Canine fossa trephine is a beneficial procedure in patients with Samter`s triad

Abstract

Background: Canine fossa trephine (CFT) is an adjunctive technique to sinus surgery in patients with recalcitrant maxillary sinusitis. CFT allows for disease clearance in areas of the maxillary sinus that are hard to reach with standard endoscopic techniques. The objective of this study was to compare the surgical outcome of CFT to standard middle meatal antrostomy (MMA) in matched patients with the severely diseased maxillary sinus. Study design: Prospective clinical study Methods: Patients undergoing sinus surgery were enrolled in either the CFT or MMA group. All patients had nasal polyps, Lund Mackay score of 2 in the maxillary sinus, and nasal endoscopy showing the maxillary sinus full of polyps. The patients were followed and the maxillary sinus was graded endoscopically at 3, 6 and 12 months after the surgery. Length of surgery, disease recurrence and need for revision surgery was documented. Results: Forty-two CFTs and MMA were performed in each group. At 6 and 12 months the CFT group demonstrated statistically significant improvement in nasal endoscopy scores. Six patients recurred by the one year mark in the MMA group, 4 of which underwent revision surgery. In the CFT group 2 patients recurred, one who underwent a unilateral revision CFT. Furthermore the CFT did not prolong the surgical time and was often faster than performing a MMA. Conclusion: CFT allows for clearance of all gross disease in the maxillary sinus and appears to improve postoperative outcome at 6 and 12 months and decrease the need for revision surgery.

The Role of Surgery in Management of Samter’s Triad

“…This study was excluded from our review because there were no data specific to postoperative outcomes in patients with AERD reported. A prospective cohort study by Seiberling et al 18 was also excluded from our study but included in the review by Yip et al 13 This article compared 2 surgical techniques in patients with AERD, canine fossa trephination and middle meatal antrostomy. It did not specifically examine the role of endoscopic sinus surgery in the AERD population by comparing pre‐ and postoperative outcomes.…”

Cochrane Corner

“…15,16 Similarly, more extensive surgery to the frontal or maxillary sinus is also associated with longer times to recurrence or lower revision procedures. 17,18 Unfortunately, all these studies are directed at surgical technique rather than CRS with nasal polyps management and fail to account or incorporate the local therapies used in disease maintenance. The efficacy of these ongoing local therapies is most likely to be affected by surgery.…”

“…We may not know the true efficacy of ESS, but we do know from observational studies that some patients do well afterward, at least for a period of time, and that complications are minimal with experienced surgeons. 7,[15][16][17][18] Conversely, not all surgeons are experienced, and complications can be serious. Risk-averse patients with acceptable quality of life may opt for medical therapy, some may prefer an office-based polypectomy, and others will sleep best after a ''thorough'' cleaning with ESS.…”

“…Despite the lack of randomized trials of surgery, there are data to support such an approach, with lower revision rates reported from the UK national audit for patients undergoing ethmoidectomy vs polypectomy 15,16 . Similarly, more extensive surgery to the frontal or maxillary sinus is also associated with longer times to recurrence or lower revision procedures 17,18 . Unfortunately, all these studies are directed at surgical technique rather than CRS with nasal polyps management and fail to account or incorporate the local therapies used in disease maintenance.…”

“…The uncertainty noted above sounds a clarion call for honesty and shared decision making with patients. We may not know the true efficacy of ESS, but we do know from observational studies that some patients do well afterward, at least for a period of time, and that complications are minimal with experienced surgeons 7,15–18 . Conversely, not all surgeons are experienced, and complications can be serious.…”