Who do I refer a patient to for removal of a Frontal Sinus (paranasal sinus) retention cyst?

From the Guidelines

For a frontal sinus retention cyst removal, you should refer someone to an otolaryngologist (ENT specialist) who specializes in sinus surgery. These specialists have the training and equipment necessary to evaluate and treat sinus cysts properly, as indicated by the American College of Radiology's 2021 update on sinonasal disease 1. The ENT will likely perform a nasal endoscopy and order CT imaging to assess the cyst's size, location, and whether it's causing any obstruction or symptoms. Not all frontal sinus retention cysts require removal - many are asymptomatic and discovered incidentally on imaging.

• Surgery is typically only recommended if the cyst is causing symptoms like headaches, pressure, recurrent sinusitis, or vision changes, which are common symptoms of chronic rhinosinusitis (CRS) 1.
• The procedure is usually performed endoscopically through the nose, avoiding external incisions, and has been shown to improve symptoms and quality of life in over 75% of patients 1.
• Recovery typically takes 1-2 weeks with saline rinses and possibly antibiotics or steroids to reduce inflammation.
• Insurance typically covers this procedure when medically necessary, but a referral from a primary care physician may be required depending on the insurance plan. It's essential to note that functional endoscopic sinus surgery, which may be used for frontal sinus retention cyst removal, is now the standard of care for restoring patency of paranasal sinus outflow tracts, and imaging that provides anatomical detail is needed for surgical planning 1.

From the Research

Referral for Frontal Sinus Retention Cyst Removal

To refer someone for a frontal sinus retention cyst removal, consider the following options:

• An Ear, Nose, and Throat (ENT) specialist or an otolaryngologist who has experience in performing endoscopic sinus surgery 2
• A head and neck surgeon who specializes in sinus surgery and has experience in removing retention cysts
• A rhinologist who is a specialist in the diagnosis and treatment of nasal and sinus disorders, including frontal sinus retention cysts

Anesthesia Options

For the removal of a frontal sinus retention cyst, the anesthesia options may include:

• Local anesthesia with intravenous sedation, which can help reduce blood loss and complications 3, 4
• General anesthesia, which may be preferred in some cases to ensure a clear surgical field and stable cardiovascular and respiratory status 3, 4, 5
• Total intravenous anesthesia (TIVA), which has been shown to be effective in reducing blood loss and providing a clear surgical field 5

Surgical Procedure

The surgical procedure for removing a frontal sinus retention cyst typically involves:

• Endoscopic sinus surgery, which is a minimally invasive procedure that uses a nasal endoscope to visualize the sinuses and remove the cyst 2
• Middle meatal antrostomy, which is a procedure that involves creating an opening in the maxillary sinus to allow for drainage and access to the cyst 2