Factors associated with failure of frontal sinusotomy in the early follow-up period

To understand factors associated with failure of endoscopic frontal sinusotomy.

Retrospective review of 130 consecutive frontal sinusotomies. The preoperative extent of disease was graded radiologically in each frontal sinus as total opacification, partial opacification, or mucosal thickening. Records were also reviewed to determine the incidence of comorbid conditions.

Patency at most recent follow-up was observed in 117/130 (90%). Patency was achieved after our first procedure in 107 sinusotomies. These were considered successes. Ten required revision surgery, and an additional 13 were not patent at last follow-up. These 23 sinusotomies were considered failures. Among those failing our initial surgery, 19/23 (83%) were partially or totally opacified preoperatively. In contrast, only 47/107 (44%) in the success group contained partial or total opacification preoperatively (P = 0.003), with the majority exhibiting mucosal thickening only. Mean follow-up was 8.3 months for the successes and 10.7 months for the failures (P = NS). No significant differences were observed between the success and failure groups with respect to the prevalence of asthma, aspirin sensitivity, or allergic fungal disease. Patients in the failure group, however, had a higher mean number of prior surgeries before undergoing frontal sinusotomy at our institution (1.8 vs 0.9, P = 0.033).

During the early follow-up period, failure of endoscopic frontal sinusotomy is associated with advanced degrees of preoperative disease within the sinus and is also more likely in patients who have failed prior surgical management.