Integrated Approach Key to Evaluating Recalcitrant Rhinosinusitis Patients

When evaluating and managing the patient with frontal disease, on the other hand, establishing a functional outflow tract is critically important, according to Martin J. Citardi, MD, of the Cleveland Clinic.

The other important concept is that the frontal sinus problem is very rarely, if ever, in the frontal sinus, he said. In fact, you could almost argue that the problem is never in the frontal sinus; it’s always in the frontal recess.

The big issue, Dr. Citardi noted, is understanding the anatomy and using that understanding to employ the right combination of procedures before choosing a surgical approach.

Having good imaging is critical in putting together the comprehensive treatment, and that imaging includes high-resolution CT and MRI in selected cases, he said. Then, at the time of surgery, you need to execute on the plan, and in the postoperative period, you’re committing the patient to perioperative management to promote wound healing and maintain frontal recess and frontal ostial patency.

Although the frontal sinus is similar in many ways to the maxillary sinus, in that it is primarily a surgical problem, the anatomy is so complex and there are so many different procedures that have been proposed over the years, Dr. Citardi said there are a lot of factors that go into the imaging and evaluation of these patients.

When we talk about frontal sinus disease, we have to remember that sinusitis overall is primarily a medical disease, he said. The overall principles of the management of sinusitis also apply to the management of frontal sinusitis.

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