BICORONAL BIFRONTAL OSTEOPLASTIC APPROACH

RESECTION OF FRONTAL / ETHMOIDAL / ORBITALMUCOCELE 
INFORMED CONSENT

DESCRIPTION AND PURPOSE OF THE OPERATION

You have a large cyst (mucocele) that has destroyed the bone of the frontal sinus and extended posteriorly to compress the brain.  Inferiorly, it has destroyed the left ethmoid sinus and reached the nose.  In addition, it has extended into the left orbit and pushed the left eyeball downward and outward toward the ear.  The purpose of the operation is to remove this mucocele and reconstruct the left orbit.  A barrier will also be created to prevent the brain from herniating into the nose or into the eye.

The operation is done under general anesthetic. The hair is cut or shaved in the appropriate spot. A cut is made from one temple in front of the ear, curving upwards to the crown of the head and down to the opposite temple. The skin and muscle of the scalp are moved downwards and a piece of the skull bone is removed to open the frontal sinus.  The mucocele (cyst ) will be removed from the frontal sinus from the left ethmoid sinus and from the left orbit where it has displaced the left eye downward and to the side. The cyst which has already destroyed the back wall of the frontal sinus and displaced the frontal lobe of the brain backward will then be peeled off the covering of the brain (dura). The floor of the anterior cranial fossa and the roof of the left orbit will then be reconstructed with titanium plates / mesh and bone cement.  A bone or cartilage graft may be taken from the nasal septum and placed in the roof of the orbit to separate the eye from the pulsating brain. The brain covering is then closed, the bone is replaced and held in place with metallic plates. The skin and muscle are then closed with stitches and/ or staples.  If needed, we may also remove fat from the abdomen to fill the frontal sinus.  This procedure will not improve eyesight in the left eye which already has decreased vision.

POSSIBLE COMPLICATIONS:

General Risks of Any Prolonged Surgical Procedure Under General Anesthesia:

(a) Small areas of the lungs may collapse, increasing the risk of chest infection. This
may need antibiotics and physiotherapy.
(b) Clots in the legs (deep vein thrombosis) with pain and swelling. Rarely part of this
clot may break off and go to the lungs which can be fatal.
(c) A heart attack because of strain on theheart or a stroke.

Complications of Anterior Skull Base, Frontal Sinus and Cranial Surgery

(a)Bleeding which may require transfusion.
(b)Cerebrospinal fluid leak (CSF) leak into the nose which may require another procedure to stop it.
(c)Infection or Meningitis.
(d)Nosebleed from the donor site of the bone graft.
(e)Scar formation, keloid formation and loss of hair around the scar.
(f)Loss of sensation in the skin of the forehead and scalp.


I have been given an opportunity to ask questions about my condition, alternative forms of treatment, risks of no treatment, the procedures to be used, and the risks and hazards involved, and I have sufficient information to give this informed consent. I certify this form has been fully explained to me, and I understand its contents. I understand every effort will be made to provide a positive outcome, but there are no guarantees.


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Patient / Legal Guardian

________________________________________________________________________
Witness

Date:___________________________                Time:___________________________


www.ghorayeb.com
Bechara Y. Ghorayeb, MD
Otolaryngology-Head & Neck Surgery
1140 Business Center Drive, Suite 560.  Houston, Texas 77043
Phone: (713) 464 2614