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A New Device for Frontal Sinus Endoscopy: First Clinical Report

OBJECTIVE: Endoscopically or microscopically controlled paranasal sinus surgery currently represents the state of the art. For anatomic reasons the ostium of the frontal sinus and the frontal sinus itself are difficult to observe. Flexible endoscopes are often difficult to implement and do not provide enough light intensity to visualize all parts of the frontal sinus. MATERIALS AND METHODS: A specially curved rigid endoscope with a working channel of 1.5 mm that allows passage into the frontal sinus has been developed to manage this problem. The system was used on 15 patients during paranasal sinus surgery to evaluate possible indications and its clinical usefulness. RESULTS: The endoscope could be introduced into the frontal sinus after an ethmoidectomy had been performed in all of the patients. The anatomy of the sinus could be visualized with sufficient light intensity in 14 patients. The shadowing of the frontal sinus seen in CT was not due to polyps of the mucosa of the frontal sinus in all cases, but rather due to secretion with otherwise normal mucosa. In the cases with polyps, it was necessary to irrigate with saline solution to prevent the buoyant polyps from collapsing over the endoscope. The following specific indications for this endoscopic version were established during this first test: intraoperative and postoperative control of the frontal sinus, clinical evaluation of tumor growth into the frontal sinus, biopsies within the frontal sinus, and evaluation of fractures. CONCLUSION: The new device provides further insight within the field.