Limits of endoscopic visualization and instrumentation in the frontal sinus

Abstract

BACKGROUND: Endoscopic limitations in the frontal sinus are poorly defined. We set out to define these limits. METHODS: Fifteen cadaveric heads underwent endoscopic frontal sinusotomies (Draf IIA, IIB, III). Areas of frontal sinus openings were calculated. Coordinates of the most distant points for instrumentation, visualization, and instrumentation with visualization in the frontal sinus were identified with the use of image guidance. RESULTS: Twenty-eight frontal sinuses were evaluated. The mean sinus opening areas were 47.5 mm2, 105.1 mm2, and 246.4 mm2 for Draf IIA, IIB, and III. Visualization exceeds instrumentation and visualized reach ( P < 0.05) regardless of different frontal sinusotomies. Anterior and lateral instrumentation and visualized reach increase as the frontal sinus opening increases ( P < 0.05). For lateral visualization, Draf III > IIB > IIA ( P < 0.04). There is no statistical difference for superior visualization, instrumentation, and visualized reach among various sinusotomies ( P > 0.05). CONCLUSIONS: Endoscopic visualization exceeds instrumentation and instrumentation exceeds visualized reach. Enlarging frontal sinus opening area increases instrumentation and visualization.