Endoscopic radical antrectomy: a permanent replacement for the Caldwell-Luc operation

Area of Science:

• Otolaryngology
• Surgical Innovation
• Sinonasal Disease Research

Background:

• Chronic sinusitis involves persistent inflammation of sinus lining, potentially leading to irreversible changes.
• Hyperplastic, eosinophilic sinusitis presents a specific challenge in chronic inflammation.
• Identifying effective surgical interventions is crucial for managing refractory sinonasal conditions.

Purpose of the Study:

• To compare the efficacy of endoscopic radical antrectomy versus endoscopic middle meatal antrostomy.
• To evaluate surgical success rates in patients with chronic, hyperplastic, eosinophilic sinusitis.
• To assess both subjective patient improvement and objective endoscopic sinus appearance.

Main Methods:

• A randomized controlled trial involving 119 patients diagnosed with chronic, hyperplastic, eosinophilic sinusitis.
• Patients were allocated to either classical endoscopic middle meatal antrostomy or endoscopic radical antrectomy.
• Outcomes including subjective improvement and endoscopic sinus evaluation were recorded.

Main Results:

• Endoscopic radical antrectomy showed significantly lower surgical failure rates (14.5%) compared to endoscopic middle meatal antrostomy (32%).
• The study found a statistically significant difference in failure rates (p = 0.023).
• Endoscopic middle meatal antrostomy was associated with a higher prevalence of unhealthy maxillary sinuses post-surgery (p = 0.029).

Conclusions:

• Primary endoscopic radical antrectomy is a superior surgical option for chronic, irreversible sinonasal pathology.
• The procedure demonstrated better subjective and objective results compared to endoscopic middle meatal antrostomy.
• This finding supports endoscopic radical antrectomy as a preferred treatment for specific chronic sinusitis cases.