Staff Reporter

Surgeons remove entire floor of frontal sinus on both sides

CHENNAI: A team of doctors at a city hospital, confronted with a rare meningitis condition in a 25-year-old woman patient, performed the challenging task of removing the entire floor of the frontal sinus on both sides to resolve a case of CSF rhinorrhoea (reverse flow of mucous into the brain leading to contamination of the Cerebro Spinal Fluid).

The young woman was admitted to Venkataeswara Hospitals in the last week of December 2005, with a severe attack of meningitis.

On December 28, a team led by P. Thulasi Das, ENT and Plastic Surgeon operated her.

During the six-hour surgery, her left frontal nose was opened and used as the gateway to drill the right frontal sinus.

As the defect was positioned in the deep posterior wall of the right frontal sinus, a piece of cartilage was harvested from the ear and used to close the leak.

The symptoms have gone and the patient is due for discharge on Wednesday.

"Frontal sinus which is situated deep inside the forehead and opens into the nose is difficult terrain for surgeons in terms of access, smallness and obstructing structures," Dr. Thulasi Das told presspersons.

Using endoscopy and a side-viewing telescope, doctors adopted the Lothrop technique of removing the floor of the sinus to access the problem area and repair the leak entirely through the nose.

"Discharge of pure watery drops from the nose should raise suspicion of CSF rhinorrhoea," said Dr. Thulasi Das.

The patient had been having recurrent bouts of meningitis since the age of 12.

She had last been operated in a Delhi hospital in 2002.

Following another meningitis attack three years later, she consulted several doctors in Delhi before being referred to Chennai.