Efficacy of the Modified Endoscopic Frontal Sinus Surgery for Recurrent Chronic Frontal Sinusitis

Abstract

To modify the endoscopic frontal sinus surgery and improve the therapeutic effect of recurrent chronic frontal sinusitis (RCFS). Eighty-five patients with RCFS were divided into two groups. Endoscopic frontal sinus surgery through an approach of Frontomaxillary ProcessAgger Nasi, a modified Draf IIb procedure, was carried out in 51 patients (Group A), and conservative medication was applied in 34 patients as control (Group B). The therapeutic effect was prospectively evaluated with statistically validated measures of sinusitis-specific quality of life, sinonasal outcome test-20 questionnaire . Compared with pre-treatment, the average total score of SNOT-20 in RCFS patients was significantly decreased at the time of 6, 12 months after modified endoscopic frontal sinus surgery and medical treatments (p \ 0.05). However, the total score of SNOT20 was significantly lower in group A than group B at the same period of the follow-up after treatments (p \ 0.05). The overall efficacy evaluated by patients' self showed that the rate of ''much improved'' and ''improved'' was respectively 68.6 and 17.6 % in group A, and significantly better than group B (p \ 0.001). Furthermore, the frontal sinus patency rate in group A was 85 %, and significantly higher than group B (p \ 0.001). Endoscopic frontal sinus surgery through an approach of Frontomaxillary Process-Agger Nasi, a modified Draf IIb procedure, is an effective procedure to treat the RCFS.

Agger Nasi Cells Versus Lacrimal Cells and Uncinate Bullae in Cone-Beam Computed Tomography

“…11 A modified endoscopic frontal sinus surgical approach was proposed that uses the agger nasi landmark to approach the frontal sinus floor by drilling the frontal process of the maxillary bone (termed the “frontomaxillary process”). 11 The prevalence of ANCs in the 85 patients included in the study was not presented 11 nor was a discussion provided of how the substitution of an ANC with an LC could impede the modified endoscopic procedure. Rather, it was reported that the “frontomaxillary process was directly drilled out upward between the orbital plate of the ethmoid bone and attachment of middle turbinate.” 11 This overlooks the lacrimal bone intercalated between the frontal process and ethmoidal labyrinth.…”

“…11 The Draf procedures and endoscopic modified Lothrop procedure are challenging techniques that are useful for the management of difficult frontal sinus diseases. 11 A modified endoscopic frontal sinus surgical approach was proposed that uses the agger nasi landmark to approach the frontal sinus floor by drilling the frontal process of the maxillary bone (termed the ''frontomaxillary process''). 11 The prevalence of ANCs in the 85 patients included in the study was not presented 11 nor was a discussion provided of how the substitution of an ANC with an LC could impede the modified endoscopic procedure.…”

“…Although conventional endoscopic frontal sinus surgery can alleviate most chronic frontal sinusitis, peculiar anatomic patterns challenge the endoscopic intranasal approach. 11 The Draf procedures and endoscopic modified Lothrop procedure are challenging techniques that are useful for the management of difficult frontal sinus diseases. 11 A modified endoscopic frontal sinus surgical approach was proposed that uses the agger nasi landmark to approach the frontal sinus floor by drilling the frontal process of the maxillary bone (termed the ''frontomaxillary process'').…”

“…Rather, it was reported that the ''frontomaxillary process was directly drilled out upward between the orbital plate of the ethmoid bone and attachment of middle turbinate.'' 11 This overlooks the lacrimal bone intercalated between the frontal process and ethmoidal labyrinth. Endoscopy is used for both nasal and sinus surgery and dacryocystorhinostomy (DCR).…”

Comparison between the draf IIc and standard draf IIb procedure for frontal sinus drainage: single center experience and comparison of outcomes

“…Results of recent studies show relatively high and comparable rates of mucosal hyperplasia in ventilated frontal sinuses of patients who underwent an endoscopic drainage procedure: after a 12-98 month follow-up 12 % in type II and 17% in type III procedure. [6][7][8] Hyperplastic mucosa after an endoscopic rhinosurgery does not necessarily dictate an adjunctive conservative therapy, in particular not when these patients are symptom-free and have a normal endoscopic finding, in spite of a thickened mucosa seen on a computerized tomography (CT) scan. In our experience, CT and endoscopic findings often do not correlate well when the former shows mucosal thickening.…”