Transcaruncular approach for the management of frontoethmoidal mucoceles: a comment
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《英国眼科学杂志》
Royal Adelaide Hospital, North Terrace, Adelaide, Australia
Correspondence to:
DrJwu Jin Khong
Royal Adelaide Hospital, North Terrace, Adelaide, Australia; jjkhong@yahoo.com
Accepted for publication 3 October 2003
Keywords: transcaruncular approach; frontoethmoidal
We read the article by Lai et al1 with interest.
The authors report a modification of the non-obliterative external procedure that was first described by Lynch in 1921.2 The Lynch-Howarth procedure2–4 involved transnasal stenting to prevent medial-ward collapse of the orbit obstructing drainage from the frontal sinus into the nose. Although the transcaruncular procedure uses a different external approach, it nevertheless often involves removal of part of the lamina papyracea for access to the sinuses. Hence, as with the Lynch approach, prolapse of orbital contents into the defect may occur, increasing the risk of re-stenosis. In addition, the cells in the frontal recess are not formally cleared and thus drainage into the nasal cavity is not assured. Stenting of sinus openings results in a significant fibrotic reaction in a proportion of patients, and closure of such a previously stented opening is likely. Furthermore, the follow up period in this study is too short to confirm the success or failure of this technique as recurrence often takes years to manifest.4
Endoscopic management of mucoceles protruding into the other sinuses or nasal cavity has been an accepted treatment for years.5–9 Frontoethmoidal mucoceles are typical of such mucoceles where the bony wall surrounding the mucocele is thin and therefore easily accessible transnasally. The endoscopic procedure creates a large area clear of cells which allows the greatest possible marsupialisation of the mucocele. No stenting is required. Har-El9 reported the largest series of 108 mucoceles with a median follow up of 4.7 years with a recurrence rate of only 0.9%. Therefore, we would recommend an endoscopic approach for frontoethmoidal mucoceles as the integrity of the lamina papyracea is maintained and the largest possible opening is created into the mucocele, which in turn minimises the chances of recurrence.
References
Lai PC, Liao SL, Jou JR, et al. Transcaruncular approach for the management of frontoethmoid mucoceles. Br J Ophthalmol 2003;87:699–703.
Lynch RC. The technique of a radical frontal sinus operation which has given me the best results. Laryngoscope 1921;31:1–5.
Ritter FN, ed. Surgical procedures on the paranasal sinuses: the frontal sinus. In: The paranasal sinuses: surgery and technique, 2nd ed. St Louis: Mosby, 1978:136–45.
Neel HB, McDonald TJ, Facer GW. Modified Lynch procedure for chronic frontal sinus diseases: rationale, technique, and long-term results. Laryngoscope 1987;97:1274–9.
Kennedy DW, Josephson JS, Zinreich SJ, et al. Endoscopic sinus surgery for mucoceles: a viable alternative. Laryngoscope 1989;99:885–95.
Schaefer SD, Close LG. Endoscopic management of frontal sinus disease. Laryngoscope 1990;100:155–60.
Har-EL G, Balwally AN, Lucente FE. Sinus mucoceles: is marsupialization enough? Otolaryngol Head Neck Surg 1997;117:633–40.
Lund VJ. Endoscopic management of paranasal sinus mucocoeles. J Laryngol Otol 1998;112:36–40.
Har-El G. Endoscopic management of 108 sinus mucoceles. Laryngoscope 2001;111:2131–4.(J J Khong, P Wormald and )
Correspondence to:
DrJwu Jin Khong
Royal Adelaide Hospital, North Terrace, Adelaide, Australia; jjkhong@yahoo.com
Accepted for publication 3 October 2003
Keywords: transcaruncular approach; frontoethmoidal
We read the article by Lai et al1 with interest.
The authors report a modification of the non-obliterative external procedure that was first described by Lynch in 1921.2 The Lynch-Howarth procedure2–4 involved transnasal stenting to prevent medial-ward collapse of the orbit obstructing drainage from the frontal sinus into the nose. Although the transcaruncular procedure uses a different external approach, it nevertheless often involves removal of part of the lamina papyracea for access to the sinuses. Hence, as with the Lynch approach, prolapse of orbital contents into the defect may occur, increasing the risk of re-stenosis. In addition, the cells in the frontal recess are not formally cleared and thus drainage into the nasal cavity is not assured. Stenting of sinus openings results in a significant fibrotic reaction in a proportion of patients, and closure of such a previously stented opening is likely. Furthermore, the follow up period in this study is too short to confirm the success or failure of this technique as recurrence often takes years to manifest.4
Endoscopic management of mucoceles protruding into the other sinuses or nasal cavity has been an accepted treatment for years.5–9 Frontoethmoidal mucoceles are typical of such mucoceles where the bony wall surrounding the mucocele is thin and therefore easily accessible transnasally. The endoscopic procedure creates a large area clear of cells which allows the greatest possible marsupialisation of the mucocele. No stenting is required. Har-El9 reported the largest series of 108 mucoceles with a median follow up of 4.7 years with a recurrence rate of only 0.9%. Therefore, we would recommend an endoscopic approach for frontoethmoidal mucoceles as the integrity of the lamina papyracea is maintained and the largest possible opening is created into the mucocele, which in turn minimises the chances of recurrence.
References
Lai PC, Liao SL, Jou JR, et al. Transcaruncular approach for the management of frontoethmoid mucoceles. Br J Ophthalmol 2003;87:699–703.
Lynch RC. The technique of a radical frontal sinus operation which has given me the best results. Laryngoscope 1921;31:1–5.
Ritter FN, ed. Surgical procedures on the paranasal sinuses: the frontal sinus. In: The paranasal sinuses: surgery and technique, 2nd ed. St Louis: Mosby, 1978:136–45.
Neel HB, McDonald TJ, Facer GW. Modified Lynch procedure for chronic frontal sinus diseases: rationale, technique, and long-term results. Laryngoscope 1987;97:1274–9.
Kennedy DW, Josephson JS, Zinreich SJ, et al. Endoscopic sinus surgery for mucoceles: a viable alternative. Laryngoscope 1989;99:885–95.
Schaefer SD, Close LG. Endoscopic management of frontal sinus disease. Laryngoscope 1990;100:155–60.
Har-EL G, Balwally AN, Lucente FE. Sinus mucoceles: is marsupialization enough? Otolaryngol Head Neck Surg 1997;117:633–40.
Lund VJ. Endoscopic management of paranasal sinus mucocoeles. J Laryngol Otol 1998;112:36–40.
Har-El G. Endoscopic management of 108 sinus mucoceles. Laryngoscope 2001;111:2131–4.(J J Khong, P Wormald and )