Objective:Anatomical variation or scar atresia of the drainage channel of the frontal sinus on the affected side, and opening the frontal sinus through the drainage channel of the frontal sinus on the affected side may lead to surgical failure. The purpose of this study is to explore a modified Draf Ⅲ operation to complete the drainage of the affected frontal sinus by removing the floor wall and septum of the frontal sinus and connecting the bilateral frontal sinus through the healthy side of the frontal sinus. Methods:Through the anatomical study of 2 skull bone specimens and 2 fresh frozen specimens, the surgical landmark and surgical approach were explored. Four patients with frontal sinus atresia and frontal sinusitis after DrafⅡb surgery in Eye & ENT Hospital of Fudan University were retrospectively analyzed. Descriptive method was used to analyze the data. Results:The bottom wall of bilateral frontal sinus was removed, and the bilateral frontal sinus was enlarged above the nasal septum to form a large common cavity. The uncinate process and ethmoid bubble were retained, and the midline drainage of the affected frontal sinus in the healthy side of the nasal cavity was completed. From August 2022 to April 2023, 4 patients with frontal sinus atresia and frontal sinusitis after DrafⅡb surgery for unilateral frontal sinus papilloma in Eye & ENT Hospital of Fudan University were treated with surgery. The headache symptoms disappeared after surgery, and the drainage of frontal sinus was spacious, the mucosa healed well and the drainage was unobstructed under endoscopy. There were no other postoperative complications. Conclusion:DrafⅢ approach to unilateral frontal sinus for contralateral drainage can drain the affected frontal sinus adequately. The essence of this operation is to drain the bilateral frontal sinus in the unilateral nasal cavity, and this operation has short path, less trauma, and a broader prospect, which is suitable for promotion.
目的：患侧额窦的引流通道解剖变异或瘢痕闭锁，经患侧额窦引流通道开放额窦，可能会导致手术失败。本研究拟探索一种借健侧额窦和额隐窝为通路，磨除额窦底壁及额窦间隔，连通双侧额窦的改良DrafⅢ手术术式，完成患侧额窦的引流。 方法：通过对2个头颅骨性标本和2个新鲜冷冻标本的解剖研究，探索手术相关标志及手术路径。回顾性分析4例采用此术式进行治疗的患者。记录患者的相关临床资料，探讨该术式的技术细节和优缺点。 结果：通过2例头颅解剖研究，确认手术路径，借健侧额窦和额隐窝为通路，磨除双侧额窦底壁和额窦间隔，将双侧额窦在鼻中隔上方扩大成为一个大的共同腔，完成患侧额窦在健侧鼻腔的中线引流。4例患者因单侧额窦乳头状瘤行DrafⅡb手术，术后发生额窦闭锁、额窦炎，遂采用DrafⅢ借道引流术进行治疗。术后患者头痛症状消失，内镜下检查额窦引流口宽敞、黏膜愈合良好、引流通畅，无其他术后并发症。 结论：单侧额窦入路DrafⅢ借道引流术能充分引流患侧额窦。该术式创伤小，成功率高，有临床应用价值，适合单侧DrafⅡb手术失败的患者。.

OBJECTIVE: The frontal sinus remains a challenging site for irrigation due to its position relative to the nostril and ethmoid sinus. This study aims to summarize the necessary factors for efficient irrigation of the frontal sinus after endoscopic sinus surgery (ESS) among patients with chronic rhinosinusitis (CRS).
METHODS: Using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a systematic literature review was conducted on PubMed, Scopus, and Cochrane databases to identify studies assessing the effect of frontal sinus irrigation in patients with CRS, cadaver models, or 3D-printed models of the sinonasal cavity after ESS.
RESULTS: Of the initial 206 abstracts reviewed, 18 full-text articles were included. The degree of the frontal sinus ostium opening after ESS was found to be associated with the efficacy of frontal sinus irrigation. More extensive frontal sinus surgeries tended to increase frontal sinus penetration. A Draf IIA procedure was identified as the minimum standard to achieve sufficient irrigation in the frontal sinus. Due to decreased backpressure in the nasal passage, increasing septectomy in Draf III did not significantly improve irrigation delivery. Squeeze bottles achieved significantly higher irrigation flow in the frontal sinus than syringes and pulsating devices. Large-volume irrigation devices provided better irrigation for the frontal sinus by entering or flushing the entire frontal sinus. The head position influenced the frontal sinus irrigation by altering the ostia position relative to fluid flow and vertical height of the frontal sinus during irrigation. While the vertex down head position was likely to enhance frontal sinus irrigation, the comfort of the head position and patient compliance should be considered.
CONCLUSIONS: Elements for optimization of frontal sinus irrigation are a minimum of a Draf IlA procedure for frontal sinus dissection, use of large-volume irrigation, and vertex down head positioning. Developing comfortable head positions with high frontal sinus irrigation efficiency would increase patient compliance and improve outcomes.
UNASSIGNED: NA.

Objective:To investigate the criteria for selecting surgical approaches for frontal and ethmoid sinus osteomas of different locations and sizes on CT imaging. Methods:Using sagittal and coronal CT images, the following lines were delineated: the F-line（a horizontal line passing nasofrontal beak）, the M-line（a vertical line passing paries medialis orbitae）, and the P-line（a vertical line passing the center of the pupil）. Classification of frontal and ethmoid sinus osteomas was based on their relationship with these lines. Appropriate surgical approaches were selected, including pure endoscopic approaches, endoscopic combined with eyebrow incision approach, and endoscopic combined with coronal incision approach. This method was applied to a single center at the Third Affiliated Hospital of Sun Yat-sen University for endoscopic resection of frontal and ethmoid sinus osteoma. Case Data: Sixteen cases of ethmoid sinus osteomas were treated from January 2020 to September 2023. Among these cases, there were 9 males and 7 females, with ages ranging from 18 to 69 years, and a median age of 48 years. Results:Thirteen cases underwent pure endoscopic resection of the osteoma, while in three cases, a combined approach was utilized. Among the combined approach cases, two exceeded both the M-line and the F-line but did not cross the P-line; therefore, they underwent endoscopic combined with eyebrow incision approach. One case exceeded all three lines and thus underwent endoscopic combined with coronal incision. In all cases, complete resection of the osteoma was achieved as per preoperative planning, and none of the patients experienced significant postoperative complications. Conclusion:For frontal and ethmoid sinus osteomas, it is advisable to perform a thorough preoperative radiological assessment. Based on the size of the osteoma and its relationship to the three lines, an appropriate surgical approach should be chosen to optimize the diagnostic and treatment plan.
目的：探讨在CT影像上不同位置和大小额筛窦骨瘤的手术入路选择标准。 方法：分别在鼻窦矢状位和冠状位CT上选择F线（额嘴水平线）、M线（眶内侧壁线）、P线（瞳孔中心垂直线），根据额筛窦骨瘤和F线、P线、M线的关系进行分类，并选择合适的手术入路（包括单纯内镜入路、内镜联合眉弓切口入路及内镜联合冠状切口入路），2020年1月-2023年9月中山大学附属第三医院收治的16例额筛窦骨瘤患者均应用此方法完成额筛窦骨瘤切除手术，其中男9例，女7例；年龄18～69岁，中位年龄48岁。 结果：16例患者中，13例单纯内镜下切除骨瘤；3例采用联合入路，其中2例超越M线及F线且未过P线者采用内镜联合眉弓切口入路，余1例超越三线者采用内镜联合冠状切口入路。患者的骨瘤均按照术前设计得到完整切除，术后均未发生明显并发症。 结论：额筛窦骨瘤术前建议影像学上仔细评估，根据骨瘤的大小及三线的位置关系，选择合适手术入路，优化诊疗方案。.

BACKGROUND: The present investigation documented a case of bilateral sinonasal inverted papilloma (SNIP) that arose from both sides of the frontal sinus and ethmoid sinus. The occurrence of bilateral involvement of the nasal cavities and frontal sinus is rather infrequent.
METHODS: Informed consent was obtained from the patient.
METHODS: Bilateral SNIP.
METHODS: The tumor was completely removed by Draf III endoscopic resection complemented by an external eyebrow arch approach, and the postoperative recovery was uneventful.
RESULTS: The purpose of this paper is to present a comprehensive reference for the management of bilateral SNIP that affects the frontal sinuses.
CONCLUSIONS: This study addresses the staging and surgical management of bilateral SNIP, along with a review of the factors contributing to its recurrence. The recommended treatment method involves applying the Draf III technique combined with an external nasal approach.

Large defects of frontal sinus (FS) might be difficult to manage effectively. Mismanagement of the large defects could lead to serious postoperative complications in anterior skull base surgery. This study introduces a simple and reliable method applying small supporting bone pieces to cover or insert into large FS defects, then the large defect of FS was transformed into the small defects which was sealed by bone wax successfully.
Eleven patients underwent anterior skull base surgery for lesions or aneurysms, with the reconstruction of large FS defects by small supporting bone pieces. During craniotomy, mild violations of the FS mucosa were spared and sterilized, while severe violations required mucosal removal. Small supporting bone pieces were obtained from the inner plate of the bone flap and carefully covered or inserted into the large defects. The large defects were transformed into some small ones, which could be sealed effectively by bone wax. Demographic, intraoperative, and postoperative complication data were collected.
Four patients had severe mucosal violations requiring removal, while 7 had mild violations sparing the mucosa. All underwent effective reconstruction with small supporting bone pieces. Median follow-up was 6 months. All cases showed effective FS morphology reconstruction, with no FS-related complications.
Applying the small supporting bone pieces for large FS defect reconstruction can restore the FS morphology, preserve physiological function, and avoid postoperative complications.

UNASSIGNED: The goal of this systematic review and meta-analysis was to assess whether the dimensions of the frontal air sinus correlate with skeletal malocclusion.
UNASSIGNED: PubMed, Scopus, Embase, and Google Scholar were searched for relevant studies published up to May 23, 2023. The review included observational and retrospective studies that compared the dimensions of the frontal air sinus between different skeletal malocclusions. The PECOS method was used in this study (\"Population, Exposure, Comparator, Outcome, and Study design\"). The search was done using the following English keywords: \"frontal sinus\" OR \"lateral cephalometric\" OR \"malocclusion\" AND \"surface area\".
UNASSIGNED: Seven studies were included, which involved 1101 participants, of whom 403 were class I, 375 were class II, and 323 were class III. These studies had a moderate risk of bias. The surface area of the frontal sinus in class III was significantly larger than in class I (standardized difference in means (SDM) = -0.971; 95 % CI = -1.147- -0.796; P < 0.001) and in class II (SDM = -1.535; 95 % CI = -1.732- -1.337; P < 0.001).
UNASSIGNED: Class III malocclusion is associated with a larger surface area of the frontal sinus compared to classes I and II.

The lateral profile is an important indicator of facial attractiveness. This study explored the general characteristics of the forehead profile and protrusion, and their relationship with related factors in structure and development.
Four hundred fourteen Chinese participants in the Yangtze River Delta region were involved. Including 206 males (17.15 ± 7.68 years old) and 208 females (18.35 ± 8.06 years old); 94 children (8.54 ± 2.21 years old, ranging from 4 to 12 years old), 166 adolescents (14.83 ± 1.50 years old, ranging from 13 to 17 years old), and 154 adults (25.52 ± 4.89, 18 years or older). The frontal section of the forehead was used to explore its shape. The straight distance between the vertical line of the FH plane through the nasal root point and its parallel line, which is tangential to the forehead, indicates the forehead prominence. Frontal sinus width was measured using the method described by Mahmood.
The general shape of the forehead was straight and slightly bulged near the eyebrow arch in males but rounder in females. The average forehead protrusion in males was higher than that in females in adults. Significant differences in forehead protrusion between the dentoskeletal classifications and growth phases were notable. Frontal protrusion significantly correlated with frontal sinus depth, especially in males, adults, Class I, and those whose convex points were located in the lower section of the forehead.
Age, race, and sex affect the forehead protrusion and frontal sinus width. Forehead protrusion may be an indicator of dentoskeletal deformities in the early stage. And dentoskeletal deformities may impair the correlation between the frontal sinuses and forehead protrusion during development.
This retrospective, cross-sectional study was reviewed and approved by the Research Ethical Committee (T2020008), and registered at ClinicalTrial.gov with an identified number (ChiCTR2100041913).

OBJECTIVE: To explore the effects of Draf1-3 on frontal sinus airflow and frontal sinus irrigation in people with different frontal sinus development METHODS: The development of the frontal sinus and the distribution of the frontal recess cells were evaluated by CT scan in 150 adults (300 sides). The airflow changes into the frontal sinus and frontal recess after Draf were analyzed by Fluent software under a steady state and quiet inspiratory state. Nasal irrigation after Draf in adults with well-developed frontal sinus was simulated using 120 mL saline at a rate of 12 mL/s in a position at 45° to observe the changes in transient flow distribution.
RESULTS: The moderately developed type of the frontal sinus was the most common. The airflow patterns in the frontal sinus and frontal recess in the moderate development group were laminar, while several large vortexes were formed between the frontal sinus and frontal recess in the well-development group. The Draf exerted more significant effects on the patterns, pressure, and velocity of the airflow in the frontal sinus and frontal recess in the well development group than in the moderate development group. The volume fraction of saline in the frontal sinus increased significantly from Draf1 to Draf3, and the time required for a complete infiltration of saline in the frontal sinus mucosa was significantly reduced.
CONCLUSIONS: Draf1-3 has different effects on the airflow field of the frontal sinus with different developmental types; and Draf1-3 can significantly improve the postoperative flushing of the frontal sinus.

暂无摘要。

Sinonasal inverted papilloma（SNIP） is a kind of benign tumor originating from the nasal cavity and paranasal sinuses, accounting for 70% of papillomas. The incidence of the disease is more common in males, with an average age of 50-60 years. It is most likely to occur in unilateral maxillary sinus and ethmoid sinus, followed by sphenoid sinus and frontal sinus.It has the characteristics of local invasion, high recurrence rate and malignant tendency, and most malignant transformation into squamous cell carcinoma. Endoscopic nasal resection and appropriate adjuvant therapy can help to reduce the recurrence rate and inhibit further deterioration. We report the results of a 10-year follow-up of a SNIP patient, including the clinical manifestations, recurrence course and treatment plan during the 10 years. The patient underwent multiple nasal endoscopic surgeries, and had a recurrence of multiple focal attachment pattern, and finally had direct invasion and distant metastasis. Tumor recurrence and further deterioration persisted despite the use of a comprehensive treatment.
摘要: 腔鼻窦内翻性乳头状瘤（sinonasal inverted papilloma，SNIP）是一种起源于鼻腔和鼻窦的良性肿瘤，占乳头状瘤的70%，人群中男性发病较多，平均发病年龄50～60岁，好发于单侧上颌窦及筛窦，其次是蝶窦和额窦，具有局部浸润、易复发和恶变倾向等特征，多恶变为鳞状细胞癌，鼻内镜手术切除和适当的辅助治疗有助于降低复发率和抑制肿瘤进展。本文报告了1例SNIP患者10年的随访结果，包括这10年的临床表现及复发过程、治疗方案，患者多次行鼻内镜手术，为多病灶附着模式的复发，最后出现直接侵犯及远处转移。尽管采用了综合的治疗方法，但肿瘤复发和恶化仍持续存在。.