Endoscopic frontal sinus surgery is a highly specialized procedure that aims to address various pathologies within the frontal sinuses, such as chronic sinusitis, benign and malignant tumors, and other anatomical abnormalities.
While endoscopic access to frontal sinus offers significant advantages over traditional open surgical methods, including reduced recovery time and minimized scarring, it is still considered as difficult, risky to perform, and a procedure likely to result in a high failure rate due for several reasons. These include the
- complex anatomy of frontal sinus and recess,
- the limited surgical field,
- high learning curve of the procedure
- technical demand like need for special instruments,
- proximity of frontal sinuses to critical structures, including the brain, optic nerves, and major blood vessels etc.
The Carolyn’s Window Approach
To overcome the above mentioned hurdles, several techniques for an endoscopic approach to the frontal sinus have been suggested. In this article, I am describing how I am doing the Carolyn’s window approach for frontal sinus surgery.
This approach is recommended especially in cases with thick frontal beak, hypoplastic frontal sinus etc. The approach was popularized by Prof. Richard J Harvey from Sydney Rhinology Group.
Most of primary endoscopic frontal sinus surgeries are performed with Draf I or Draf IIa technique using 30° or 0° endoscopes. But in cases with thick frontal beak, hypoplastic frontal sinus etc. doing a Draf 2a frontal sinusotomy is difficult. The Carolyn’s window approach aims doing a Draft 2a frontal sinusotomy easier for the surgeon. The approach is entirely a 0° endoscope technique and provides an excellent view of the frontal sinus and recess.
The concept is that of an “axillectomy,” which includes removal of the entire frontal process of the maxilla and nasofrontal beak (axilla). The utilization of high-speed powered drill makes this technique rapid and efficient. The inferior-based lateral wall mucosal flap (modified-Woodworth flap) and free mucosal grafting of any exposed bone make for rapid mucosal healing.