Extended endoscopic frontal sinus surgery to interrupted nasofrontal communication caused by scarring of the anterior ethmoid: long-term results.

OBJECTIVE: To examine the long-term results of extended endoscopic frontal sinus surgery, including removal of the floor of the frontal sinus (Draf type II procedure) and the median drainage operation (Draf type III procedure or modified Lothrop procedure), for obstructive frontal sinusitis caused by postoperative scar formation, with the emphasis on the long-term success of the median drainage procedure.

DESIGN: Retrospective review of 22 consecutive cases of extended endonasal frontal sinus surgery in patients with obstructive frontal sinusitis caused by postoperative scarring.

SETTING: The procedures were performed at a private surgicenter in Japan.

PATIENTS: Twenty-two patients (15 males and 7 females) ranging in age from 14 to 61 years. All patients had scar formation in the anterior ethmoid, either with or without middle turbinate lateralization or ethmoiditis. Three patients underwent Draf type II procedure followed by Draf type III procedure because of surgical failure of the type II procedure.

MAIN OUTCOME MEASURES: Restoration of communication to the frontal sinus was evaluated by computed tomography. All patients were examined at least 12 months after surgery or stent removal.

RESULTS: Of the 16 patients who underwent the type III procedure, in 14 (88%) the patency of the opening to the frontal sinus and an aerated sinus were confirmed. Of 12 sides in 9 patients who underwent Draf type III procedure, 5 sides (42%) were also confirmed as "cured."

CONCLUSIONS: The median drainage operation (Draf type III procedure) on the frontal sinus showed excellent long-term results compared with the type II procedure. Extended endoscopic frontal sinus surgery, particularly the median drainage procedure, is useful in the functional treatment of obstructive frontal sinusitis caused by postoperative scarring.