Endoscopic assisted supraorbital approach for management of extensive and/or complicated frontal sinus lesions

Abstract

Background: Successful surgical management of frontal sinus disease remains a significant challenge for rhinologists. The purely endoscopic/endonasal approach has limitations, especially in patients with complex frontal sinus pneumatization patterns as well as alterations in anatomy. Supraorbital approach that provides improved access and visualization of these challenging anatomical regions might enhance the management of anterior skull base and extensive frontal sinus lesions. Aim: To evaluate the efficacy and safety of the supraorbital approach for management of extensive frontal sinus lesions. Patients and Methods: The study was conducted on 20 patients with extensive frontal sinus pathologies using the supraorbital approach via the eyebrow incision at Kasr Al-Ainy Hospital and Alexandria Main University Hospital in 4 years (from March 2015 till March 2019). The patients were followed-up for 24 months. Results: Supraorbital approach used alone or in multiportal combination with endoscopic sinus surgery to safely and effectively treat extensive frontal sinus lesions. The only complication that occurred was parasthesia in the forehead due to supraorbital nerve injury in one patient (5%) which is resolved within 6 months post-operatively. No late complications or evidence of recurrence of the disease were developed till the end of the follow-up period. Conclusion: The supraorbital approach is a safe, direct and minimally disruptive approach to the anterior skull base and frontal sinus lesions and should be considered as an alternative to more extensive craniofacial approaches for selected pathologies of the frontal sinus and the anterior skull base.