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In Reply.—All 60 cases of frontoethmoidal mucoceles in our series were unilateral, a point of considerable interest when considering etiologic factors that are often bilateral in their effect. In a recently completed series of 100 cadaver dissections, the incidence of naturally occurring patent intersinus septa was found to be 10% This may occasionally provide an alternative pathway of drainage and may in part explain why mucoceles do not result in all cases of frontonasal duct obstruction.
However, while a surgically performed intersinus septectomy is an important component in the treatment of an established frontoethmoidal mucocele, it would be inadequate alone. Apart from the necessity of dealing with any associated ethmoidal pathology, to eradicate the mucocele and prevent recurrence, it is necessary to completely strip the lining mucosa, thereby overcoming the inflammation and bone resorption at the mucocele/bone interface. Since an external operation is therefore necessary, the Lynch-Howarth frontoethmoidectomy offers
LUND VJ. The Lynch-Howarth Operation and Unilateral Sinus Disease-Reply. Arch Otolaryngol Head Neck Surg. 1986;112(9):993. doi:10.1001/archotol.1986.03780090089025
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