Brief Answer:
You do not require FESS surgery.

Detailed Answer:
Hi,

Thank you for your query.

1. Your CT PNS (Para Nasal Sinuses) Scan shows hypoplastic (very small) frontal sinuses that are clear (no sinusitis).

2. There is very minimal sinusitis (mild mucosal thickening) in both the maxillary sinuses,in the osteomeatal complex (OMC near the opening of the maxillary sinuses) with possibility of a mild OMC block.

3. There is a mild sinusitis in the ethmoid sinuses more on the left. Most of them are clear. Sphenoid sinuses are clear.

4. The septum is central. There is bilateral inferior nasal turbinate atrophy. This represents atrophic rhinitis or from previous nasal surgery, if any.

5. Medical management including anti allergic, steroid nasal sprays, steam inhalation and hypertonic saline nasal washes should resolve your sinusitis.

6. It is abundantly lcear from your CT Scan that FESS surgery is not required. Balloon Sinuplasty is a minimally invasive option (for the maxillary sinuses) if your symptoms do not resolve after maximum medical therapy (8-12 weeks). That too is a borderline indication depending upon your exact symptoms (and definitely not for the frontal sinuses).

7. The costs mentioned are astronomical. You can easily fly down and operate at least 40-50 patients in XXXXXXX for that sum.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.

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Brief Answer:
There is no third sinus in the frontal side.

Detailed Answer:
Hi,

Thank you for writing back.

1. You have only one hypo-pneumatized frontal sinus on the right side. This appears as the third sinus (like an inter-frontal cell). However the the two cells on either side are supra-orbital cells.

2. The hypoplastic right frontal sinus has a normal scalloping septum which appears to be both the frontals. However, this is a single frontal sinus on the right side. The left frontal sinus is absent.

3. It is also important to note that these cells are clear with the right frontal sinus having a wide opening and drainage. I strongly suggest that you do not attempt any surgery for this otherwise normal anatomical variant.

4. Sustained medical treatment should resolve your problem.

5. Headache is confirmed as sinus related in barely 5% of patients.

6. For the recurrent sinusitis, medication or balloon sinuplasty may suffice. You need a nasal endoscopy to rule out atrophic rhinitis. in atrophic rhinitis, surgical intervention is usually avoided though other surgical options are available.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.

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Brief Answer:
Absent as in not present or not developed.

Detailed Answer:
Hi,

Thank you for writing back.

1. The frontal sinuses are not present at birth. They develop by the 6th-7th year and are fully developed by puberty. Pneumatization of the skull bones gives rise to the growth of the para nasal sinuses. (Only the maxillary, ethmoid and very small sphenoid sinuses are present at birth).

2. Absence / agenesis / non development of frontal sinuses is seen in about 5% of adults.

3. There is problem with this except this knowledge helps in treatment and planning surgery.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.

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