Surgical outcomes of drillout procedures for complex frontal sinus pathology.

OBJECTIVES: The purpose of this report is two-fold: 1) to determine the incidence and 2) to determine the efficacy of drillout procedures in the management of frontal sinus disease in a tertiary rhinology practice.

STUDY DESIGN: Retrospective data analysis.

METHODS: Chart review was performed for all patients undergoing frontal sinus surgery from May 1999 to April 2004. The incidence of drillout surgery was determined. Demographic data, symptomatology, type of drillout procedure, and primary pathology were determined. Postoperative outcome was assessed based on subjective symptomatology and objective endoscopic patency.

RESULTS: A total of 186 patients underwent 207 frontal sinus procedures during this time period; 25 patients (13.4%) required a total of 30 (14.5%) drillout procedures. The patient population had previously undergone an average of 3.2 procedures; four cases were primary and 26 were revision procedures. The breakdown of the procedures was as follows: Draf III, 17; Draf IIB, 7; and transseptal frontal sinusotomy, 6. The major indications included mucoceles (11 cases), chronic frontal sinusitis (6 cases), and tumors (5 cases). Postoperatively, presenting symptomatology resolved in 32%, improved in 56%, and remained unchanged in 12% of the patients. Endoscopic patency of the neo-ostium was noted in 23 cases (92%). Average follow-up was 16.3 months.

CONCLUSIONS: In this series, drillout procedures were successfully used in 25 patients as an important adjunct to the standard endoscopic techniques for management of complex frontal sinus disease. Because the procedure was used only 30 times during a 5-year period, it was reserved for specific circumstances in carefully selected patients.