Sphenoid "drill-out" for chronic sphenoid rhinosinusitis

Area of Science:

• Otolaryngology
• Rhinology
• Surgical Innovation

Background:

• Chronic sphenoid rhinosinusitis (CSR) refractory to medical management and sphenoidotomy presents a treatment challenge.
• A surgical hierarchy for frontal sinus disease exists, but not for persistent sphenoid sinus disease.
• Sphenoid marsupialization is an established method for recurrent sphenoid sinusitis.

Purpose of the Study:

• Introduce a novel surgical technique, the sphenoid drill-out, for managing recalcitrant CSR.
• Position the sphenoid drill-out within the existing surgical hierarchy for CSR treatment.
• Evaluate the safety and efficacy of the sphenoid drill-out procedure.

Main Methods:

• Retrospective review of 10 patients undergoing sphenoid drill-out for CSR between 2005 and 2009.
• Analysis of patient demographics, diagnoses, comorbidities, and prior surgical history.
• Assessment of surgical outcomes using Lund-Kennedy scores to measure endoscopic improvement.

Main Results:

• Ten patients underwent the sphenoid drill-out procedure with an average follow-up of 17 months.
• Patients had a history of an average of 5 prior sinus surgeries, including 2.6 prior sphenoidotomies.
• Significant improvement in Lund-Kennedy scores from a mean of 6.67 preoperatively to 1.78 postoperatively (p < 0.001).

Conclusions:

• The sphenoid drill-out procedure is a safe and effective treatment for recalcitrant chronic sphenoid rhinosinusitis.
• This technique serves as an intermediate option between traditional sphenoidotomy and sphenoid marsupialization.
• The sphenoid drill-out offers a valuable addition to the surgical armamentarium for complex CSR cases.