Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Trephination of the Frontal Sinus

Introduction Trephination of the frontal sinus can be used in three ways. Traditionally, it was used for the drainage of acute processes such as a Pott’s puffy tumor or bacterial frontal sinusitis. Second, trephination can be combined with transnasal endoscopic approaches to the frontal sinus for severe inflammatory disease or challenging frontal recess anatomy, frequently referred to as a minitrephine. Finally, it can potentially obviate the…

Endoscopic Sphenoidotomy

Introduction The paired sphenoid sinuses are the most posteriorly positioned of the paranasal sinuses. Due to this location, endoscopic approaches to the sphenoid sinus are preferred to address most pathology that may arise in this location. The pathology may be isolated within the sphenoid sinus or may be part of inflammatory sinonasal disease involving the ethmoid or other paranasal sinuses. The sphenoid sinus is also the…

External Ethmoidectomy

Introduction In many countries, external ethmoidectomy is rarely performed due to the widespread adoption of endoscopic techniques. However, in some clinics where endoscopic equipment is not available, the external ethmoidectomy approach is still an important technique used in the management of ethmoid disease. It also still has value for the management of sinonasal tumors, epistaxis, orbital infection, and trauma in special circumstances. It may be used…

Endoscopic Ethmoidectomy

Introduction The decision to proceed with ethmoidectomy in the context of endoscopic sinus surgery (ESS) should be based on the patient’s pathology, degree of symptoms, and response or lack of response to appropriate medical therapy. The goal is to eliminate chronic disease and restore function to the ethmoid sinuses and frequently to the frontal and maxillary sinuses, which can be secondarily infected or diseased because of…

Complete Maxillectomy

Acknowledgment I would like to thank Satyan B. Sreenath, MD for his work on this chapter and figure production Introduction Both benign and malignant tumors may originate within or around the maxillary sinus and hard palate. These tumors may arise from the epithelial surfaces of the oral cavity (hard palate or alveolar ridge) or the sinonasal mucosa (within the maxillary sinus or lateral nasal wall). Tumors…

Medial Maxillectomy

Introduction Medial maxillectomy is most commonly indicated for resection of tumors of the nasal cavity, lateral nasal wall, and medial maxillary sinus. The incision most commonly used for exposure is the lateral rhinotomy. This offers the best exposure for a medial maxillectomy and can be combined with a transcranial approach for an anterior craniofacial resection commonly used for removal of advanced tumors of the anterior skull…

Oroantral Fistulas

Introduction An oroantral communication occurs when there is an abnormal connection between the maxillary sinus and the oral cavity. The communication may be the result of trauma, osteomyelitis, pathologic lesions, or foreign bodies such as dental implants or endodontic material. However, the most common cause of an oroantral communication is the extraction of a posterior maxillary tooth. The root apices are in close proximity to the…