[Endonasal frontal sinus surgery with permanent implantation of a place holder]

R Weber, W Hosemann, W Draf, R Keerl, B Schick, S Schinzel
Laryngo- Rhino- Otologie 1997, 76 (12): 728-34

BACKGROUND: Endonasal frontal sinus surgery is well established. It is not yet clear what degree of enlargement of the frontal sinus neoostium is required to achieve permanent drainage or whether stenting improves the results.

PATIENTS AND METHODS: Prospective survey with two groups: Group 1. included 10 patients (15 operations) who underwent endonasal sinus surgery because of chronic polypoid sinusitis with stenting of the frontal sinus neoostium for 6 months. Group 2. included 11 patients (21 operations) without stenting.

INTERVENTION: Endonasal frontal sinus surgery with extended drainage Draf Type II (NFA II according to May) with (group 1) and without (group 2) long-term stenting of the neoostium for 5 months using a silicone stent.

MAIN OUTCOME MEASURE: 12-16 months postoperatively: flexible endoscopy of nose and frontal sinus; computed tomography; magnetic resonance tomography; Wilcoxon-Mann Withney-Test.

RESULTS: With stenting: neoostium endoscopically patent in 80% (including 20% with edematous swelling only at the opening to the frontal sinus), occluded by scar tissue in 6.7%, occluded by polyps in 13.3%. Endoscopy and CT/MRT together: normal mucosa and aeration in 93.3%, complete opacification in 6.7%. Without stenting: neoostium endoscopically patent in 33%, occluded by scar tissue in 48%, occluded by polyps in 19%. Endoscopy and CT together: normal mucosa and aeration in 71.4%, aeration and mucosal swelling in 14.3%, complete opacification in 14.3%. With stenting of the frontal sinus neoostium for six months endoscopic evaluation of the frontal sinus was possible in a significantly higher proportion of cases (p = 0.0416).

CONCLUSION: Long-term stenting of the frontal sinus significantly reduces the rate of recurrent stenosis of the frontal neoostium and is recommended in all cases where an extended frontal sinus drainage is necessary. The optimal design for such a stent has not yet been clearly defined.

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