A Patient Benefits from the Carolyn’s Window Approach to Unilateral Frontal Sinus Surgery
In 2024, after years of nasal symptoms, bouts of atypical pneumonia, and treatment with antibiotics, 65-year-old Houstonian Lisa Wood developed a bacterial sinus infection that continued to worsen. Her ENT in Cypress, Texas, referred her to Xiaoyang Hua, MD, PhD, a physician researcher and associate professor in the Department of Otorhinolaryngology at McGovern Medical School at UTHealth Houston.
“A CT scan showed dense, calcified material in her left frontal sinus, consistent with a fungus ball,” Dr. Hua says. “Fungal balls are relatively common and tend to affect patients with normal immune systems. Depending on their location, they can cause symptoms like nasal congestion, headaches, eye discomfort, an altered sense of smell, facial pressure, or even visual disturbances. In rare cases, particularly when a patient’s immune system is compromised, a fungal ball can evolve into a very serious condition known as invasive fungal sinusitis.”
Fungal balls are generally treated with endoscopic sinus surgery. “Mrs. Wood has three unique anatomical challenges that made traditional endoscopic surgery more difficult: involvement of the crista galli, a bony structure extending from behind the nasal roof into the cranial vault; a thick frontal beak, the bone that narrows the natural drainage pathway of the frontal sinus; and a widely lateralized frontal sinus that extends far above the left eye socket,” Dr. Hua says. “Because of these factors, a traditional approach would not have allowed us full access to her frontal sinus and would have carried a higher risk of complications. With Mrs. Wood, we used the alternative Carolyn’s window approach in which we drilled away the very thick frontal beak, which allowed us to successfully remove all the disease in her left frontal sinus and pneumatized crista galli.”
Wood, a retired surgical nurse, underwent surgery in September 2024. “My left side had been plugged for as long as I can remember – for years and years,” she says. “I adore Dr. Hua. I’ve tried to avoid any kind of surgery and was nervous about the procedure, but he showed me his scope and instruments and explained everything in advance. My recovery was smooth, and I have no congestion. After the surgery, I felt dramatically better, like I had a rainbow in my head. I was totally blessed to find him.”
“In addition to being minimally invasive, the Carolyn’s window approach is straightforward and safe,” Dr. Hua says. “I now use this approach regularly for difficult frontal sinus surgery. In her case, it allowed us to provide a minimally invasive cure.”