Different Endoscopic Approaches Addressing Frontal Sinus

Abstract

Background: Chronic frontal sinusitis as a component of chronic rhinosinusitisis is one of the greatest challenges in rhinology. The endoscopic endonasal approach to the frontal sinus became the standard approach in chronic rhino sinusitis refractory to medical management. Objectives: The aim of this work is to assess different approaches addressing frontal sinus disease in twenty four patients with chronic frontal sinusitis resistant to medical treatment for a period not less than twelve weeks in Otorhinolaryngology Department in Zagazig University Hospitals from March 2018 to November 2018. Patients and methods: Patients' age ranged from 20 to 58 years with a mean of 32.6 ± 10.68. These patients had two different approaches on each nasal side: Zero angled endoscopic approach (to perform standard uncinectomy and anterior ethmoidectomy including resection of ethmoidal bulla with middle turbinate preservation then removal of agger nasi cells accessing frontal sinus) and resection of the superior attachment of uncinate process (with preservation of ethmoidal bulla then using 70 degree angled endoscope to expose the frontal sinus). Results: In both techniques, preservation of ethmoid artery, middle turbinate and lamina papracyae were maintained. Residual mucopurulent discharge in the frontal recess area was found in 4 sides (10%) and managed medically. Endoscopic assessment revealed lateralization of middle turbinate in 6 sides only (15 %) which had ethmoidectomy prior to frontal sinusotomy. Conclusion: Addressing frontal sinus through intact bulla technique is less invasive guarding against anterior ethmoidal artery injury, scarring at frontal recess area and frontal ostium restenosis.

Intact Bulla Technique versus Classic Technique as an Endoscopic Approaches to Frontal Sinus

“…Intact bullae technique had the least duration with a mean of 26.57 ± 1.86 minutes compared to classic approach with a mean of 35.61 ± 2.13 minutes. Also, Mobashir et al (7) discovered a statistically significant distinction in operative time between the two procedures. The average time for the intact bullae procedure was only 26.14 minutes, while the time for the traditional method was 35.47 minutes.…”

“…Female represented 72% of patients. Also, Mobashir et al (7) revealed that twenty-four individuals with frontal sinus illness who had failed to improve on medical treatment for at least twelve weeks were studied. Twenty-four patients participated in the research.…”

“…In our study, subjective assessment revealed recurrence of symptoms in one patient with intact bulla technique and one patient with the classic technique, while frontal ostium restenosis occurred in one patient with intact bulla technique and two patients with the classic technique. Objective postoperative endoscopic assessment revealed nasal adhesions between inferior turbinate and septum in 3 sides only 1 in the intact bulla technique and 2 in the classic technique that were excised locally at outpatient clinic, Mobashir et al (7) found nasal adhesions in 4 sides.…”