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Old 10-21-2008, 08:26 AM   #1
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Frontal Sinus Obliteration???

Hubby had endoscopic surgery 2 weeks ago for a sinus abcess that had spread to the orbit around the eye and ate thru the frontal bone. They are now giving us a 50/50 chance that this will work and if not we are looking at sinus obiteration surgery which I understand to be major surgery. Anybody have had it done? How long of a hospital stay? Pain? What about the abdominal incision where they harvest the fat? Complications? Recover time? Success rate?? Any info is greatly appreciated as this seems to be rare and I have yet to find someone who has been through it!

 
Old 10-21-2008, 10:29 AM   #2
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Re: Frontal Sinus Obliteration???

Frontal sinus obliteration is a fairly rare procedure that has been largely replaced by endoscopic procedures so the chances of finding someone who has been through it are slim.

The best advice I can give you is to be sure that you have an exceptionally qualified surgeon who has exhausted all of the other options and who has experience with the procedure.

You should probably get a second opinion before having the procedure done just to be sure that there isn't another option.

 
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Old 10-21-2008, 07:19 PM   #3
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Re: Frontal Sinus Obliteration???

Quote:
Originally Posted by gcsmithjr View Post

The best advice I can give you is to be sure that you have an exceptionally qualified surgeon who has exhausted all of the other options and who has experience with the procedure.

You should probably get a second opinion before having the procedure done just to be sure that there isn't another option.
I agree with Smith....I'd get a second opinion to ensure you don't have any other options. From everything I've read, sinus obliteration surgery is the procedure of last resort. I would guess that the recovery time would be extensive due to the complicated nature of the procedure.

Why did your Doc say this procedure was necessary? Has your husband had recurring infections that can't be healed?

Best of luck to you and I hope this latest procedure works!

Ex

 
Old 10-22-2008, 04:25 AM   #4
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Re: Frontal Sinus Obliteration???

Dilli-

I've thought about your post quite a bit since my initial response and wanted to ask two questions (if you don't mind).

1. Are they recommending the frontal sinus obliteration because of the damage to the frontal bone from the abscess or because his frontal sinuses aren't draining correctly and they are concerned about future infections?

There is another much less invasive procedure called the Endoscopic Modified Lothrop Procedure that is used instead of the Frontal Sinus Obliteration if the problem is that his frontal sinuses aren't draining properly.

2. I noticed that you're in PA and just wondered which part of the state, there are some truly excellent ENTs in both Philadelphia and Pittsburgh who are experts in treating frontal sinus disease. Hopefully you're already seeing one of them (at the University of Pittsburgh or the University of Pennsylvania in Philadelphia), but you might consider going to one of them for a second opinion.

 
Old 10-22-2008, 03:59 PM   #5
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Re: Frontal Sinus Obliteration???

Thanks so much for the responses and please keep em coming! The ENT [ who is from Pittsburgh] told us that the condition my husband had to begin with [ the abcess, etc] was rare and life threatening before he did the first surgery. He told us then that there was a possibility that the abcess would grow back. At that time he said we had to do this surgery to drain the abcess and get rid of the infection. [ He is on antibiotics for probally at least 6 months.] There is a drainage tube protruding above his eye and the Doc said it must stay there until he is certain that area is draining. When I asked what the chances are that this surgery will work he said right now 50/50. He said we could go ahead with the major surgery [ obliteration] or take our chances. At this point we basically have a wait and see attitude. My BIG problem is Hubby is VERY nervous [ to the point of passing out] about this kind of stuff and I would like to know the possibilities of what I am dealing with so I can clue him in calmly if the need arises.

 
Old 10-22-2008, 04:01 PM   #6
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Re: Frontal Sinus Obliteration???

Oh and I forgot......you asked about the damage to the bone.......we were told the infection had ate right thru the bone but nobody has mentioned any problems that can arise from that?? When I asked about damage to the bone the Doc said " the damage is already done, there's nothing I can do about that" Should we be worried about the bone???

 
Old 10-22-2008, 06:09 PM   #7
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Re: Frontal Sinus Obliteration???

Quote:
The ENT [who is from Pittsburgh] told us that the condition my husband had to begin with [the abcess, etc] was rare and life threatening before he did the first surgery.
An abscess is very rare and can be life threatening if it's left untreated.

Quote:
He told us then that there was a possibility that the abcess would grow back.
That is a possibility IF your husband's frontal sinuses aren't draining properly (the mucus collects, gets infected and trapped, causing an abscess).

Quote:
He said we could go ahead with the major surgery [obliteration] or take our chances.
That's where I think a second opinion would be a good idea. The Endoscopic Modified Lothrop Procedure is much less invasive and can successfully restore normal function and drainage to the frontal sinuses. It requires special training and equipment (in particular an imaging system that allows the surgeon to see exactly where his/her instruments are on a 3D image of the patient's sinus cavities) that are usually only available at a major teaching hospital.

Treating a situation like your husband's is probably beyond the expertise of most office-based ENTs - and truly requires a surgeon who specializes in hard-to-treat sinus disorders (most likely at a major teaching hospital). Depending on your husband's ability to travel I would recommend that you contact Dr. David Kennedy at the University of Pennsylvania in Philadelphia. He is a world-renowned specialist in frontal sinus surgery.

If Philadelphia is too far, you could contact Dr. Pete Batra at the Cleveland Clinic, he's another well known and respected expert in sinus surgery.

I'm not familiar with anyone at the University of Pittsburgh who specializes in treating someone in your husband's situation. I definitely wouldn't move forward with the Frontal Sinus Obliteration procedure without a second opinion.


Quote:
Should we be worried about the bone???
Not necessarily (I thought that the bone damage was why he was recommending the obliteration procedure), but it doesn't sound like that's the case.

 
Old 10-25-2008, 04:50 PM   #8
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Re: Frontal Sinus Obliteration???

Actually the endoscopic surgery he had was done with the image guided system to drain and open/create the drainage pathway. I never heard the name of the procedure so I don't know if it was the lathrop procedure or not but sounds like it. The problem is at this point they are not sure yet if the sinuses are draining properly or if they are if they will continue to do so. I don't even know how they know if they are draining properly, or how they know if the infection in the bone is going away.......can they tell when they look up the nose or are we in for more scans?? Also have NO idea how much longer this drainage tube will have to stay in. See Doc on Wed. so maybe I can get some info then.

 
Old 10-25-2008, 09:28 PM   #9
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Re: Frontal Sinus Obliteration???

Quote:
Originally Posted by dilli View Post

The problem is at this point they are not sure yet if the sinuses are draining properly or if they are if they will continue to do so. I don't even know how they know if they are draining properly, or how they know if the infection in the bone is going away.......can they tell when they look up the nose or are we in for more scans?? Also have NO idea how much longer this drainage tube will have to stay in. See Doc on Wed. so maybe I can get some info then.
I would imagine that they will do a regular examination, and a scan, just to be sure. As mentioned, the surgery is a major one, so they'll want to be use all the diagnostic tools they can.

It sounds as if you are in very good hands. The ENTs at the Univ. of Pittsburgh are very, very good. One of them has a son in Charlotte who is leading the way in progressive sinus disease and has won several top awards for surgery innovation. I would still get a 2nd opinion as it never hurts. This way, you'd be 100% sure.

Take care, and I hope all works out for your husband. I'll be interested to hear how your next appt goes.

Regards,

Ex

 
Old 10-26-2008, 05:20 AM   #10
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Re: Frontal Sinus Obliteration???

Quote:
I never heard the name of the procedure so I don't know if it was the lathrop procedure or not but sounds like it.
If the drainage tube is "protruding above his eye" then he did not have the Modified Lothrop procedure, it was most likely a Frontal Sinus Trephination (in which they drill a small hole in the orbital bone above the eye to allow direct access to the frontal sinus). They may have done some additional endoscopic procedure to try and open up the interior drainage pathways for his frontal sinuses but it's somewhat unlikely that they'd do both at the same time (the Lothrop is a purely internal procedure that wouldn't require an external drain).

Quote:
I don't even know how they know if they are draining properly, or how they know if the infection in the bone is going away.......can they tell when they look up the nose or are we in for more scans?
They may be able to see some evidence of the frontal sinuses draining via and endoscopic exam but I suspect you're in for more scans. The drainage pathways for the frontal sinuses are tricky and can be hard to see.

 
Old 11-05-2008, 01:59 PM   #11
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Re: Frontal Sinus Obliteration???

Well we seen the Doc today. Next week he will take him back to the OR and do a endoscopic sinus debridement [ he said this would take about 15 minutes] and a dye test to see if the drainage path is open. He did debridement in the office last time...I am assuming this is just a more detailed procedure of the same?? And do you know anything about the dye test?? How is it done?? After the debridment will he have dripping blood like after the original surgery?? Any comments appreciated!!

 
Old 11-06-2008, 04:33 AM   #12
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Re: Frontal Sinus Obliteration???

The debridement should just be a little more of what he's already had done. He shouldn't be dripping blood after the procedure (although there may be a tiny bit of bleeding), the debridement is designed to gently remove any "crusts" of blood that might lead to scar tissue that would keep the sinus from draining correctly.

For the dye test, the doctor will probably just irrigate his frontal sinus with saline (salt water) that is colored with dye so that he can see if the colored saline is draining into the nasofontal duct in his nose (as it should be).

 
Old 11-10-2008, 12:17 AM   #13
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Re: Frontal Sinus Obliteration???

Quote:
Originally Posted by dilli View Post
Thanks so much for the responses and please keep em coming! The ENT [ who is from Pittsburgh] told us that the condition my husband had to begin with [ the abcess, etc] was rare and life threatening before he did the first surgery. He told us then that there was a possibility that the abcess would grow back. At that time he said we had to do this surgery to drain the abcess and get rid of the infection. [ He is on antibiotics for probally at least 6 months.] There is a drainage tube protruding above his eye and the Doc said it must stay there until he is certain that area is draining. When I asked what the chances are that this surgery will work he said right now 50/50. He said we could go ahead with the major surgery [ obliteration] or take our chances. At this point we basically have a wait and see attitude. My BIG problem is Hubby is VERY nervous [ to the point of passing out] about this kind of stuff and I would like to know the possibilities of what I am dealing with so I can clue him in calmly if the need arises.

 
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