The Hybrid Lid Crease Approach to Address Lateral Frontal Sinus Disease With Orbital Extension

Abstract

Objective This study aimed to describe the hybrid lid crease approach in conjunction with functional endoscopic sinus surgery (FESS) for lateral frontal sinus disease with orbital extension. Study Design Retrospective case review. Methods Patients undergoing hybrid lid crease approach with FESS for frontal sinus disease were reviewed retrospectively. Surgical indications consisted of inverting papilloma with extension into the frontal sinus (n = 1) and frontal sinus mucocele (n = 2). Inclusion criteria included presence of disease in the lateral frontal sinus with extension into the orbital space and erosion of the superior orbital rim. Preoperative and postoperative parameters included complete ophthalmologic exam, endoscopic exam, and computed tomography scan. Results We were able to access the frontal sinus and orbit in all 3 cases and address sinus pathology of the lateral frontal sinus and orbit using the lid crease approach with FESS. All patients had improvement in ophthalmologic symptoms and interval disease resolution and were satisfied with their postoperative lid crease incision. Conclusion The lid crease approach offers direct access to the frontal sinus with minimal dissection through a well-hidden incision. In our case series of lateral frontal sinus pathology with orbital extension, the hybrid lid crease approach with FESS allowed complete eradication of disease without recurrence.

Minimally invasive surgery of the anterior skull base: transorbital approaches

“…The frontal infundibulum was simultaneously opened endonasally in the sense of Draf II surgery. Complete resection of the pathology was achieved in 3/3 cases, the functional and cosmetic outcomes were described as excellent in 3/3 cases [ 128 ].…”

Combined endonasal and eyelid approach for management of extensive frontal sinus inverting papilloma

“…Combining the endonasal and transpalpebral orbitofrontal approaches capitalizes on the unique advantages of endonasal and open craniotomy approaches to skull base lesions. A few authors have previously reported their experience using the combined transpalpebral endonasal approach with frontal sinus disease extending laterally into the orbital and frontal sinus . In this series, we presented the utility of this combined approach in four consecutive cases with IP with extended frontal and orbital extension.…”

“…A few authors have previously reported their experience using the combined transpalpebral endonasal approach with frontal sinus disease extending laterally into the orbital and frontal sinus. 25,26 In this series, we presented the utility of this combined approach in four consecutive cases with IP with extended frontal and orbital extension. Furthermore, we illustrated how a unilateral mini-orbitocranial window can provide direct access to the entire frontal sinus on both sides to completely clear bilateral disease.…”

Implication of frontal sinus mucocele’s location and intrasinus septation

“…Endoscopic lateralisation of the orbit can also be done for better access to the frontal sinus 13. On the other hand, for a similar far laterally located frontal sinus lesion with or without intraorbital extension, combined lid crease and endoscopic approach is relatively safer and effective technique 14 15. In broad terms, endoscopic approach can be considered safe and effective in lesions occupying the inferomedial quadrant of orbit 16.…”