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Endoscopic Frontal Sinusotomy with Osteoma Removal

A 49-year-old female presented with a one-year history of right frontal headaches, not controlled despite OTC medication. Work up with head CT revealed an osteoma of the right frontal sinus. The patient experienced no improvement in headache severity and elected to have surgical intervention.

Methods: ENT Fusion Navigation system was used during the entire case.  A ball-tip probe was used to fracture out the uncinate bone and a backbiter was used to remove the uncinate in its entirety.  The natural ostium of the right maxillary sinus was then visualized.  Again, the backbiter was used to remove tissue anterior to the natural ostium. A straight Tru-Cut was used to remove the ostium towards the posterior fontanelle. The right middle turbinate was resected in order to gain sufficient access for the resection of the osteoma.  In order to remove the right middle turbinate, a turbinate scissors were used to make 3 cuts along the attachment of the middle turbinate and this was pulled down.  A down biter was used to open up the maxillary sinus inferiorly. There was no tissue seen in the maxillary sinus. After this was done, an ethmoidectomy was performed by placing a J-curette behind the ethmoid bulla point anteriorly.  This ethmoid bulla was removed along with several other anterior ethmoid cells.  After this was done, a frontal sinus seeker was used to identify the right frontal osteoma.  The patient did not have a right frontal sinus. Instead, an osteoma was in the area of what would have been the right frontal sinus or nasal frontal outflow tract.  Image guidance was meticulously used to identify the osteoma.  A 70-degree frontal drill was used and this osteoma was slowly drilled to remove as much as possible.   Drilling was done from the posterior edge of the osteoma up to the skull base superiorly, to the lamina papyracea laterally and all bone that could be safely removed was removed. A right frontal propel stent was placed in the bony cavity created by the drill out and after this, the sinus was irrigated and suctioned.

Results: The patient was sent to recovery in good condition and no adverse reactions were reported by the surgeon or patient.

Surgeons: Alissa Kanaan, MD. Zachary V. Anderson, MD.

Institution: Department of Otolaryngology – Head and Neck Surgery at the University of Arkansas for Medical Sciences.

ENT Fusion Navigation system was used during the entire case.  A ball-tip probe was used to fracture out the uncinate bone and a backbiter was used to remove the uncinate in its entirety.  The natural ostium of the right maxillary sinus was then visualized.  Again, the backbiter was used to remove tissue anterior to the natural ostium. A straight Tru-Cut was used to remove the ostium towards the posterior fontanelle. The right middle turbinate was resected in order to gain sufficient access for the resection of the osteoma.  In order to remove the right middle turbinate, a turbinate scissors were used to make 3 cuts along the attachment of the middle turbinate and this was pulled down.  A down biter was used to open up the maxillary sinus inferiorly. There was no tissue seen in the maxillary sinus. After this was done, an ethmoidectomy was performed by placing a J-curette behind the ethmoid bulla point anteriorly.  This ethmoid bulla was removed along with several other anterior ethmoid cells.  After this was done, a frontal sinus seeker was used to identify the right frontal osteoma.  The patient did not have a right frontal sinus. Instead, an osteoma was in the area of what would have been the right frontal sinus or nasal frontal outflow tract.  Image guidance was meticulously used to identify the osteoma.  A 70-degree frontal drill was used and this osteoma was slowly drilled to remove as much as possible.   Drilling was done from the posterior edge of the osteoma up to the skull base superiorly, to the lamina papyracea laterally and all bone that could be safely removed was removed. A right frontal propel stent was placed in the bony cavity created by the drill out and after this, the sinus was irrigated and suctioned.  
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A 49-year-old female presented with a one-year history of right frontal headaches, not controlled despite OTC medication. Work up with head CT revealed an osteoma of the right frontal sinus. The patient experienced no improvement in headache severity and elected to have surgical intervention.
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University of Arkansas for Medical Sciences
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Review Endoscopic Frontal Sinusotomy with Osteoma Removal.

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