Diseases of the Sinuses, 2001

8/13/2019 Diseases of the Sinuses, 2001

1/12

DISEASESof theSINUSESDiagnosis andManagement

Exit


2/12

DAVID W. KENNEDY, MD, FACS, FRCSIProfessor and Chairman

Department of Otorhinolaryngology: Head and Neck Surgery

University of Pennsylvania Health System

Philadelphia, Pennsylvania

WILLIAM E. BOLGER, MD, FACSAssociate Professor

Chief of Rhinology and Sinus Surgery

Department of Otorhinolaryngology: Head and Neck Surgery

University of Pennsylvania Health System

Philadelphia, Pennsylvania

S. JAMES ZINREICH, MDAssociate Professor

Department of Radiology/Otolaryngology: Head and Neck SurgeryChief, Head and Neck Imaging

Johns Hopkins Medical Institutions

Baltimore, Maryland

2001

B.C. Decker Inc.

Hamilton London

DISEASESof theSINUSES

Diagnosis and

Management


3/12

B.C. Decker Inc.

20 Hughson Street South

P.O. Box 620, L.C.D. 1

Hamilton, Ontario L8N 3K7

Tel: 905-522-7017; 1-800-568-7281

Fax: 905-522-7839

E-mail: [email protected]

Website: www.bcdecker.com

2001 by David W. Kennedy, William E. Bolger, S. James Zinreich

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any

means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

00 01 / QP / 9 8 7 6 5 4 3 2 1

ISBN 1-55009-045-3

Printed in Canada

Sales and Distribution

United States U.K., Europe, Scandinavia, Middle East Japan

B.C. Decker Inc. Harcourt Publishers Limited Igaku-Shoin Ltd.

P.O. Box 785 Customer Service Department Foreign Publications DepartmentLewiston, NY 14092-0785 Foots Cray High Street 3-24-17 HongoTel: 905-522-7017 / 1-800-568-7281 Sidcup, Kent Bunkyo-ku,Tokyo, Japan 113-8719Fax: 905-522-7839 DA14 5HP, UK Tel: 3 3817 5680E-mail: [email protected] Tel: 44 (0) 208 308 5760 Fax: 3 3815 6776Website: www.bcdecker.com Fax: 44 (0) 181 308 5702 E-mail: [email protected]

E-mail : cservice@harcourt_brace.com

Canada Australia, New Zealand Singapore, Malaysia, Thailand, Phi lippines,

B.C. Decker Inc. Harcourt Australia Pty. Limited Indonesia, Vietnam, Pacific Rim20 Hughson Street South Customer Service Department Harcourt Asia Pte LimitedP.O. Box 620, L.C.D. 1 STM Division 583 Orchard RoadHamilton, Ontario L8N 3K7 Locked Bag 16 #09/01, ForumTel: 905-522-7017 / 1-800-568-7281 St. Peters, New South Wales, 2044 Singapore 238884Fax: 905-522-7839 Australia Tel: 65-737-3593E-mail: [email protected] Tel: (02) 9517-8999 Fax: 65-753-2145Website: www.bcdecker.com Fax: (02) 9517-2249

E-mail: [email protected] Rights Website: www.harcourt.com.au

John Scott & Company

International Publishers AgencyP.O. Box 878Kimberton, PA 19442Tel: 610-827-1640Fax: 610-827-1671

Notice: The authors and publisher have made every effort to ensure that the patient care recommended herein, including choice of drugsand drug dosages, is in accord with the accepted standard and practice at the time of publication. However, since research and regulationconstantly change clinical standards, the reader is urged to check the product information sheet included in the package of each drug, whichincludes recommended doses, warnings, and contraindications. This isparticularly important with new or infrequently used drugs.


4/12

DEDICATIONS

v

I would like to dedicate this book to my family, to those who have taught me, and to those who will con-tinue to advance the field of rhinologic knowledge in future years. My wife Eddie has been most supportivewhile I have been busy trying to gain a better understanding and to teach what I have learned of this excit-ing field. My son Garrett and my daughter Kirin have each lost a portion of their childhood because ofthe times that I have either been away teaching at courses or working in my study. I thank each of you for

your love and understanding and dedicate this book to you.

David W. Kennedy, MD, FACS, FRCSI

In working on this text I dedicate my efforts to those wanting to learn more of the field of rhinology andsinus surgery and hope the text will be helpful.

Will iam E. Bolger, MD, FACS

I dedicate this work to my wife, whose love, support, and dedication have created the necessary founda-tion for my career and accomplishments.

S. James Zinreich, MD


5/12

1 Anatomy of the Paranasal Sinuses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

William E. Bolger

2 Radiographic Anatomy of the Sinuses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

S. James Zinreich and Thaddaeus Gotwald

3 A Genetics of Rhinosinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Garry R. Cutting

B Physiology, Mucociliary Clearance, and Neural Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Pontus L.E. Stierna

4 Etiologic Factors in Inflammatory Sinus Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Robert M. Naclerio and Anil Gungor

5 Nasal Polyps: Origin, Etiology, Pathogenesis, and Structure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

Mirko Tos and Per Leganger Larsen

6 Nasal Polyps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

Joel M . Bernstein7 Microbiology of Sinusitis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

Birgit Winther and Jack M. Gwaltney Jr

8 Granulomatous Diseases and Tumors of the Nose and Paranasal Sinuses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

Valerie J. Lund

9 Environmental Influence on Sinus Disease: the Role of Chemical Air Pollutants. . . . . . . . . . . . . . . . . . . . . . 107

Dean M. Clerico

10 Nasal Endoscopy: Diagnosis and Staging of Inflammatory Sinus Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . 119

Stephanie A. Joe, William E. Bolger, and David W. Kennedy

11 Imaging in Sinus Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129David M. Yousem

12 Management of Acute Rhinosinusitis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149

Erica R. Thaler

13 Medical Treatment of Chronic Sinus Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155

Dean M. Clerico

14 Complications in Sinus Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169

Sukgi S. Choi and Kenneth M. Grundfast

CONTENTS

vii
http://docs/chapt01.pdfhttp://docs/chapt01.pdfhttp://docs/chapt02.pdfhttp://docs/chapt02.pdfhttp://docs/chapt03a.pdfhttp://docs/chapt03a.pdfhttp://docs/chapt03a.pdfhttp://docs/chapt03a.pdfhttp://docs/chapt03b.pdfhttp://docs/chapt03b.pdfhttp://docs/chapt03b.pdfhttp://docs/chapt04.pdfhttp://docs/chapt04.pdfhttp://docs/chapt05.pdfhttp://docs/chapt05.pdfhttp://docs/chapt06.pdfhttp://docs/chapt06.pdfhttp://docs/chapt07.pdfhttp://docs/chapt07.pdfhttp://docs/chapt08.pdfhttp://docs/chapt08.pdfhttp://docs/chapt09.pdfhttp://docs/chapt09.pdfhttp://docs/chapt10.pdfhttp://docs/chapt10.pdfhttp://docs/chapt11.pdfhttp://docs/chapt11.pdfhttp://docs/chapt12.pdfhttp://docs/chapt12.pdfhttp://docs/chapt13.pdfhttp://docs/chapt13.pdfhttp://docs/chapt14.pdfhttp://docs/chapt01.pdfhttp://docs/chapt14.pdfhttp://docs/chapt13.pdfhttp://docs/chapt12.pdfhttp://docs/chapt11.pdfhttp://docs/chapt10.pdfhttp://docs/chapt09.pdfhttp://docs/chapt08.pdfhttp://docs/chapt07.pdfhttp://docs/chapt06.pdfhttp://docs/chapt05.pdfhttp://docs/chapt04.pdfhttp://docs/chapt03b.pdfhttp://docs/chapt03a.pdfhttp://docs/chapt02.pdf


6/12


7/12

FOREWORD

ix

In mid 1984, David Kennedy spoke to me about a new approach to surgery of the paranasal sinuses. Asa new department chairman at Johns Hopkins and trained in the then standard approaches to sinussurgery, I have to admit that I was skeptical. Davids enthusiasm and passion to pursue this was fueled byhis knowledge and understanding of the physiology of the sinuses as taught to him by then emeritus Hop-kins faculty member Don Proctor. He was not to be denied. We agreed we would obtain the necessary

endoscopic equipment and David would first develop his skills in the anatomy laboratory.David did just that. He took a careful and systematic approach and developed his new skills in the

laboratory before taking them to his patients. His reading and work raised many questions in his mind andhe pursued their answers relentlessly. Today, 16 years later, David is a master endoscopic sinus surgeon, clin-ician, researcher and academic leader. He has instructed thousands of physicians in the clinical care of sinusdisease and he has contributed to our understanding of the pathophysiology of sinusitis.

David also quickly recognized the importance of high quality imaging to the proper diagnosis andtreatment of sinus disease. He partnered with Jim Zinreich, a talented neuroradiologist who developedand refined techniques to image the paranasal sinuses, adding value to the diagnostic and therapeuticapproach to diseases of the sinuses. In this book, Kennedy, Zinreich, and Bolger provide an authoritativetext that comprehensively covers all medical and surgical aspects of the paranasal sinus and the diseases thataffect them. They have recruited an international group of contributors known for their clinical expertiseand contributions to the scientific literature. Disease of the paranasal sinuses and particularly chronic sinusi-tis is one of the most common clinical illnesses to present to the physician. This book will serve as a pen-etrating and guiding beacon both to those who are entering otolaryngologyhead and neck training andto experienced clinicians.

Michael M .E. Johns, MDChairman and CEO, Emory Healthcare

Executive Vice President for Health Affairs, Emory UniversityDirector of the Robert W. Woodruff Health Sciences Center of Emory University


8/12

Those who work with patients suffering from chronic rhinosinusitis recognize that it has a much greatereffect on the quality of life of affected individuals than was previously recognized. Chronic rhinos-inusit is is also one of the most common healthcare complaints and frequently has an insidious onset. Thesignificant international prevalence of this disease has been brought home to me as I travel to meetingsand to give courses. Whether in a developed nation or a developing nation, one of the most commongreetings is You have come to the right place; this must be the sinusitis capital of the world.

In recent years, our understanding of rhinosinusitis has increased significantly, along with our diag-nostic potential and our ability to treat the disorder effectively. At the same time, there has been a resur-gence of clinical and basic research in an area which was, for a long time, relatively ignored.

The goal of this book is to provide a comprehensive volume, produced by the international lead-ers in the field, which details our current level of knowledge regarding diagnosis, medical care, and sur-gical therapy of rhinosinusitis. We hope that we have succeeded, but as in any first edition, there willundoubtably be some areas which would have benefitted from expansion, some which could have beencondensed, and others that could have been included. I would particularly like to thank all of the chap-ter authors for their hard work and patience during the process of development of this book.

As a resident, I was frequently concerned about the seemingly poor results of our treatment ofsinonasal disease. However, I was fortunate to have the opportunity to work with Donald Proctor, MD,on a sinus mucocil iary clearance research project. Clinically, he also taught us the importance of endo-

scopic diagnosis and the key role of the ethmoid sinuses in the pathogenic process. In my early academiccareer as an otologist, the influence of sino-nasal disease on eustachian tube function was evident. There-fore we would frequently perform medical management and intranasal ethmoidectomy under the micro-scope in patients where the sinus disease appeared to be a significant factor in the patients otologic process.

In the late 70s, I had reviewed Professor Messerklingers classical work, Endoscopy of the Nosefor one of the journals and was intrigued with the level of diagnostic precision that he described. How-ever, at that time it was not evident why such detailed diagnosis was required, since a wide extirpativesurgical procedure with mucosal stripping was typically performed. In the early 1980s I had the oppor-tunity to interact with Professor Messerklinger at a meeting, and to see him present the superb work thathe had performed on mucociliary clearance. This, combined with his concepts of more focused surgicalprocedures under endoscopic visualization, rekindled my interest in sinus disease.

Since we originally introduced the concept of functional endoscopic sinus surgery, I have had theopportunity to visit and to learn from many great rhinologists and my thinking, as well as that of the spe-

cialty, has become more refined. This book provides all the specialists who have an interest in this excit-ing area with a synopsis of our current state of knowledge of the pathogenesis and treatment of sinus dis-ease. It is our hope that it will improve clinical care and spur some individuals onto additional research.


PREFACE

xi


9/12

To my many teachers I would also like to extend my sincere thanks for the time that you have spentwith me. Space does not permi t me to mention each of you who has contributed to this work and,directly or indirectly, to this field. William McGowan and Harold Brown taught me how to be a sur-geon, my uncle John McAuliffe Curtin taught me that otolaryngology could be fun, George Nager taughtme how to really care for patients, Donald Proctor taught me the excitement of research in sinus dis-

ease, Walter Messerklinger shared his knowledge and techniques with me and Michael Johns encour-aged me to proceed with developing this exciting field. To each of you, and to others too numerous tomention, I dedicate this book. Finally, I would also like to dedicate this book to those of you who wil lpick up the torch and, by continued research, close clinical observation and the highest quality of clin-ical care, publications, and selfless teaching will further advance our knowledge in rhinology and sinusdisease from this point forward.


Iwish to acknowledge those who have helped in my pursuit to learn about rhinology and to grow as asinus surgeon. For introducing me to rhinology, inspiring me to learn more, and patiently teachingme I acknowledge and thank David S. Parsons, MD, Frederick A. Kuhn, MD, and David W. Kennedy,MD. For their leadership and direction that helped guide and nurture my growth as a surgeon Iacknowledge and thank David H . Thompson, MD, and Norman M. Rich, MD.

For endless support over many years and for teaching me the most valuable lessons in colleague-ship I acknowledge and thank Eric A. Mair, MD, and John D. Casler, MD.

William E. Bolger, MD, FACS

ACKNOWLEDGMENTS

xiii


10/12

CONTRIBUTORS

xv

JOEL M. BERNSTEIN, MD, PhDProfessor of Clinical Otolaryngology and PediatricsState University of New York at BuffaloBuffalo, New YorkNasal Polyps

WILLIAM E. BOLGER, MD, FACSAssociate ProfessorChief of Rhinology and Sinus SurgeryDepartment of Otorhinolaryngology: Head and Neck SurgeryUniversity of Pennsylvania Health SystemPhiladelphia, PennsylvaniaAnatomy of the Paranasal Sinuses;Revision Endoscopic Sinus Surgery for Recurrent Rhinosinusit is;Surgical Compli cations and Postoperative Care

SUKGI S. CHO I, MDAssociate Professor in Otolaryngology and PediatricsGeorge Washington University

Vice-Chairman Department OtolaryngologyChildrens National Medical CenterWashington, DCComplications in Sinus Disease

DEAN M. CLERICO , MDPrivate Practice, Valley ENTKingston, PennsylvaniaEnvi ronmental Influence on Sinus Disease: The Roleof Chemical Air Pollutants;Medical Treatment of Chronic Sinus Disease

MICHELLE MARIE CULLEN, MD

Director, The Sinus Institute, LLCDuluth, GeorgiaRevision Endoscopic Sinus Surgery for Recurrent Rhinosinusit is

GARRY R. CUTTING, MDProfessor of PediatricsInstitute of Genetic MedicineJohns Hopkins University School of MedicineBalt imore, MarylandGenetics of Rhinosinusit is

HUN-JONG DHONG, MDAssociate Professor of OtorhinolaryngologySamsung Medical CenterSungkyunkwan University School of MedicineSeoul, Korea

Fungal Rhinosinusiti s

JILL A. FOSTER, MD, FACSDirector of Ophthalmic Plastic and Orbital SurgeryDivision of OphthalmologyThe Cleveland Clinic FoundationCleveland, OhioEndoscopic Appli cations in Orbi tal Surgery

WILLIAM H. FRIEDMAN, MD, FACSDirector, Park Central InstituteChief of OtolaryngologyDeaconess/Incarnate World Health Care SystemSt. Louis, MissouriExternal Approaches to the Frontal Sinuses

THADDAEUS GOTWALD, MDAssistant Professor, RadiologyUniversity Clinic of InnsbruckInnsbruck, AustriaRadiographic Anatomy of the Sinuses

KENNETH M. GRUNDFAST, MDProfessor and ChairmanDepartment of OtolaryngologyBoston University Medical SchoolBoston Medical Center

Boston, MassachusettsCompli cations in Sinus Disease

ANIL GUNGOR, MDAssistant ProfessorDepartment of Pediatric OtolaryngologyUniversity of Pittsburgh School of MedicineChildrens Hospital of PittsburghPittsburgh, PennsylvaniaEtiologic Factors in Inflammatory Sinus Disease


11/12

xvi

JACK M. GWALTNEYJR, MDHead, Division of Epidemiology and VirologyDepartment of Internal MedicineUniversity of Virginia School of MedicineCharlottesville, VirginiaMicrobiology of Sinusiti s

ROBERT T. HARVEY, MD

Instructor in RadiologyFellow in Interventional RadiologyDepartment of RadiologyUniversity of Pennsylvania Health SystemPhiladelphia, PennsylvaniaOpen Surgical Resection of Sinus Neoplasms

WERNERHOSEMANN, MDAssistant ProfessorDepartment of OtorhinolaryngologyUniversity of RegensburgRegensburg, GermanyEthmoidectomy with Head Li ght and Endoscope;Role of Endoscopic Surgery in Tumors

STEPHANIE A. JOE, MDLecturerDepartment of Otorhinolaryngology: Head and Neck SurgeryFellow in Rhinology and Sinus SurgeryUniversity of Pennsylvania Health SystemPhiladelphia, PennsylvaniaNasal Endoscopy: Diagnosis and Staging ofInflammatory Sinus Disease

DAVID W. KENNEDY, MD, FACS, FRCSIProfessor and ChairmanDepartment of Otorhinolaryngology: Head and Neck Surgery

University of Pennsylvania Health SystemPhiladelphia, PennsylvaniaSurgical Compli cations and Postoperative Care

FREDERICK A. KUH N, MD, FACSGeorgia Nasal and Sinus InstituteMemorial Health University Medical CenterSavannah, GeorgiaSurgery of the Frontal Sinus

DONALD C. LANZA, MD, FACSHead, Section of Nasal and Sinus DisordersDepartment of Otolaryngology and

Communicative DisordersThe Cleveland Clinic FoundationCleveland, OhioFungal Rhinosinusiti s

PERLEGANGERLARSEN, MDENT DepartmentHil lerd HospitalHillerd, DenmarkNasal Polyps: Ori gin, Eti ology,Pathogensis, and Structure

WILLIAM LAWSON, MDProfessor of OtolaryngologyMount Sinai School of Medicine, New YorkChief of OtolaryngologyVeterans Hospital, Bronx, New YorkAttending Otolaryngologist, Mount Sinai HospitalNew York, New YorkThe Intranasal and External Ethmoidectomy

RAYMOND LESSER, MD, FACSAssistant Clinical ProfessorMLP/Hahnemann UniversityPhiladelphia, PennsylvaniaEndoscopic Appli cations in Orbi tal Surgery

MARK LOURY, MD, FACSPrivate Practice, Intermountain OtolaryngologyFt. Collins, ColoradoEndoscopic Management of Cerebrospinal Fluid Leaks andCephaloceles

VALERIEJ. LUN D, MS, FRCS, FRCSEdProfessor of Rhinology, Institute of Laryngology and OtologyHonorary Consultant OtorhinolaryngologistRoyal National Throat, Nose and Ear HospitalGranulomatous Diseases and Tumors of the Noseand Paranasal Sinuses

RODNEY P. LUSK, MDProfessor and Director, Pediatric OtolaryngologySt.Louis Childrens Hospitalat Washington University Medical CenterSt. Louis, MissouriPediatri c Sinusiti s

RICHARD L. MABRY, MDProfessor and DirectorResident EducationDepartment of Otolaryngology: Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallas, TexasOpen Maxil lary Sinus Procedures

BRADLEY F. MARPLE, MDAssociate Professor of OtolaryngologyDepartment of OtolaryngologyUniversity of Texas, Southwestern Medical CenterChief of Otolaryngology, Parkland Memorial Hospital

Chief of Otolaryngology, Dallas Veterans Administration HospitalDallas, TexasOpen Maxil lary Sinus Procedures

DOUGLAS E. MATTOX, MDProfessor and ChairDepartment of Otolaryngology: Head and Neck SurgeryEmory University School of MedicineThe Emory ClinicAtlanta, GeorgiaManagement of Cerebrospinal Fluid Rhinorrhea


12/12

RALPH METSON, MDAssociate Clinical ProfessorDepartment of Otology & LaryngologyHarvard Medical SchoolMassachusetts Eye and Ear InfirmaryBoston, MassachusettsDacryocystorhinostomy

H IROSHI MORIYAMA, MDDepartment of OtorhinolaryngologyJikei University School of MedicineJikei University HospitalTokyo, JapanEndoscopic Modifications of the Takahashi Technique

ROBERT NACLERIO, MDProfessor and Chief of OtolaryngologyHead and Neck SurgeryUniversity of Chicago HospitalChicago, IllinoisEtiologic Factors in Inflammatory Sinus Disease

GARY NISHIOKA, DMD, MDPrivate Practice in OtolaryngologySalem, OregonEnvi ronmental Influence on Sinus Disease;Medical Treatment of Chronic Sinus Disease

DAVID S. PARSONS, MD, FAAP, FACSClinical ProfessorPediatric Otolaryngology and Sinus SurgeryUniversity of South CarolinaGreenville Hospital System, St. Francis Hospital SystemGreenville, South CarolinaPediatr ic Sinus Surgery

ELIE E. REBEIZ, MDAssociate ProfessorDirector, Head and Neck SurgeryDepartment of Otolaryngology: Head and Neck SurgeryNew England Medical CenterBoston, MassachusettsRole of Lasers in Intranasal and Sinus Surgery

ANTHONYJ. REINO, MD, MScAssistant Clinical ProfessorMount Sinai School of MedicineAssociate Director Otolaryngology

Bronx VA Medical HospitalAssistant Attending Mt. Sinai Medical CenterNew York, New YorkAssistant Attending St. Lukes-Roosevelt Medical CenterNew York, New YorkThe Intranasal and External Ethmoidectomy

STANLEY M. SHAPSHAY, MDProfessor and ChairmanDepartment of Otolaryngology: Head and Neck SurgeryTufts University School of Medicine

New England Medical CenterBoston, MassachusettsRole of Lasers in I ntranasal and Sinus Surgery

PONTUS L.E. STIERNA, MD, P DDepartment of Clinical ServicesDivision of Otorhinolarygology, Karolinska InstituteHuddinge, Sweden

Physiology, Mucoci li ary Clearance, and Neural Control

MIRKO TOS, MDProfessor and Head, Department of Otorhinolaryngology,Head and Neck SurgeryGentofte University HospitalCopenhagen, DenmarkNasal Polyps: Origin, Et iology, Pathogenesis, and Structure

ERICA R. THALER, MDAssociate ProfessorDepartment of Otorhinolaryngology: Head and Neck SurgeryUniversity of Pennsylvania Health SystemPhiladelphia, PennsylvaniaManagement of Acute Rhinosinusiti s

GREGORY S. WEINSTEIN, MDAssociate ProfessorDepartment of Otorhinolaryngology: Head and Neck SurgeryUniversity of Pennsylvania Health SystemPhiladelphia, PennsylvaniaOpen Surgical Resection of Sinus Neoplasms

BIRGIT WINTHER, MDAssistant Professor, Department of OtolaryngologyUniversity of Virginia Health SystemResearch Director, Virginia Sinus Center

Charlottesville, VirginiaMicrobiology of Sinusiti s

ALLAN E. WULC, MD, FACSClinical Associate ProfessorScheie Eye Institute, University of PennsylvaniaAbington Memorial HospitalAbington, PennsylvaniaEndoscopic Surgery of the Orbit

DAVID M. YOUSEM, MDProfessor of Radiology, Department of RadiologyJohns Hopkins Hospital

Balt imore, MarylandImaging in Sinus Disease

S. JAMES ZINREICH, MDAssociate Professor in Radiology /Otolaryngology: Head and Neck SurgeryChief Head and Neck ImagingJohns Hopkins Medical InstitutionsBalt imore, MarylandRadiographic Anatomy of the Sinuses;Image-Guided Functional Endoscopic Sinus Surgery

ii

Documents

Diseases of the Sinuses, 2001