Frontal Sinus Patency after Extended Frontal Sinusotomy Type III

Document Type: Original

Authors

1 Department of Otorhinolaryngology, Khatamolanbia Hospital, Zahedan University of Medical Sciences, Zahedan, Iran.

2 Department of Otorhinolaryngology , Medical school, Tehran University of Medical Sciences, Tehran, Iran.

3 Department of Otorhinolaryngology Head Neck Surgery, Valiasr Hospital, Imam Khomeini Hospital Complex, Tehran, Iran.

Abstract

Introduction:
The surgical management of chronic frontal sinus disorders remains a challenge for rhinologists. The aim of this study was to evaluate the result of Draf III in a series of patients who underwent this procedure.
 
Materials and Methods:
Twenty patients were included in this study. Demographic data, history of prior surgery, asthma,  aspirin sensitivity and Lund–Mackay score were recorded. A visual analog scale was used for frontal-related symptoms. Patients were followed for a mean duration of 17.5 months and the patency of the frontal sinus ostium was closely monitored.
 
Results:
Fifteen patients with chronic frontal sinusitis, two patients with mucoceles, two with malignancy, and one with osteoma underwent Draf III. The mean symptoms score significantly decreased from 5.9 to 3. No ostial closure was seen in the follow-up period. Among 15 patients with chronic frontal sinusitis, 12 had patent ostia of whom three had significant stenosis. All patients with mucocele and osteoma had patent ostia in the follow-up period but patients with sinonasal malignancy showed significant stenosis.
 
Conclusion:
Draf III frontal sinusotomy is successful in alleviating patient symptoms and the frontal sinus neo-ostium will remain patent in long-term follow-up of most patients. Revision surgery will be required in some cases, which seems to be related to the nature of the underlying chronic sinus diseases.

Keywords

Main Subjects


1. Scott NA, Wormald P, Close D, Gallagher R, Anthony A, Maddern GJ. Endoscopic modified Lothrop procedure for the treatment of chronic frontal sinusitis: a systematic review. Otolaryngol Head Neck Surg. 2003; 129(4):427–38.

2. Gross WE, Gross CW, Becker D, Moore D, Phillips D. Modified transnasal endoscopic Lothrop procedure as an alternative to frontal sinus obliteration. Otolaryngol Head Neck Surg 1995; 113: 427–34.

3. Silverman JB, Prasittivatechakool K, Busaba NY. An evidence-based review of endoscopic frontal sinus surgery. Am J Rhinol Allergy 2009;23(6):e59–62.

4. Philpott CM, Thamboo A, Lai L, Park J, Javer AR. Endoscopic frontal sinusotomy-preventing recurrence or a route to revision? Laryngoscope. 2010; 120(8): 1682–6.

5. Weber R, Draf W, Kratzsch B, Hosemann W, Schaefer SD. Modern concepts of frontal sinus surgery. Laryngoscope. 2001;111(1):137–46.

6. Schlosser RJ, Zachmann G, Harrison S, Gross CW. The endoscopic modified Lothrop: long-term follow-up on 44 patients. Am J Rhinol. 2002; 16:103–8.

7. Tran KN, Beule AG, Singal D, Wormald PJ.
Frontal ostium restenosis after the endoscopic modified Lothrop procedure. Laryngoscope. 2007; 117(8):1457–62.

8. Hwang PH, Han JK, Bilstrom EJ, Kingdom TT, Fong KJ. Surgical revision of the failed obliterated frontal sinus. Am J Rhinol. 2005;19(5):425–9.

9. Draf W. Endonasal micro-endoscopic frontal sinus surgery: The fulda concept. Op Tech Otolaryngol Head Neck Surg. 1991; 2:234–40.

10. Ting JY, Wu A, Metson R. Frontal sinus drillout (modified Lothrop procedure): long-term results in 204 patients. Laryngoscope. 2014;124 (5): 106–70.

11. Shirazi MA, Silver AL, Stankiewicz JA. Surgical outcomes following the endoscopic modified Lothrop procedure. Laryngoscope. 2007; 117(5):765–9.

12. Georgalas C, Hansen F, Videler WJ, Fokkens WJ. Long terms results of Draf type III (modified endoscopic Lothrop) frontal sinus drainage procedure in 122 patients: a single center experience. Rhinology. 2011; 49(2):195–201.