DISEASES

of the
SINUSES
Diagnosis and
Management

Exit

DISEASES
of the
SINUSES
Diagnosis and
Management
DAVID W. KENNEDY, MD, FACS, FRCSI
Professor and Chairman
Department of Otorhinolaryngology: Head and Neck Surgery
University of Pennsylvania Health System
Philadelphia, Pennsylvania

WILLIAM E. BOLGER, MD, FACS

Associate Professor
Chief of Rhinology and Sinus Surgery
Department of Otorhinolaryngology: Head and Neck Surgery
University of Pennsylvania Health System
Philadelphia, Pennsylvania

S. JAMES ZINREICH, MD
Associate Professor
Department of Radiology/Otolaryngology: Head and Neck Surgery
Chief, Head and Neck Imaging
Johns Hopkins Medical Institutions
Baltimore, Maryland

2001
B.C. Decker Inc.
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2001 by David W. Kennedy, William E. Bolger, S. James Zinreich
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DEDICATIONS

I would like to dedicate this book to my family, to those who have taught me, and to those who will continue to advance the field of rhinologic knowledge in future years. My wife Eddie has been most supportive
while I have been busy trying to gain a better understanding and to teach what I have learned of this exciting field. My son Garrett and my daughter Kirin have each lost a portion of their childhood because of
the 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 and
sinus surgery and hope the text will be helpful.
William E. Bolger, MD, FACS

I dedicate this work to my wife, whose love, support, and dedication have created the necessary foundation for my career and accomplishments.
S. James Zinreich, MD

CONTENTS

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

William E. Bolger

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

S. James Zinreich and Thaddaeus Gotwald

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

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

Pontus L.E. Stierna

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

Robert M. Naclerio and Anil Gungor

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

Mirko Tos and Per Leganger Larsen

Nasal Polyps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Joel M. Bernstein

Microbiology of Sinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Birgit Winther and Jack M. Gwaltney Jr

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

Valerie J. Lund

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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129

David 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
vii

15

Fungal Rhinosinusitis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179

Hun-Jong Dhong and Donald C. Lanza

16

Functional Endoscopic Sinus Surgery: Concepts, Surgical Indications, and Instrumentation . . . . . . . . . . 197
David W. Kennedy

Functional Endoscopic Sinus Surgery: Anesthesia, Technique, and Postoperative Management . . . . . . . . 211
David W. Kennedy

17

Ethmoidectomy with Head Light and Endoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223

Werner Hosemann

18

Endoscopic Modifications of the Takahashi Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235

Hiroshi Moriyama

19

Revision Endoscopic Sinus Surgery for Recurrent Rhinosinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245

Michelle Marie Cullen and William E. Bolger

20

Pediatric Sinusitis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255

Rodney P. Lusk

21

Pediatric Sinus Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271

David S. Parsons and Gary Nishioka

22

Surgery of the Frontal Sinus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281

Frederick A. Kuhn

23

Surgical Complications and Postoperative Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303

William E. Bolger and David W. Kennedy

24

Dacryocystorhinostomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317
Ralph Metson

25

Endoscopic Applications in Orbital Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325

Raymond W. Lesser, Allan E. Wulc, and Jill A. Foster

26

Endoscopic Management of Cerebrospinal Fluid Leaks and Cephaloceles . . . . . . . . . . . . . . . . . . . . . . . . . . . 335

Douglas E. Mattox and Mark Loury

27

Role of Endoscopic Surgery in Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341

Werner Hosemann

28

Role of Lasers in Intranasal and Sinus Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351

Elie E. Rebeiz and Stanley M. Shapshay

29

Image-Guided Functional Endoscopic Sinus Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357

S. James Zinreich

30

Intranasal and External Ethmoidectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369

William Lawson and Anthony J. Reino

31

Open Maxillary Sinus Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383

Richard L. Mabry and Bradley F. Marple

32

External Approaches to the Frontal Sinuses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391

William H. Friedman

33

Open Surgical Resection of Sinus Neoplasms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405

Gregory S. Weinstein and Robert Harvey

viii

FOREWORD

n mid 1984, David Kennedy spoke to me about a new approach to surgery of the paranasal sinuses. As
a new department chairman at Johns Hopkins and trained in the then standard approaches to sinus
surgery, I have to admit that I was skeptical. Davids enthusiasm and passion to pursue this was fueled by
his knowledge and understanding of the physiology of the sinuses as taught to him by then emeritus Hopkins 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 and
he pursued their answers relentlessly. Today, 16 years later, David is a master endoscopic sinus surgeon, clinician, researcher and academic leader. He has instructed thousands of physicians in the clinical care of sinus
disease 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 and
treatment of sinus disease. He partnered with Jim Zinreich, a talented neuroradiologist who developed
and refined techniques to image the paranasal sinuses, adding value to the diagnostic and therapeutic
approach to diseases of the sinuses. In this book, Kennedy, Zinreich, and Bolger provide an authoritative
text that comprehensively covers all medical and surgical aspects of the paranasal sinus and the diseases that
affect them. They have recruited an international group of contributors known for their clinical expertise
and contributions to the scientific literature. Disease of the paranasal sinuses and particularly chronic sinusitis is one of the most common clinical illnesses to present to the physician. This book will serve as a penetrating and guiding beacon both to those who are entering otolaryngologyhead and neck training and
to experienced clinicians.
Michael M.E. Johns, MD
Chairman and CEO, Emory Healthcare
Executive Vice President for Health Affairs, Emory University
Director of the Robert W. Woodruff Health Sciences Center of Emory University

ix

PREFACE

hose who work with patients suffering from chronic rhinosinusitis recognize that it has a much greater
effect on the quality of life of affected individuals than was previously recognized. Chronic rhinosinusitis is also one of the most common healthcare complaints and frequently has an insidious onset. The
significant international prevalence of this disease has been brought home to me as I travel to meetings
and to give courses. Whether in a developed nation or a developing nation, one of the most common
greetings 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 diagnostic potential and our ability to treat the disorder effectively. At the same time, there has been a resurgence 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 leaders in the field, which details our current level of knowledge regarding diagnosis, medical care, and surgical therapy of rhinosinusitis. We hope that we have succeeded, but as in any first edition, there will
undoubtably be some areas which would have benefitted from expansion, some which could have been
condensed, and others that could have been included. I would particularly like to thank all of the chapter 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 of
sinonasal disease. However, I was fortunate to have the opportunity to work with Donald Proctor, MD,
on a sinus mucociliary clearance research project. Clinically, he also taught us the importance of endoscopic diagnosis and the key role of the ethmoid sinuses in the pathogenic process. In my early academic
career as an otologist, the influence of sino-nasal disease on eustachian tube function was evident. Therefore we would frequently perform medical management and intranasal ethmoidectomy under the microscope 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 Nose
for one of the journals and was intrigued with the level of diagnostic precision that he described. However, at that time it was not evident why such detailed diagnosis was required, since a wide extirpative
surgical procedure with mucosal stripping was typically performed. In the early 1980s I had the opportunity to interact with Professor Messerklinger at a meeting, and to see him present the superb work that
he had performed on mucociliary clearance. This, combined with his concepts of more focused surgical
procedures under endoscopic visualization, rekindled my interest in sinus disease.
Since we originally introduced the concept of functional endoscopic sinus surgery, I have had the
opportunity to visit and to learn from many great rhinologists and my thinking, as well as that of the specialty, has become more refined. This book provides all the specialists who have an interest in this exciting area with a synopsis of our current state of knowledge of the pathogenesis and treatment of sinus disease. It is our hope that it will improve clinical care and spur some individuals onto additional research.
David W. Kennedy, MD, FACS, FRCSI

xi

ACKNOWLEDGMENTS

o my many teachers I would also like to extend my sincere thanks for the time that you have spent
with me. Space does not permit 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 surgeon, my uncle John McAuliffe Curtin taught me that otolaryngology could be fun, George Nager taught
me how to really care for patients, Donald Proctor taught me the excitement of research in sinus disease, Walter Messerklinger shared his knowledge and techniques with me and Michael Johns encouraged me to proceed with developing this exciting field. To each of you, and to others too numerous to
mention, I dedicate this book. Finally, I would also like to dedicate this book to those of you who will
pick up the torch and, by continued research, close clinical observation and the highest quality of clinical care, publications, and selfless teaching will further advance our knowledge in rhinology and sinus
disease from this point forward.
David W. Kennedy, MD, FACS, FRCSI

wish to acknowledge those who have helped in my pursuit to learn about rhinology and to grow as a
sinus surgeon. For introducing me to rhinology, inspiring me to learn more, and patiently teaching
me 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 I
acknowledge 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 colleagueship I acknowledge and thank Eric A. Mair, MD, and John D. Casler, MD.
William E. Bolger, MD, FACS

xiii

CONTRIBUTORS

JOEL M. BERNSTEIN, MD, PhD

Professor of Clinical Otolaryngology and Pediatrics
State University of New York at Buffalo
Buffalo, New York
Nasal Polyps
WILLIAM E. BOLGER, MD, FACS
Associate Professor
Chief of Rhinology and Sinus Surgery
Department of Otorhinolaryngology: Head and Neck Surgery
University of Pennsylvania Health System
Philadelphia, Pennsylvania
Anatomy of the Paranasal Sinuses;
Revision Endoscopic Sinus Surgery for Recurrent Rhinosinusitis;
Surgical Complications and Postoperative Care
SUKGI S. CHOI, MD
Associate Professor in Otolaryngology and Pediatrics
George Washington University
Vice-Chairman Department Otolaryngology
Childrens National Medical Center
Washington, DC
Complications in Sinus Disease
DEAN M. CLERICO, MD
Private Practice, Valley ENT
Kingston, Pennsylvania
Environmental Influence on Sinus Disease: The Role
of Chemical Air Pollutants;
Medical Treatment of Chronic Sinus Disease
MICHELLE MARIE CULLEN, MD
Director, The Sinus Institute, LLC
Duluth, Georgia
Revision Endoscopic Sinus Surgery for Recurrent Rhinosinusitis
GARRY R. CUTTING, MD
Professor of Pediatrics
Institute of Genetic Medicine
Johns Hopkins University School of Medicine
Baltimore, Maryland
Genetics of Rhinosinusitis

HUN-JONG DHONG, MD
Associate Professor of Otorhinolaryngology
Samsung Medical Center
Sungkyunkwan University School of Medicine
Seoul, Korea
Fungal Rhinosinusitis
JILL A. FOSTER, MD, FACS
Director of Ophthalmic Plastic and Orbital Surgery
Division of Ophthalmology
The Cleveland Clinic Foundation
Cleveland, Ohio
Endoscopic Applications in Orbital Surgery
WILLIAM H. FRIEDMAN, MD, FACS
Director, Park Central Institute
Chief of Otolaryngology
Deaconess/Incarnate World Health Care System
St. Louis, Missouri
External Approaches to the Frontal Sinuses
THADDAEUS GOTWALD, MD
Assistant Professor, Radiology
University Clinic of Innsbruck
Innsbruck, Austria
Radiographic Anatomy of the Sinuses
KENNETH M. GRUNDFAST, MD
Professor and Chairman
Department of Otolaryngology
Boston University Medical School
Boston Medical Center
Boston, Massachusetts
Complications in Sinus Disease
ANIL GUNGOR, MD
Assistant Professor
Department of Pediatric Otolaryngology
University of Pittsburgh School of Medicine
Childrens Hospital of Pittsburgh
Pittsburgh, Pennsylvania
Etiologic Factors in Inflammatory Sinus Disease

xv

JACK M. GWALTNEY JR, MD

Head, Division of Epidemiology and Virology
Department of Internal Medicine
University of Virginia School of Medicine
Charlottesville, Virginia
Microbiology of Sinusitis
ROBERT T. HARVEY, MD
Instructor in Radiology
Fellow in Interventional Radiology
Department of Radiology
University of Pennsylvania Health System
Philadelphia, Pennsylvania
Open Surgical Resection of Sinus Neoplasms
WERNER HOSEMANN, MD
Assistant Professor
Department of Otorhinolaryngology
University of Regensburg
Regensburg, Germany
Ethmoidectomy with Head Light and Endoscope;
Role of Endoscopic Surgery in Tumors
STEPHANIE A. JOE, MD
Lecturer
Department of Otorhinolaryngology: Head and Neck Surgery
Fellow in Rhinology and Sinus Surgery
University of Pennsylvania Health System
Philadelphia, Pennsylvania
Nasal Endoscopy: Diagnosis and Staging of
Inflammatory Sinus Disease
DAVID W. KENNEDY, MD, FACS, FRCSI
Professor and Chairman
Department of Otorhinolaryngology: Head and Neck Surgery
University of Pennsylvania Health System
Philadelphia, Pennsylvania
Surgical Complications and Postoperative Care
FREDERICK A. KUHN, MD, FACS
Georgia Nasal and Sinus Institute
Memorial Health University Medical Center
Savannah, Georgia
Surgery of the Frontal Sinus
DONALD C. LANZA, MD, FACS
Head, Section of Nasal and Sinus Disorders
Department of Otolaryngology and
Communicative Disorders
The Cleveland Clinic Foundation
Cleveland, Ohio
Fungal Rhinosinusitis
PER LEGANGER LARSEN, MD
ENT Department
Hillerd Hospital
Hillerd, Denmark
Nasal Polyps: Origin, Etiology,
Pathogensis, and Structure

xvi

WILLIAM LAWSON, MD
Professor of Otolaryngology
Mount Sinai School of Medicine, New York
Chief of Otolaryngology
Veterans Hospital, Bronx, New York
Attending Otolaryngologist, Mount Sinai Hospital
New York, New York
The Intranasal and External Ethmoidectomy
RAYMOND LESSER, MD, FACS
Assistant Clinical Professor
MLP/Hahnemann University
Philadelphia, Pennsylvania
Endoscopic Applications in Orbital Surgery
MARK LOURY, MD, FACS
Private Practice, Intermountain Otolaryngology
Ft. Collins, Colorado
Endoscopic Management of Cerebrospinal Fluid Leaks and
Cephaloceles
VALERIE J. LUND, MS, FRCS, FRCSEd
Professor of Rhinology, Institute of Laryngology and Otology
Honorary Consultant Otorhinolaryngologist
Royal National Throat, Nose and Ear Hospital
Granulomatous Diseases and Tumors of the Nose
and Paranasal Sinuses
RODNEY P. LUSK, MD
Professor and Director, Pediatric Otolaryngology
St.Louis Childrens Hospital
at Washington University Medical Center
St. Louis, Missouri
Pediatric Sinusitis
RICHARD L. MABRY, MD
Professor and Director
Resident Education
Department of Otolaryngology: Head and Neck Surgery
University of Texas Southwestern Medical Center
Dallas, Texas
Open Maxillary Sinus Procedures
BRADLEY F. MARPLE, MD
Associate Professor of Otolaryngology
Department of Otolaryngology
University of Texas, Southwestern Medical Center
Chief of Otolaryngology, Parkland Memorial Hospital
Chief of Otolaryngology, Dallas Veterans Administration Hospital
Dallas, Texas
Open Maxillary Sinus Procedures
DOUGLAS E. MATTOX, MD
Professor and Chair
Department of Otolaryngology: Head and Neck Surgery
Emory University School of Medicine
The Emory Clinic
Atlanta, Georgia
Management of Cerebrospinal Fluid Rhinorrhea

RALPH METSON, MD
Associate Clinical Professor
Department of Otology & Laryngology
Harvard Medical School
Massachusetts Eye and Ear Infirmary
Boston, Massachusetts
Dacryocystorhinostomy
HIROSHI MORIYAMA, MD
Department of Otorhinolaryngology
Jikei University School of Medicine
Jikei University Hospital
Tokyo, Japan
Endoscopic Modifications of the Takahashi Technique
ROBERT NACLERIO, MD
Professor and Chief of Otolaryngology
Head and Neck Surgery
University of Chicago Hospital
Chicago, Illinois
Etiologic Factors in Inflammatory Sinus Disease
GARY NISHIOKA, DMD, MD
Private Practice in Otolaryngology
Salem, Oregon
Environmental Influence on Sinus Disease;
Medical Treatment of Chronic Sinus Disease
DAVID S. PARSONS, MD, FAAP, FACS
Clinical Professor
Pediatric Otolaryngology and Sinus Surgery
University of South Carolina
Greenville Hospital System, St. Francis Hospital System
Greenville, South Carolina
Pediatric Sinus Surgery
ELIE E. REBEIZ, MD
Associate Professor
Director, Head and Neck Surgery
Department of Otolaryngology: Head and Neck Surgery
New England Medical Center
Boston, Massachusetts
Role of Lasers in Intranasal and Sinus Surgery
ANTHONY J. REINO, MD, MSc
Assistant Clinical Professor
Mount Sinai School of Medicine
Associate Director Otolaryngology
Bronx VA Medical Hospital
Assistant Attending Mt. Sinai Medical Center
New York, New York
Assistant Attending St. Lukes-Roosevelt Medical Center
New York, New York
The Intranasal and External Ethmoidectomy
STANLEY M. SHAPSHAY, MD
Professor and Chairman
Department of Otolaryngology: Head and Neck Surgery
Tufts University School of Medicine

New England Medical Center

Boston, Massachusetts
Role of Lasers in Intranasal and Sinus Surgery
PONTUS L.E. STIERNA, MD, P D
Department of Clinical Services
Division of Otorhinolarygology, Karolinska Institute
Huddinge, Sweden
Physiology, Mucociliary Clearance, and Neural Control
MIRKO TOS, MD
Professor and Head, Department of Otorhinolaryngology,
Head and Neck Surgery
Gentofte University Hospital
Copenhagen, Denmark
Nasal Polyps: Origin, Etiology, Pathogenesis, and Structure
ERICA R. THALER, MD
Associate Professor
Department of Otorhinolaryngology: Head and Neck Surgery
University of Pennsylvania Health System
Philadelphia, Pennsylvania
Management of Acute Rhinosinusitis
GREGORY S. WEINSTEIN, MD
Associate Professor
Department of Otorhinolaryngology: Head and Neck Surgery
University of Pennsylvania Health System
Philadelphia, Pennsylvania
Open Surgical Resection of Sinus Neoplasms
BIRGIT WINTHER, MD
Assistant Professor, Department of Otolaryngology
University of Virginia Health System
Research Director, Virginia Sinus Center
Charlottesville, Virginia
Microbiology of Sinusitis
ALLAN E. WULC, MD, FACS
Clinical Associate Professor
Scheie Eye Institute, University of Pennsylvania
Abington Memorial Hospital
Abington, Pennsylvania
Endoscopic Surgery of the Orbit
DAVID M. YOUSEM, MD
Professor of Radiology, Department of Radiology
Johns Hopkins Hospital
Baltimore, Maryland
Imaging in Sinus Disease
S. JAMES ZINREICH, MD
Associate Professor in Radiology /
Otolaryngology: Head and Neck Surgery
Chief Head and Neck Imaging
Johns Hopkins Medical Institutions
Baltimore, Maryland
Radiographic Anatomy of the Sinuses;
Image-Guided Functional Endoscopic Sinus Surgery

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