The Frontal Sinus: Surgical Approaches and Controversies

Review by L Flood
Middlesbrough, UK

Now I fully planned to send this book to one of my most reliable reviewers, who happens also to be an expert in this field. It was this that suddenly made me wonder if she had actually contributed to this work and, sure enough, she had. There is indeed the expected international contribution (and world-wide it surely is) but it is nice to see so many UK authors, even if the majority I remember as trainees alas!

The Preface tells us that there has been a major increase in interest in the challenges of frontal sinus surgery, with a doubling in PubMed citations over the last two decades. It also describes a “pendulum” to surgical approaches, from the extended open, through the advent of minimally invasive endoscopic surgery, but now back again towards modern extended techniques.

50 chapters in 5 sections cover the anatomy, endoscopic approaches, open surgery, management of specific frontal sinus conditions (pneumosinus dilatans, barosinusitis, osteomas and mucoceles to name but 4 out of 14) and a final section, controversial topics in current practice (unsurprisingly the highlight of the book).
The opening chapter taught me so much about nitric oxide and sinus functions, quite what humming does to NO production and how this is further influenced by living in the highlands of Tibet. By now, as a simple ex-otologist, I was captivated and knew the book would be “different”.

Imaging is sharply printed and the lavish colour illustrations (especially of endoscopy) reflect great photography and publishing. If you get a chance see Fig 4.7 on page 30 for an example. By the end of Section II I was able to distinguish a Draf IIb from a III (the Endoscopic Modified Lothrop) helped of course by the videos (of which there are over 30).

Section V, the controversial topics, I had really been looking forward to and this did not disappoint. For each topic there is an impressively consistent style, despite multi-authorship, with sections on published evidence, controversies and opinions and finally “Unanswered Questions”. The list of subjects includes questioning of the value of balloon technology, the role of the drill and the necessity of image guidance. Chapter 45 made me rethink everything I “knew” about sinus disease, having read that bilateral frontal sinus disease may well have little to do with outflow obstruction. It is obvious now, having read that, but somehow had never occurred to me as I tried to create a huge drain through a Lynch Howarth incision, all those years ago.

It did strike me, in these hard times, that this is particularly good value for money and I would recommend it to any trainee, anyone who might have to quiz them over a viva table, and even the most experienced rhinologist.

Amazon Link: The Frontal Sinus: Surgical Approaches and Controversies
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