الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
The introduction of endoscopic techniques to the frontal sinus has markedly
decreased the morbidity associated with management of frontal sinus diseases.
However endoscopic intervention to the frontal sinuses is still a challenging mission
because of the complex and variable anatomy of the frontal sinus drainage pathway,
the acute angle from the nostril to the frontal sinus, the vital organs surrounding the
nasofrontal outflow tract, and the narrow opening of the frontal sinus ostium.
Multiple endoscopic approaches are now used to address different
pathological lesions of the frontal sinuses, these include: endoscopic clearance of
the frontal recess, modified endoscopic Lothrop procedure, and balloon dilatation of
the frontal sinus ostium. Also adjuvant techniques can be used to help endoscopic
identification of the frontal sinus drainage pathway in case of complex anatomy of
the frontal sinus drainage pathway either due to anatomical variations or due to
scaring following previous surgery.
In the current environment of evidence-based medicine, there is an ethical
obligation to ensure that medical interventions are clinically effective and beneficial.
This ultimately requires a comparison of the effectiveness of different procedures
used to treat a particular condition, so as to eliminate those that are not effective, and
to choose the most cost-effective procedure from amongst clinically equally
effective ones.
This study evaluates different endoscopic approaches to the frontal sinuses
and the reliability of these approaches to address different frontal sinus diseases, the
indication for adjuvant external approach e.g. frontal sinus minitrephination.
Validated questionnaires e.g. SNOT22 questionnaire and Glasgow benefit inventory
were used to assess the improvement in patients’ sinonasal symptoms and to assess
the general, social, psychological, and physical quality of life following endoscopic
interventions to the frontal sinuses.
This study evaluates different endoscopic approaches to the frontal sinuses
and the reliability of these approaches to address different frontal sinus diseases, the indication for adjuvant external approach e.g. frontal sinus minitrephination. The
study validates the mentioned endoscopic frontal sinus procedures for treating
frontal sinus diseases particularly the inflammatory lesions as it leads to an
improvement in quality of life of patients.
Balloon dilatation of the frontal sinuses is an efficient technique for managing
inflammatory conditions of the frontal sinuses with results comparable to traditional
endoscopic dissection of the frontal recess and with less liability of iatrogenic
compromisation of frontal recess. More studies with longer periods of follow up are
needed for evaluation of the long term results.
The use of modified endoscopic Lothrop procedure for managing advanced
and some recurrent frontal sinus diseases is associated with marked improvement in
the quality of life of those patients as indicated from the scores of SNOT 22
questionnaire and GBI.
The axillary flap approach facilitates the clearance of the frontal recess in
patient without previous dissection of the frontal recess.
Non obvious frontal sinus drainage pathway due to anatomical variations or
previous surgical intervention may indicate an adjunct external frontal
minitrephination for instillation of saline and fluorescene mixture and probing the
area of emergence of the coulored solution to identify the frontal sinus drainage
pathway.