 Advantages

9.4 Disadvantages

9.5 Surgical Steps

9.6 Tips and Tricks

9.6.1 Case Example

9.7 Complications

10 Endoscopic Endonasal Orbital Transposition for Lateral Frontal Sinus Lesions

10.1 Indications

10.2 Surgical Steps

10.3 Tips and Tricks

10.4 Case Example

10.5 Complications

11 The Role of Frontal Sinus in Anterior Skull Base Surgery and the Transcribriform Approach

11.1 Indications

11.2 Surgical Steps

11.3 Tips and Tricks

11.4 Complications

12 Extended Endonasal Anterior Skull Base Approaches

12.1 Indications

12.2 Surgical Steps

12.2.1 Principles

12.2.2 Operative Setup

12.2.3 Surgical Technique

12.2.4 Reconstruction

12.2.5 Postoperative Considerations

12.3 Tips and Tricks

12.4 Case Examples

12.4.1 Esthesioneuroblastoma (Rranscribriform Approach)

12.4.2 Tuberculum Sellae Meningioma: Endoscopic Transtuberculum/Transplanum Approach

12.5 Complications and Management

12.5.1 Vascular Complications

12.5.2 Cranial Nerve Injury

12.5.3 Cerebrospinal Fluid Fistulas

12.5.4 Postoperative Infection

12.5.5 Other Complications

13 Revision Endoscopic Frontal Sinus Surgery

13.1 Introduction

13.2 Indications

13.2.1 Ongoing Mucosal Disease

13.2.2 Incomplete Dissection

13.2.3 Lateralization of the Middle Turbinate

13.2.4 Scarring and Synechiae

13.2.5 Neo-Osteogenesis

13.3 Patient Selection

13.4 Preoperative Planning

13.4.1 Analyzing the Computed Tomography Imaging

13.4.2 Computer-Assisted Navigation during Surgery

13.4.3 Endoscopes and Equipment

13.5 Choice of Procedure

13.6 Surgical Steps

13.6.1 The Axillary Flap Technique

13.6.2 Frontal Sinus Mini-Trephine

13.7 Specific Scenarios

13.7.1 Retained Cells in the Frontal Recess or Extending into the Frontal Sinus (Draf I or International Classification of Extent of Endoscopic Frontal Sinus Surgery Grades 1–3)

13.7.2 A Narrow Frontal Ostium and/ or Extensive Supra Agger/Bulla Frontal Cells, or Ongoing Significant Burden of Disease (CRSwNP, Aspirin- Sensitive Asthma, Allergic Fungal Disease [Draf III/EFSS 6])

13.8 Tips and Tricks

13.9 Case Example

13.10 Complications: Management

13.10.1 Scarring and Restenosis

13.10.2 Anterior Ethmoid Artery

13.10.3 Orbital Injury

13.10.4 Cerebrospinal Fluid Leak

14 Complications of Frontal Sinus Surgery

14.1 Introduction

14.2 Epidemiology and Etiology

14.3 Specific Complications of Endoscopic Approaches to the Frontal Sinus

14.3.1 Failure to Accomplish the Specific Aim of the Procedure

14.3.2 Pain

14.3.3 Bleeding

14.3.4 Infection

14.3.5 Scar/Stenosis

14.3.6 Mucocele Formation

14.3.7 Anterior Skull Base Injury/Cerebrospinal Fluid Leak

14.3.8 Orbital Injury

14.4 Prevention of Complications

14.4.1 Preoperative Planning

14.4.2 Perioperative Technique

14.4.3 Postoperative Care

15 Delivery of Topical Therapy to the Frontal Sinus

15.1 Introduction

15.2 Basic Science Research on Topical Distribution to the Sinuses

15.3 Clinical Research on Topical Distribution to the Sinuses

15.3.1 Tips and Tricks

15.4 Conclusion

16 Postoperative Management: Dressings and Toilet

16.1 Natural History of Sinus Ostia after Surgery

16.2 Intranasal Packing

16.2.1 Nonabsorbable Packs

16.2.2 Absorbable Packings

16.3 To Pack or Not to Pack

16.4 Inert Stents

16.5 Drug-Eluting Stents

16.6 Postoperative Care

16.6.1 Saline Irrigations

16.6.2 Endoscopic Debridement

16.6.3 Topical Treatments

16.7 Conclusion

17 Office-Based Frontal Sinus Procedures

17.1 Indications

17.1.1 Anatomic Considerations

17.1.2 Patient Selection

17.1.3 Frontal Sinusitis

17.1.4 Frontal Mucoceles

17.1.5 Nasal Polyps

17.2 Surgical Steps/Anesthesia

17.3 Postoperative Management and Procedures

17.3.1 Nasal Irrigations and Topical Therapies

17.4 Tips and Tricks

17.4.1 Case Examples

17.5 Controversies

17.5.1 Balloon Catheter Dilation

17.6 Emerging Technologies

17.7 Conclusion

Section III Open Surgical Approaches to Frontal Sinus Disease

18 Mini- and Maxi-Trephines

18.1 Indications

18.2 Surgical Steps

18.3 Tips and Tricks

18.4 Case Example

18.5 Complications

19 Osteoplastic Flap Approach with and without Obliteration

19.1 Indications

19.2 Surgical Steps

19.2.1 Osteoplastic Flap without Obliteration

19.2.2 Osteoplastic Flap with Obliteration

19.3 Tips and Tricks

19.4 Complications: Management

19.5 Conclusion

20 Riedel’s Procedure and Cranialization of the Frontal Sinus

20.1 Riedel’s Procedure

20.1.1 Historic Perspective

20.1.2 Indications

20.1.3 Technique

20.2 Cranialization of the Frontal Sinus

20.2.1 Historic Perspective

20.2.2 Indications

20.2.3 Technique

Section IV Management of Specific Frontal Sinus Conditions

21 Frontal Sinus Barosinusitis

21.1 Epidemiology and Etiology

21.2 Clinical Presentation and Investigations

21.3 Management

21.4 Case Example (Courtesy of Christos Georgalas)

22 Frontal Sinus in Patients with Cystic Fibrosis

22.1 Epidemiology and Etiology

22.2 Clinical Presentation and Investigations

22.2.1 Radiographic Abnormalities in Cystic Fibrosis and the Frontal Sinus

22.3 Management

22.3.1 Medical Therapy

22.3.2 Nasal Saline Irrigations

22.3.3 Corticosteroids

22.3.4 Topical Antibiotics

22.3.5 Oral Antibiotics

22.3.6 Dornase Alfa

22.3.7 Cystic Fibrosis Transmembrane Conductance Regulator modulators

22.3.8 Surgical Therapy

22.3.9 Endoscopic Approaches

22.4 Complications: Management

23 Pneumosinus Dilatans

23.1 Introduction

23.2 Epidemiology and Etiology

23.3 Clinical Presentation and Investigations

23.4 Diagnosis

23.5 Management

23.6 Complications

23.7 Conclusion

24 Frontal Sinusitis in Chronic Rhinosinusitis without Nasal Polyposis

24.1 Introduction

24.2 Epidemiology

24.3 Pathophysiology

24.3.1 Anatomic Factors

24.3.2 Physiological Factors

24.4 Management

24.4.1 Medical Management

24.4.2 Surgical Management

24.5 Conclusion

25 Frontal Sinus Surgery in CRSwNP, AFRS, and ASA Triad

25.1 Epidemiology and Etiology

25.1.1 Chronic Rhinosinusitis with Nasal Polyps

25.1.2 Aspirin-Exacerbated Respiratory Disease

25.1.3 Allergic Fungal Sinusitis

25.2 Clinical Presentation and Investigations

25.2.1 Chronic Rhinosinusitis with Nasal Polyps

25.2.2 Aspirin-Exacerbated Respiratory Disease

25.2.3 Allergic Fungal Sinusitis

25.3 Management Overview

25.3.1 Chronic Rhinosinusitis with Nasal Polyps

25.3.2 Aspirin-Exacerbated Respiratory Disease

25.3.3 Allergic Fungal Sinusitis

25.4 Extent of Surgery and Outcomes

25.4.1 Goals of Surgery

25.4.2 Effect of Extent of Surgery on Outcomes for Maxillary and Ethmoid Sinuses

25.4.3 Effect of Extent of Surgery on Outcomes for the Frontal Sinus

25.5 Case Examples

25.5.1 Samter’s Triad Successfully Managed with Draf IIa

25.5.2 Samter’s Triad Only Controlled after Draf III

25.5.3 Nasal Polyp Recurrence in Frontal Ostium Managed in the Office

25.5.4 Allergic Fungal Sinusitis Presenting with Proptosis

25.6 Complications

26 Frontal Sinus Mucoceles

26.1 Terminology

26.2 Epidemiology

26.3 Pathology

26.4 Clinical Presentation

26.5 Investigations

26.6 Classification

26.7 Management

26.8 Outcomes

26.9 Conclusion

27 Frontoethmoidal Osteomas

27.1 Epidemiology and Etiology

27.2 Histology.

27.3 Clinical Presentation and Investigations

27.4 Management

27.5 Approaches for Frontoethmoidal Osteomas

27.5.1 External Approaches

27.5.2 Endoscopic Approaches

27.6 Summary

27.7 Case Examples

27.7.1 Case 1

27.7.2 Case 2

27.7.3 Case 3

27.7.4 Case 4

28 Frontal Inverted Papilloma

28.1 Epidemiology and Etiology

28.2 Clinical Presentation and Investigations

28.3 Management

28.4 Case Examples

28.4.1 Case 1

28.4.2 Case 2

28.4.3 Case 3

28.5 Complications: Management

29 The Frontal Sinus: Fibro-Osseous Lesions

29.1 Fibrous Dysplasia

29.1.1 Epidemiology and Etiology

29.1.2 Clinical Presentation and Investigations

29.1.3 Management

29.2 Ossifying Fibroma

29.2.1 Epidemiology and Etiology

29.2.2 Clinical Presentation and Investigations

29.2.3 Management

29.2.4 Surgical Steps

29.2.5 Consent

29.3 Summary

30 Malignant Disease Involving the Frontal Sinus

30.1 Epidemiology and Etiology

30.2 Clinical Presentation and Investigation

30.3 Staging

30.4 Management

30.5 Case Example

30.6 Complications: Management

30.7 Tips and Tricks

31 Acute Frontal Osteomyelitis: Intracranial and Orbital Complications

31.1 Epidemiology and Etiology

31.1.1 Epidemiology

31.1.2 Etiology

31.2 Clinical Presentation and Investigations

31.2.1 Orbital Complications

31.2.2 Intracranial Complications

31.2.3 Osseous Complications

31.2.4 Investigations

31.3 Management

31.3.1 Frontal Sinus Drainage Techniques

31.3.2 Management of Orbital Complications

31.3.3 Management of Intracranial Complications

31.3.4 Management of Osseous Complications

31.4 Case Examples

31.4.1 Case 1: Subperiosteal Abscess (Contrast-Enhanced CT)

31.4.2 Case 2: Orbital Abscess (Magnetic Resonance Imaging

31.4.3 Case 3: Cerebral Abscess (Magnetic Resonance Imaging)

31.4.4 Case 4: Epidural Abscess (Contrast-Enhanced CT)

31.4.5 Case 5: Subdural Abscess (Contrast-Enhanced CT)

31.4.6 Case 6: Pott’s Puffy Tumor

32 Fungal Frontal Sinusitis: Allergic and Nonallergic

32.1 Introduction

32.2 Epidemiology and Etiology

32.2.1 Invasive

32.2.2 Noninvasive

32.3 Clinical Presentation and Investigations

32.3.1 Invasive

32.3.2 Noninvasive

32.3.3 Special Considerations in Frontal Sinus Fungal Disease

32.4 Management

32.4.1 Medical Management

32.4.2 Surgical and Postoperative Management in the Frontal Sinus

32.4.3 Complications: Management

32.5 Conclusion

33 Frontal Sinus Trauma and Its Management

33.1 Epidemiology and Etiology

33.1.1 Anatomy

33.1.2 Trauma Mechanism

33.2 Clinical Presentation and Investigations

33.2.1 Initial Examination of the Patient

33.2.2 Imaging and Paraclinical Investigations

33.3 Management

33.3.1 Surgical Techniques

33.3.2 Surgical Decision-Making

33.4 Case Example

33.5 Complications: Management

34 Cerebrospinal Fluid Leak in the Frontal Sinus: Endoscopic Management

34.1 Epidemiology and Etiology

34.1.1 Etiologies

34.2 Clinical Presentation and Investigations

34.3 Management

34.3.1 Surgical Management

34.3.2 Endoscopic versus Open Repair

34.3.3 Postprocedural Care

34.3.4 Postprocedural Adjuvants

34.3.5 Outcomes

34.4 Case Examples

34.5 Complications: Management

34.6 Conclusion

Section V Controversial Topics in Current Practice

35 The Use of Flaps in Frontal Sinus Surgery

35.1 Published Evidence

35.1.1 Background

35.1.2 Rationale for Flaps

35.1.3 Literature Review and Surgical Techniques

35.2 Controversies and Opinions

35.2.1 Promising Outcome for Flaps

35.2.2 Recommendation for Future Studies

35.2.3 Flaps Feasibility

35.2.4 Illustrative Cases

35.3 Surgical Tips

35.4 Unanswered Questions

36 Osteitis and the Frontal Sinus

36.1 Introduction

36.2 Epidemiology and Etiology

36.2.1 Definitions

36.2.2 Histology: Pathophysiology

36.2.3 Allergy

36.2.4 Bacteriology

36.2.5 Biofilms

36.2.6 Incidence

36.3 Clinical Presentation and Investigations

36.3.1 Radiological Features

36.3.2 Clinical Implications

36.3.3 Prognostic Factor

36.4 Management

36.5 Case Example

36.6 Summary

36.7 Key Points

37 Extreme Lateral Lesions: What Is the Limit of Endoscopic Surgery?

37.1 Published Evidence

37.1.1 Traditional External Approaches for Far Lateral Lesions

37.1.2 Endonasal Endoscopic Surgery and Evolution of Lateral Disease Management

37.1.3 Evolution of Far Lateral Frontal Sinus Surgery: Exploring Limits of ESS

37.2 Controversies and Opinions

37.3 Unanswered Questions

38 Use of Image Guidance Technology: Mandatory or Not

38.1 Introduction

38.1.1 Indications

38.1.2 Applications

38.2 Published Evidence

38.2.1 Complications

38.2.2 Revision Rate

38.2.3 Clinical and Quality-of-Life Outcomes

38.2.4 Medicolegal Concerns

38.2.5 Cost

38.3 Controversies and Opinions

38.3.1 Indications

38.3.2 Surgical Train

38.3.3 Future Use

38.4 Unanswered Questions

39 Balloon Technology in the Frontal Sinus: Useful or Gimmick

39.1 Published Evidence

39.1.1 Level 1 Evidence

39.1.2 Nonrandomized Studies

39.2 Controversies and Opinions

39.2.1 Diffuse versus Localized CRS

39.2.2 Polyp Disease

39.2.3 Miscellaneous Uses

39.2.4 Contraindications

39.2.5 Preoperative Preparation

39.2.6 Training Requirements

39.2.7 Complications

39.3 Unanswered Questions

39.3.1 Cost-Effectiveness

39.3.2 Extrapolation to Wider Patient Cohort

40 Minimum versus Maximal Surgical Sinusotomy

40.1 Published Evidence

40.1.1 Balloon Dilation

40.1.2 Draf I

40.1.3 Draf IIa

40.1.4 Draf IIb

40.1.5 Draf III

40.1.5 Draf III

40.2 Controversies and Opinions

40.3 Case Studies

40.3.1 Case 1

40.3.2 Case 2

40.3.3 Case 3

40.4 Unanswered Questions

41 Patient-Reported Outcome Measures and Outcomes in Frontal Sinus Surgery: Do They Make a Difference?

41.1 Published Evidence

41.1.1 Patient-Reported Outcome Measures in Rhinology

41.1.2 Patient-Reported Outcome Measures in Frontal Sinus Treatment

41.2 Controversies and Opinions

41.3 Unanswered Questions

42 Symptoms of Frontal Sinus Disease: Where Is the Evidence?

42.1 Published Evidence

42.2 Controversies and Opinions

42.3 Case Examples

42.3.1 Case 1

42.3.2 Case 2

42.3.3 Case 3

42.3.4 Case 4

42.3.5 Case 5

42.4 Unanswered Questions

43 Anatomy and Classification of Frontoethmoidal Cells

43.1 Introduction

43.2 Published Evidence

43.3 Controversies and Opinions

44 To Drill or Not to Drill

44.1 Published Evidence

44.2 Indications for Drilling Approaches of the Frontal Sinus

44.3 Results of Drilling Approaches of the Frontal Sinus

44.4 Complications

44.5 Controversies and Opinions

44.6 Unanswered Questions

45 Indications for Operating the Frontal Sinus: Primary Surgery or Always Second Line?

45.1 Introduction

45.2 Controversies and Opinions

45.2.1 Does OMC/Frontal Recess Obstruction Cause Frontal CRS?

45.2.2 Is Anterior Ethmoidectomy (Draf I) Optimal as First-Line Surgery for Frontal CRS?

45.2.3 What Are the Clinical Characteristics of PatientsWho Fail Draf I?

45.2.4 Why Is Draf I not Successful in Some Patients with Frontal CRS?

45.2.5 Is Primary Draf IIa Effective as an Initial Surgical Intervention for Frontal CRS?

45.3 Case Studies

45.3.1 Case 1: Mild Diffuse CRSwNP Involving the Frontal Sinus

45.3.2 Case 2: Failed Draf I Procedure Requiring at least Draf IIa—Ciliary Dysfunction?

45.3.3 Case 3: Severe CRSwNP Requiring EMLP as Initial Surgical Intervention

45.3.4 Case 4: Odontogenic Frontal CRS

45.4 Unanswered Questions

46 Economic and Quality-of-Life Evaluation of Surgery and Medical Treatment for Chronic Rhinosinusitis

46.1 Published Evidence

46.1.1 What is Known about the Economic Burden of Chronic Rhinosinusitis?.

46.1.2 What Are the Wider Costs of CRS?.

46.1.3 What Is the Impact of CRS on QOL?.

46.1.4 Cost and Cost-Effectiveness of Treatment for CRS

46.2 Controversies Surrounding the Cost- Effectiveness of Treatment for CRS

46.3 Unanswered Questions and Future Research

47 Training Models and Techniques in Frontal Sinus Surgery

47.1 Introduction

47.2 Published Evidence

47.3 Controversies and Opinions

47.4 Unanswered Questions

48 Augmented Reality in Frontal Sinus Surgery

48.1 Role of Augmented Reality in Preoperative Planning

48.2 Role of Augmented Reality during Surgery

49 Robotic Surgery: Beyond DaVinci

49.1 Published Evidence

49.1.1 Shortcomings of DaVinci

49.2 Steering at Greater Simplicity

49.3 Steering at Reduced Dimensions

49.4 Controversies and Opinions

49.4.1 Maneuvering beyond DaVinci

49.5 Maneuvering Like a Snake

49.6 Future Steps toward Clinical Practice

49.7 Unanswered Questions

50 Pathophysiology of the Failed Frontal Sinus and Its Implications for Medical Management

50.1 Introduction

50.2 Failure due to Errors in Patient Selection

50.3 Local Causes of Recalcitrant Frontal Sinus Disease

50.4 Systemic Causes of Recalcitrant Frontal Sinus Disease

50.5 Conclusion

Index

Additional MedOne Access Information

 

An aparitie	2022
Autor	Christos Georgalas , Anshul Sama
Dimensiuni	20 x 3.1 x 27.4 cm
Editura	Thieme
Format	Hardcover
ISBN	9783132400528
Limba	Engleza
Nr pag	414
Versiune digitala	DA