Koento Trimartani
Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.
Curr Opin Otolaryngol Head Neck Surg. 2012 Aug;20(4):274-9. doi: 10.1097/MOO.0b013e328355a54a.
This review summarizes the current advances in sinus preservation techniques with endoscopic sinus surgery for the well tolerated and effective management of frontal sinus fractures.
Advances in computed tomography (CT) imaging can now reproduce higher quality reformatted images, creating excellent diagnostic coronal, axial, and sagittal image views that provide a better evaluation of the frontal sinus outflow tracts (FSOTs). The FSOTs are pivotal in determining which technique is used in the management of frontal sinus fractures. Several recent studies have proposed sinus preservation protocols using endoscopic management of the frontal outflow tract as a viable alternative to frontal sinus obliteration. Among those protocols, extended endoscopic sinus frontal surgery with reconstruction of the frontal outflow tracts has been demonstrated to be well tolerated and effective. It can be used in conjunction with frontal sinus trephinations as well as to treat complications.
Modified treatment protocols have been developed based on thorough clinical examination and CT imaging in an attempt to provide a practical and safe protocol for the management of frontal sinus injuries. Conservative care and sinus preservation with or without endoscopic surgery can be done in selected cases with good result. The importance of preserving the frontal sinus is gaining acceptance in the evidence-based literature.
本综述总结了鼻窦保留技术在鼻内镜鼻窦手术中的当前进展，用于对额窦骨折进行耐受性良好且有效的管理。
计算机断层扫描（CT）成像技术的进展现在能够生成更高质量的重建图像，创建出色的诊断冠状、轴位和矢状图像视图，从而更好地评估额窦流出道（FSOTs）。FSOTs对于确定在额窦骨折管理中使用哪种技术至关重要。最近的几项研究提出了鼻窦保留方案，使用鼻内镜管理额窦流出道作为额窦闭塞术的可行替代方案。在这些方案中，扩展鼻内镜鼻窦额部手术联合额窦流出道重建已被证明耐受性良好且有效。它可与额窦钻孔术联合使用，也可用于治疗并发症。
基于全面的临床检查和CT成像制定了改良治疗方案，旨在为额窦损伤的管理提供实用且安全的方案。在选定的病例中，可以进行保守治疗以及有或无鼻内镜手术的鼻窦保留，效果良好。保留额窦的重要性在循证医学文献中越来越得到认可。
