OPERATIONS on the frontal sinus at times produce unsatisfactory results. Analysis of the causes of failure is helpful, but improved technics are still needed.
Among the causes of failure of the radical frontal operation are:
Incomplete removal of the floor of the frontal sinus which may result in a partitioning and formation of pockets in the remaining portion of the sinus cavity.
Incomplete ethmoidectomy leaving the orbital ethmoid cell extension undisturbed.
Removal of the frontal process of the superior maxilla, allowing collapse of the nasofrontal passage from pressure of the orbital soft tissues.
Even when careful technic is observed and complete removal of the floor of the frontal sinus and the ethmoid cells is accomplished as in the Lynch operation for ethmoid and frontal chronic sinusitis, 20 per cent of the operations result in failure because of adhesions and closure of the nasofrontal duct.
Several precautions should be taken to prevent closure of the nasofrontal passage. An opening is usually made through the nose into the frontal sinus. It should be large enough to ensure subsequent drainage of the sinus when healing has occurred. At the time of operation the communication appears unnecessarily large, but the processes of healing render it incredibly small.
The tendency to closure may be prevented by leaving the frontal process of the maxilla undisturbed, thus preventing the orbital periosteum from moving mesially. Patency of the opening is best assured by the use of tantalum tubes. These tubes are inert in the tissues. . .