operative findings in the frontal recess at time of revision surgery
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Dseyo`re b`ma`mhw `m le bydmof yegeww o `ke db yer`w`dm wuyheypJy`wem N- Dd& KA& Ndlm K- AefHoua`d& KA
Aesoyqkemq db Dqdfoypmhdfdhp+Leoa oma Megj Wuyheyp& Qle Ekdyp Gf`m`g& Oqfomqo& HO& UWO
Yege`rea ?< Wesekiey 933 Emadwgds`g w`muw wuyheyp `w le hdfa womaoya bdy le yeokem db kea`goffp yebyogdyp
glydm`g yl`mdw`muw``w- Qleye `w& ldxerey& o sdsufo`dm db so`emw bdy xldk seyw`wem a`weowe `w o
sydifek- Db off le w`muwew& le bydmof w`muw `w le kdw f`jefp d lore yeguyyem diwyug`dm- Xe
erofuoea le b`ma`mhw gouw`mh bydmof yegeww diwyug dm o le `ke db yer`w dm wuyheyp-
Wquap aew hm oma weqq`mh> O yeydwseg`re yer`ex xow seybdykea `m o ey`oyp goye ogoaek`g
ddfoypmhdfdhp aesoykem-
Yewufqw> B`ma`mhw diwyug`mh le bydmof yegeww o le `ke db yer`w`dm w`muw wuyheyp xeye yer`exea-
Qxd lumayea e`hlp+m`me bydmof w`muwew xeye `mgfuaea- Werem b`ma`mhw xeye `aem`b`ea> kugdwof
a`weowe ,28%)& yeo`mea elkd`a geffw ,57%)& foeyof`~ea k`aafe uyi`moew ,73%)& yeo`mea ohhey mow`
geffw ,?7%)& wgoy ,?9%)& yeo`mea bydmof geffw , Kuf`sfe b`ma`mhw gom ie `aem b`ea lo gdmy`iue d bydmof yegeww diwyug dm
yequ`y`mh yer`w`dm w`muw wuyheyp- O gdksyelemw`re ossydogl d oaayeww off bogdyw `w megewwoyp d
syerem wuyh`gof bo`fuye okdmh so`emw syewem`mh bdy emadwgds`g bydmof w`muw wuyheyp-
93?3 Efwer`ey @mg- Off y`hlw yeweyrea-
?- @mqydaugq`dm
Emadwgds`g w`muw wuyheyp low sydrem d ie foyhefpwuggewwbuf bdy kdw so`emw o syerem`mh wpksdk yeguy+
yemge oma feoa`mh d o a`weowe+byee woe- Wuggeww yoew ow
l`hl ow 08-5% lore ieem yesdyea Z?[- Qle bydmof w`muwew&
ldxerey& w`ff yesyewem o ds`g db gdmydreywp oma aeioe
xlem ` gdkew d ldx d ebbeg refp aeof x l lek
wuyh`goffp& ldx d komohe lek kea`goffp& oma ldx d
oaayeww le wuyh`gof bo`fuyew- Qle suysdwew db l`w wuap oye d
adgukem b`ma`mhw `m le bydmof yegeww `m so`emw yequ`y`mh
yer`w`dm emadwgds`g w`muw sydgeauyew oma d a`wguww ldx
lewe b`ma`mhw uf`koefp fea d wuyh`gof bo`fuye-
9- Soq`emqw oma keqldaw
Off so`emw yequ`y`mh yer`w`dm emadwgds`g w`muw sydge+
auyew lo `mgfuaea le bydmof w`muw iexeem Kop ?008 oma
Dgdiey 9337 xeye yer`exea- So`emw xeye erofuoea idl
ip `m+dbb`ge emadwgds`g e|ok`mo`dm umaey ds`gof omewlew`o
oma mdmgdmyow gdksuea dkdhyoslp ,GQ) wgom x`lkuf`sfomoy yebdyko mh- So emw xeye dbbeyea yer w`dm
emadwgds`g wuyheyp iowea dm yeguyyemge db wpksdkw oma
ip dineg`re emadwgds`g oma GQ b`ma`mhw db w`muw a`weowe&
yebyogdyp d kea`gof leyosp- Syedseyo`re kea`gof komohe+
kem `mgfuaea gdki`mo`dmw db o 73+aop gduywe db
om`i`d`gw& o 9+ d 7+xeej gduywe db wpwek`g gdy`gdweyd`a
osey& ow xeff ow ds`goffp oak`m weyea weyd`a aydsw dy
wsyopw ow aeekea megewwoyp ip le wem`dy ouldy- So`emw
`mgfuaea `m le wuap xeye ldwe so emw xldwe bydmof
yegewwew xeye oaayewwea auy mh le yer w`dm dseyo`dm-
@mw`u`dmof yer`ex idoya ossydrof xow dio`mea iebdye
so`em gloy yer`ex-O dof db ?10 gowew xeye omofp~ea yeydwseg refp bdy
dseyo re b`ma`mhw gdmy`iu mh d a`weowe `m le bydmof w`muwew-
Aoo dm we|& owwdg`oea gdma `dmw& omaowwdg`oea a`weowe woew
,`e& Wokey(w y oa& gpw`g b`iydw w& offeyh g bumhof w`muw `w) xeye
ofwd gdffegea oma emeyea `md o aooiowe- Off yer`w`dm
dseyo`dmw xeye seybdykea ip le wem`dy ouldy ,N- K- A-)-
Yer`w`dm dseyo dmw xeye off seybdykea umaey hemeyof
omewlew`o uw`mh `kohe hu`aomge- Sydgeauyew seybdykea xeye
o fdyea d eogl so em(w umaeyfp`mh bydmof yegeww omodkp oma
Oro`foife dmf`me oq xxx-wg`emgea`yegq-gdk
Okey`gom Nduymof db DdfoypmhdfdhpLeoa oma Megj Kea`g`me oma Wuyheyp 7? ,93?3) ?85 ? *? 131 88< 77 *? 131 88< 1905-
E+ko`f oaayeww> naefhouCekdyp-eau ,N-K- AefHoua`d)-
3?02+3830$! wee bydm koey 93?3 Efwer ey @mg- Off y`hlw yeweyrea-
ad`>?3-?3?2$n-okndd-933
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b`ma`mhw oma `mgfuaea yefeowe db wgoyy`mh oma oalew`dmw&
dsem`mh db yew`auof omey`dy elkd`a o`y geffw& sdfpsegdkp&
oma ojeadxm db meddwedhem`g idme x`l`m le bydmof yegeww-
Gdmguyyem ko|`ffoyp omydwdkp& elkd`aegdkp& oma wsle+
md`a w`muwddkp xeye seybdykea xlem megewwoyp-
O dof db 90< bydmof w`muwew bydk ?10 gowew db yer`w`dm
emadwgds`g w`muw wuyheyp xeye yer`exea- Qxd w`aew xeye
e|gfuaea bydk le wuap iegouwe lep loa md ieem
syer`duwfp oaayewwea oma xeye luw gdmw`aeyea sy`koyp
gowew- Werem kdye w`aew xeye e|gfuaea iegouwe lep xeye
bef d ie a`weowe+byee idl ip l`wdyp oma slpw`gof
e|ok`mo`dm- Qlewe w`aew a`a md yequ`ye oem dm o le
`ke db yer`w`dm wuyheyp- Qle wuap hydus xow aeb`mea ow le
yeko`m`mh 9
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Wokey(w y`oa& ? so`em x`l gpw`g b`iydw`w& ? so`em x`l
Xehemey hyomufdkodw`w& ? so`em x`l woygd`adw`w& oma 5x`l glydm`g yl`mdw`muw``w- Dme so`em x`l glydm`g
yl`mdw`muw` w yequ`y`mh le kdw ,8) yer`w`dm sydgeauyew
loa loa o syer`duw kda`b`ea Fdlyds sydgeauye bdy
yegofg`yom bydmof w`muw a`weowe- Ql`w so`em xow mdea dm
emadwgds`g e|sfdyo`dm d lore o yew`auof bydmof geff `m``offp
oma wgoyy`mh `m le bydmof dw`uk oma bydmof yegeww o
wuiwequem sydgeauyew- @m le em`ye wuap hydus& gdmguyyem
a`ohmdwew xeye Wokey(w y`oa ,8 so`emw)& offeyh`g bumhof
w`muw``w ,?1 so emw)& gpw`g b`iydw`w ,9 so`emw)& oma glydm`g
yl`mdw`muw``w ,09 so`emw)- Weremeem so`emw xeye dsey+
oea dm bdy le b`ma`mh db o kugdgefe& e`ley db le bydmof
w`muw dy db le omey`dy elkd`aw- Dme so`em xow mdea d
lore youko ow le kondy gouwe db l`w glydm`g bydmofw`muw``w& lor`mh syer`duwfp umaeyhdme omey`dy oife bydmof
w`muw byoguye yeso`y-
1- A`wguww`dm
Aews`e le bog lo emadwgds`g w`muw wuyheyp `w le kdw
gdkkdmfp seybdykea wuyh`gof sydgeauye bdy le yeokem db
glydm`g yl`mdw`muw``w oma aews`e yegem w`hm`b`gom oaromge+
kemw `m le `koh`mh oma `mwyukemo`dm oro`foife d w`muw
wuyhedmw& le bydmof w`muwew w`ff yesyewem o komohekem
B`h- 9- Qy`sfomoy `kohew db o yeo`mea ohhey mow` geff gouw`mh bydmof yegeww diwyug`dm> woh`of ,O)& o|`of ,I)& oma gdydmof ,G) `kohew- Ad `w dm wusey`dy xoff
,gos) db ohhey mow` geff-
?88J-N- Dqqd& N-K- AefHoua`d $ Okey`gom Nduymof db DqdfoypmhdfdhpLeoa oma Megj Kea`g`me oma Wuyheyp 7? ,93?3) ?85?
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gloffemhe- Qle bydmof w`muw dw uk oma bydmof yegeww `m
soy`gufoy oye sydme d wemdw`w obey wuyh`gof kom`sufo`dm
iegouwe db a`bb`guf omodkp oma le f`k`ea a`kemw`dmw db
le bydmof yegeww- Qle syea`feg`dm db le bydmof w`muw
dubfdx yog d yeguyyem kugdwof a`weowe low ofwd ieem
aekdmwyoea Z9[- @m duy wuap hydus& xd l`yaw ,?07$9
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`koh`mh oww`ww x`l `aem`bp`mh bydmof geffw x`l`m le w`muw
dy le bydmof yegeww- Idl soyowoh`of oma gdydmof r`exw oye
lefsbuf `m l`w yehoya- Xlem bydmof geffw oye emgdumeyea oma
dsemea auy`mh emadwgds`g sydgeauyew& lep oye dbem
k`wojem bdy le bydmof w`muw- Oaequoe rem`fo`dm db le
w`muw `m lewe gowew `w dbem`kew md ogl`erea- Bydmof geffw
`m le hemeyof sdsufo`dm oye gdkkdm& oma lo kojew
oxoyemeww db le`y syewemge `ksdyom bdy le yl`mdfdh`w-Kepey e of Z5[ yesdyea lo db 82< gdydmof w`muw GQ wgomw
yer`exea& 93-1% xeye mdea d lore bydmof geffw- AefHoua`d
e of Z2[ bduma lo 77% db so`emw umaeyhd`mh emadwgds`g
w`muw wuyheyp lore bydmof geffw- Qle uwe db gdksuey+hu`aea
wuyheyp hyeofp oww`ww x`l `aem`b`go`dm db wugl geffw x`l`m
le bydmof w`muw oma yegeww oma wldufa ewseg`offp ie
gdmw`aeyea `m gowew db yeguyyem bydmof w`muw a`weowe Z8[-
@kohe hu`aomge hyeofp oww`ww le w`muw wuyhedm `m
mor`ho`mh le `hl gdmb`mew db le bydmof yegeww oma offdxw
`aem`b`go`dm db fomakoyjw lo xdufa dleyx`we ie k`wwea
oma sdem`offp feoa d wuyh`gof bo`fuye Z7[-
Qlewe b`ma`mhw wyeww le `ksdyomge db o gdksfee
elkd`aegdkp& `mgfua`mh oaequoe yekdrof db ohhey mow`geffw& `m emwuy`mh bydmof w`muw rem`fo`dm- Goyebuf syedseyo+
`re sfomm`mh d oww`w x`l gdksfee wuyheyp& `mgfua`mh
yer`ex`mh o GQ wgom ,seybdykea obey ko|`kof kea`gof
leyosp) bdy ohhey mow` geffw& wusyodyi`of elkd`a geffw&
bydmof geffw& oma dley elkd`a geff roy`o`dmw& `w ewwem`of-
Qle uwe db soyowoh`of r`exw sydr`aew le iew syedseyo`re
`koh`mh kdaof`p bdy wuyheyp `mrdfr`mh le bydmof yegeww-
Gdksfee umgoss`mh db le ohhey mow` geff `w megewwoyp bdy
gdksfee gfeoy`mh db le bydmof yegeww Z7[ ,B`h- 9)-
Ossyd|`koefp dme l`ya ,
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Db 90< w`muwew `m duy wuap& ?0 ,?8%) loa bydmof
yegeww diwyug`dm ip meddwedhem`g idme- Meddwedhem+
ew`w& ow ` yefoew d glydm`g w`muw `w& `w `mbfokko dm+
`maugea dwedifow`g og`r`p `m le sey`dweuk yewuf`mh `m
mex& wgfeyd g idme bdyko`dm Z??[- Qle ydfe db idme
`mrdfrekem `m glydm`g w`muw``w `w w`ff sddyfp umaeywdda&
iu `mbfokkodyp glomhew `m le idmp weso`dmw db le
w`muwew& w`k`foy d lo `m glydm`g dwedkpef w `m fdmh
idmew& low ieem aekdmwyoea Z?9[- Qlewe b`ma`mhw oye
dbem er`aem dm GQ wgom oma gom ie gdmb`ykea ip
emadwgds`g e|ok`mo`dm ,B`h- 5)- Dwe``g idme owwdg`oea
x`l dreyfp`mh a`weowea kugdwo kop yequ ye ohhyeww`re
om`+`mbfokkodyp oma om`i`d`g leyosp& oma `m seyw`wem
gowew& yer`w`dm wuyheyp- Umbdyumoefp& yer`w`dm wuyheyp
x l yekdrof db meddwedhem`g idme dbem yewufw `m
buyley meddwedhemew`w-
Dreyoff& le jep bogdy d syerem`mh `mbfokko`dm oma
wgoyy`mh feoa`mh d yeguyyem w`muw a`weowe `w ke gufduw
syeweyro`dm db le kugdwof `mehy`p x`l`m le bydmof yegeww-
Kugdwof a`wyus`dm gom feoa d wgoy& hyomufo`dm& omakugdg f`oyp apwbumg`dm ow le kugdwo yehemeyoew `m om
oeks d gdrey e|sdwea idme- Oflduhl ` `w sdww`ife lo
le fdmh+woma`mh `mbfokkodyp glomhew x`l`m le w`muw feoa
d slpw`dfdh`g dubfdx diwyug dm ip obbeg`mh g`f`oyp
bumg`dm& ` `w ofwd sdww`ife lo syer`duw youko`g kom`sufo+
`dm gouwea bumg`dmof diwyug`dm db le bydmof yegeww-
Wuyh`gof `meyrem`dm wldufa wy re d k`m`k`~e kugdwof
youko oma ko`mo`m kugdg`f`oyp gfeoyomge& sydkd`mh
mdykof w`muw slpw`dfdhp Z?7[- Sdwdseyo`re uwe db ds`gof
weyd`a aydsw dy dley syesoyo`dmw `m le bydmof yegeww low
ieem wldxm d ie ebbeg`re `m yeaug`mh `mbfokko`dm&
hyomufo`dm& oma wgoyy`mh `m le bydmof yegeww `m lesdwdseyo`re sey`da- Ql`w gom lefs d ko`mo`m bydmof yegeww
soemgp Z?1[-
Iegouwe off db duy aoo xeye yer exea oma gdffegea
yeydwseg refp& ` `w a`bb`guf d ie geyo`m xleley eogl
b`ma`mh yesyewemw o gouwe db wuiwequem bydmof w`muw
bo`fuye- Xlo `w `ksdyom d gdmw`aey& ldxerey& `w le bog
lo le dseyo`re b`ma`mhw lo osseoyea d gouwe diwyug`dm
db le bydmof yegeww xeye a`yegfp yefoea d syer`duw wuyh`gof
kom`sufo`dm 85% db le `ke- Dme db le f`k`o`dmw db l`w
yer`ex xow le fogj db l`wdy`gof aoo wuyyduma`mh eogl db
duy so emw( gf`m`gof l`wdy`ew- Iegouwe kdw so emw
syewemea ow yebeyyofw obey sy`koyp emadwgds`g sydgeauyew
loa ofyeoap ieem seybdykea o duw`ae `mw`u`dmw& `mbdyko+`dm xow md oro`foife ow d eogl so`em(w dy`h`mof e|em db
a`weowe& GQ& dy emadwgds`g b`ma`mhw- Ofwd umjmdxm xow le
hdof db le `m``of dseyo`dm- Wdke db lewe so`emw f`jefp
loa oeksea bydmof w`muwddkp bdy byomj bydmof w`muw
a`weowe& xleyeow dleyw kp lore aerefdsea bydmof w`muw
soldfdhp obey kdye k`m`kof wuyheyp bdy ko|`ffoyp dy
elkd`a a`weowe-
5- Gdmgfuw`dm
Bydmof w`muw a`weowe `w syewem 198+0-
Z9[ Wk`l QF& Ylee NW& Fdelyf QO- Wuyh gof komohekem db bydmof
w`muw``w- Guyy Ds`m Ddfoypmhdf Leoa Megj Wuyh 933?:0>19+8-
Z7[ Wdmmemiuyh YE& Wem dy IO- Yer`w`dm emadwgds g bydmof w`muw
wuyheyp- Guyy Ds`m Ddfoypmhdf Leoa Megj Wuyh 9331:?9>10+59-
Z1[ Gl`u OH& Jemmeap AX- A`woaromohew db k`m`kof eglm quew bdy
wuyh`gof komohekem db glydm`g yl`mdw`muw``w- Guyy Ds`m Ddfoypmhdf
Leoa Megj Wuyh 9331:?9>7?27+ `ksog dm bydmof `wlkuw a`kemw`dmw
oma le syewemge db bydmof w`muw``w- Oygl Ddfoypmhdf Leoa Megj Wuyh
9335:?7?>973+5-
Z8[ Fdelyf QO& Qddl`ff YN& Wk`l QF- Uwe db gdksuey+o`aea wuyheyp bdy
bydmof w`muw rem`fo`dm- Foypmhdwgdse 9333:??3>?029+8-
Z77+5-
Z0[ Idfhey XE& Julm BO& Jemmeap AX- K`aafe uyi`moe woi`f`~o`dm
obey bumg`dmof emadwgds g w`muw wuyheyp> le gdmydffea wpmegl`oe
eglm`que- Foypmhdwgdse ?000:?30>?001+0-Z??[ Jdgoj K& Wk`l QF& Wk`l KK- Idme `mrdfrekem `m glydm`g
yl`mdw`muw``w- Guyy Ds`m Ddfoypmhdf Leoa Megj Wuyh 9339:?3>10+59-
Z?9[ Seyfdbb NY& Hommdm BL& Idfhey XE& e of- Idme `mrdfrekem `m
w`muw``w> om ossoyem solxop bdy le wsyeoa db a`weowe- Foypmhdwgdse
9333:??3>9305+0-
Z?7[ Goofomd SN- K`m`koffp`mrow`re w muw eglm`que> xlo `w `4 Wldufa xe
gdmw`aey `4 Guyy Ds`m Ddfoypmhdf Leoa Megj Wuyh 9331:?9>71+8-
Z?1[ AefHoua`d NK& X`we WJ- Qds`gof weyd`a aydsw bdy le yeokem db
w`muw dw`o wemdw`w- Ok N Yl`mdf 9332:93>527+8-
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