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Clinical Challenges in Otolaryngology |

Frontal Sinus Obliteration Is Rarely Indicated

Donald C. Lanza, MD
Arch Otolaryngol Head Neck Surg. 2005;131(6):531-532. doi:10.1001/archotol.131.6.531.
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Sillers has done an excellent job of summarizing the critical issues for and against frontal sinus obliteration. His account is an accurate and nonbiased review of the pertinent data, and I concur with him that the strength of the indications for frontal sinus obliteration continues to wane.

Donald C. Lanza, MD

In general, 5 premises establish the best paradigm for the surgical management of frontal sinus disease: (1) Restoring frontal sinus function is preferred to ablation or obliteration. (2) Minimally invasive techniques are typically associated with less lost work time for the patient. (3) Ability to postoperatively monitor residual or recurrent disease is greatest (endoscopically or via imaging) when frontal sinus function is restored. (4) The need for postoperative endoscopic wound care can be more labor intensive when function is restored. (5) In experienced hands, complication rates with ablation procedures are comparable to or even higher than those associated with minimally invasive techniques.

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Donald C. Lanza, MD

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Coronal computed tomographic image demonstrating the potential for complex pnuematization patterns of the frontal bone. This pnuematization could preclude adequate mucosal stripping for frontal sinus obliteration.

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