Endonasal Frontal Sinusotomy in Surgical Management of Chronic Sinusitis: A Critical Evaluation

Abstract

Frontal sinusotomy was performed on 110 patients undergoing routine endoscopic endonasal ethmoidectomy and the minimum diameter of the frontal sinus neo-ostium was determined intraoperatively. A total of 82 patients could be subjected to follow-up and redetermination of the neo-ostium diameter 13 months later. A postoperative CT was scheduled in 62 cases. The average minimum diameter of the frontal sinus neo-ostium, measured intraoperatively, was 5.6 mm (0-11 mm). After completion of wound healing, 81% of the frontal sinuses could be explored by probing or even inspected by rigid endoscopy. The average minimum diameter of the neo-ostia determined postoperatively was 3.5 mm (0-11 mm). Patients exhibiting aspirin sensitivity or diffuse nasal polyposis showed a more pronounced scarred constriction of the frontal sinus access compared to other cases. Neo-ostia exceeding 5 mm intraoperatively were preserved with a considerably higher percentage than those with diameters of less than 5 mm. Radiologically, the fenestrated frontal sinuses frequently showed continued or even increasing mucosal congestion. No conclusive relationship was found to exist between such post-operative clouding and frontal sinus accessibility (endoscopy and/or probing) or patient complaints. The investigations confirm the safety and reliability of frontal sinusotomy in surgical management of chronic paranasal sinusitis. The mucosa of the frontal sinus often reacts to surgery in the form of persistent or even newly developing mucosal swelling to which a specific pathophysiological significance cannot always be attributed.

Outcomes of revision endoscopic modified Lothrop procedure

“…When this procedure fails, our next step is to offer an endoscopic modified Lothrop procedure (EMLP), otherwise known as a Draf III frontal sinusotomy or frontal drillout. The success of Draf IIA frontal sinusotomy with regard to subjective and objective measures has been reported in a number of works, 2,[5][6][7] as has the successful use of the EMLP for salvage surgery in the setting of failed frontal sinusotomy. 4,8 Failure rates of primary EMLP are reported to range between 5% and 32%.…”

Selecting the Best Approach to the Frontal Sinus

“…The Philadelphia group found in their series of 130 frontal sinusotomies that 10 (8%) required further intervention based on endoscopic findings and the ability to cannulate the frontal sinus [14]. Other centres have also reported excellent results using similar endoscopic techniques [3,15] and have been able to demonstrate a significant improvement in the quality of life of the patients post-operatively [16]. Maintaining the theme of the minimally invasive approach, the frontal sinus rescue procedure is an alternative option to employ when the middle turbinate has been previously resected [17,18].…”

“…Messerklinger developed the endoscopic technique with the aim to relieve diseased sinuses while preserving mucosa and at the same time being minimally invasive [2]. Whilst the technique has previously been championed [3], other endoscopic techniques have gained recent vogue, namely the modified Lothrop [4,5] (frontal sinus drill out) and balloon sinuplasty [6]. Combined and open approaches to the frontal sinus are other available options, for example trephination [7,8] and osteoplastic flaps with or without obliteration [9][10][11].…”

State of the Art Treatment of Nasal Polyposis

“…Other stents releasing doxycycline 161 and paclitaxel 162 have been also described; however, additional research is necessary to document their safety, efficacy, and indications in humans. Where Ͼ40% of the frontal recess mucosa has been disrupted 156 If frontal sinus ostium Ͻ5 mm 157 Cases of frontal sinus of unobliteration After tumor resection (inverted papilloma and osteoma) After advanced frontal sinus surgery (e.g., Draf III 158 ) 294…”