OSTEOPLASTIC FLAP//BICORONAL APPROACH//FRONTAL SINUS WITH /WITHOUT OBLITERATION скачать в хорошем качестве

OSTEOPLASTIC FLAP//BICORONAL APPROACH//FRONTAL SINUS WITH /WITHOUT OBLITERATION

#nose #throathealth #ear #science #ent #nosebleed #otolaryngology The osteoplastic flap technique is a cornerstone of frontal sinus surgery, developed in the late 19th century and refined over decades to address complex frontal sinus conditions. This technique was historically employed before the advent of advanced endoscopic procedures, providing surgeons with a reliable method to treat refractory chronic sinusitis, tumors, and trauma-related damage to the frontal sinus. The procedure starts with meticulous preoperative planning. A bicoronal incision is carefully designed to minimize scarring and preserve hairlines. Local anesthesia with epinephrine is used to reduce bleeding. Once the incision is made, the surgeon elevates the scalp while protecting critical structures like the supratrochlear and supraorbital nerves. The use of image-guidance systems or the traditional Caldwell view allows precise identification of the frontal sinus boundaries. The bone flap is then created using tools like an oscillating saw or chisel, ensuring no accidental penetration into the cranial cavity. Surgeons must take great care to preserve the underlying dura and maintain structural integrity. Once the frontal sinus is exposed, the diseased tissue is addressed. Chronic infections may require complete removal of the sinus mucosa, while tumors or mucocele formation dictate tailored interventions. In cases involving obliteration, the sinus cavity is filled with materials like abdominal fat, hydroxyapatite, or synthetic substitutes. This step is critical to prevent recurrence of disease. However, the advent of minimally invasive techniques has reduced the reliance on this method. Modern surgeons now favor endoscopic approaches for many conditions previously treated with obliteration. Postoperative complications, such as the formation of mucoceles, have been a challenge. These can develop years later, necessitating reoperation. Advanced imaging techniques like CT or MRI are used for follow-up care, ensuring early detection of complications. The osteoplastic flap remains an invaluable technique for certain complex cases. It is particularly beneficial when endoscopic approaches fail or are deemed insufficient, such as in high or lateral mucocele formations. The combination of traditional surgical skill and modern technology underscores the importance of preserving these methods in an era of rapid surgical advancements. This technique serves as a testament to the balance between innovation and established surgical practices, continuing to provide solutions for patients with challenging frontal sinus disease.