Supraorbital rim incision frontal sinus outer plate bone plate angioplasty frontal sinus osteoma resection

Frontal sinus osteoma accounts for 39% to 78% of nasal osteoma, and the growth is very slow. The smaller ones can be asymptomatic. The larger one can compress the dura mater, invade the eyelids, the intracranial, olfactory area, or block the nasal frontal tube. The main symptoms are mechanical obstruction and compression, and nasal obstruction, headache, eyeball protrusion, and local bulging may occur. If you invade the intracranial and frontal sinus, you can have a brain abscess. Smaller and asymptomatic frontal sinus osteoma may not be operated temporarily, and patients with obvious symptoms should be surgically removed. The procedure depends on the location of the osteoma, the size of the tumor, and the patient's requirements. Treatment needs attention: 1 reduce deformity. 2 Keep the nasal forehead open. 3 to prevent intracranial complications. Commonly used surgery has an upper marginal incision. The advantage of this procedure is that it is close to the surgical field and the postoperative deformity is small. However, the disadvantage is that the supraorbital nerve needs to be cut off, and the anterior frontal numbness is required. In the case of tumor invasion and ethmoid sinus, it is feasible to combine the eyebrow and bow incision. If the tumor is large, or the aesthetic requirements are higher, the large coronal incision in the hairline of the forehead may be performed, and the forehead flap may be fully turned forward and downward. The advantages of this procedure are good exposure and no deformity after surgery. The disadvantage is that the incision is larger, the bleeding is more, and the operation is more complicated. Generally, the upper marginal incision is used. Treatment of diseases: skull osteoma osteoma Indication Upper iliac margin incision frontal sinus plate sinus osteosynthesis is suitable for the treatment of frontal sinus osteoma, moderately compressing the dura mater into the skull, or blocking the nasal frontal tube, causing pain, retention cysts, deformities, etc. Contraindications The frontal sinus osteoma is larger and obviously invades the intracranial, thus the approach, the upper part of the free tumor can not be directly viewed, which may cause complications such as wearing the dura mater. In such cases, a large coronal incision in the forehead hairline should be performed to form the frontal bone flap, which is separated from the anterior skull base by epidural space under direct vision. Preoperative preparation 1. Positive lateral X-ray film, CT scan should be more complicated. 2. Treatment of nasal sinus and pharyngeal infections. Surgical procedure 1. The upper edge of the iliac crest is inserted from the outer end of the brow arch along the brow arch. The inner end of the brow arch is bent downward, and the middle line of the eyebrow is crossed to the inner end of the contralateral brow arch. The depth of the incision is only on the periosteum. 2. Sharply separate the upper flap from the periosteum to the middle of the forehead. 3. Refer to the X-ray film to mark the frontal sinus edge, and cut the periosteum 0.5cm above it and separate it to the frontal sinus edge. Saw the frontal sinus with a chainsaw at the edge of the frontal sinus. 4. Use a wide flat chisel to extend into the frontal sinus along the bone cutter, and squat forward, so that the frontal sinus outer plate is broken at the sinus floor. The frontal sinus outer plate was connected to the periosteum in the upper margin of the iliac crest and turned forward, and the frontal sinus cavity was opened to reveal the osteoma. If the osteoma is irregular and stretches far away, cut it into several pieces with a chainsaw and then remove it by tapping. If there are cysts and polyps, they should also be removed to retain normal mucosa. Expand the nasal frontal tube and open the anterior ethmoid sinus to the nasal cavity. 5. Flush the surgical cavity, inspect and repair the ruptured dura mater, and place the sinus cavity into the dilatation tube or gauze, which is taken out from the nasal cavity. The frontal sinus was repositioned, the periosteal incision was sutured, and the facial incision was layered. complication 1. The frontal plate of the frontal sinus is not fully repositioned, which may cause local deformity. In this operation, the small bone wire should be used to ligature the bone flap. 2. Intracranial infection is mainly caused by intraoperative dural rupture. The focus is on intraoperative prevention, and if it has already occurred, antibiotic treatment should be strengthened. If it is proved that a brain abscess is formed, intracranial surgery should be performed. 3. Nasal frontal stenosis, frontal sinus infection, etc., mainly due to insufficient expansion of the nasal frontal tube, can be repositioned and expanded with antibiotics. 4. Cerebrospinal fluid rhinorrhea occurs in the posterior frontal sinus and dural tears without paying attention to the repair. If you can't heal within 2 weeks, you need to re-surgery.