What are the endoscopic cues to rely on ? Would you need a image guidance for such cases.?
I personally feel the main difference is the colour of the skull base in frontal sinus which is absent in the frontal cell
Image guidance can be useful, but surely you have to identify the anatomical composition of the frontal recess on preop CT, and you should know preoperatively where is the frontal sinus drainage in order to orientate yourself during the removal of frontoethmoid cells. Intraoperatively, you should identify the posterior wall of the frontal sinus which goes up vertically and is in continuty with the skull base.
Very true, Dr Riccardo. Apart from anatomical detail obtained by preoperative CT , identifying posterior wall of frontal sinus was a reliable technique in our study. The frontal transillumination was present even before the type 4 cell was resected in a dozen of our cases.
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