Dr. André Felippu's Cases
Endoscopic frontal sinus surgery is one of the most complex procedures in rhinology and skull base surgery. Reoperations pose an even greater challenge, as they often occur in previously operated patients who develop persistent symptoms, such as chronic headache, due to synechiae or closure of drainage tracts. online surgery app SurgSchool, the Dr. André Felippu, a renowned rhinologist from Sao Paulo, presents several clinical cases in which he addresses complex frontal sinus reoperations. In both, the main symptom was recurrent frontal headache, despite good nasal breathing and absence of significant obstruction.
Surgical technique: osteotome and resection of the Agger Nasi
El Dr. Felippu demonstrates how a precise endoscopic approach allows for expanded access to the frontal sinus using:
- Curved osteotome to obtain an adequate anteroposterior opening.
- Systematic resection of the Agger Nasi, whose persistence is one of the main causes of closure of the frontal drain in reoperations.
- Drainage expansion through communication with the base of the skull and, in selected cases, with the supraorbital cell.
In this way, a wide and stable opening of the frontal sinus is achieved, avoiding the need for more aggressive procedures such as Draft III, as long as anatomy allows it.
Clinical results
In the cases presented, the pre-, intra- and postoperative endoscopic images show a significant widening of the front drainage route, with resolution of the obstruction and symptomatic improvement.
Surgery not only relieves headaches but also prevents recurrences by removing the bony and scar tissue responsible for sinus closure.
Training importance
Dr. Felippu's videos available at SurgSchool They offer ENT specialists and residents a unique opportunity to:
- Understanding the endoscopic anatomy of the frontal sinus in reoperations.
- Recognize the most common causes of surgical failure (synechiae, bony septa, persistent Agger Nasi).
- Learn safe and reproducible techniques to achieve long-lasting drainage.
