Factors affecting the outcome of frontal sinus surgery: a prospective study

Chronic frontal sinus disease has always been a difficult problem to treat. We undertook this study to evaluate our results of frontal recess surgery, to determine the factors which affected the surgical outcome and to determine whether the post-operative findings correlated with the symptomatic improvement in the patients. Twenty-four patients with chronic sinus pathologies involving the frontal sinus were included in this study. After failure of maximal medical treatment, they were subjected to endoscopic surgery. The factors assessed included the pneumatisation of the frontal recess on CT scan, the technique of surgery, the intra-operative frontal glow, the state of the frontal recess at the end of surgery, the appearance of the recess on follow-up endoscopy and the symptomatic relief in the patients. 81.2% of well pneumatised frontal recesses had a good outcome while only 42.1% of the poorly pneumatised frontal recesses had a good outcome. 76.2% of cases with a frontal glow seen intra-operatively had a favourable surgical result while 44.4% of cases without a frontal glow intra-operatively had a favourable surgical result. Two-thirds (66.7%) of cases with mucosa-lined frontal recess did well post-operatively while only 33.3% of cases with a raw frontal recess did well following surgery. Well pneumatised frontal recesses, presence of an intra-operative frontal glow and a mucosa-lined frontal recess corresponded with better post-surgical outcomes. A difference in the intra-operative technique did not influence the result after surgery. Nineteen out of 24 patients (79.2%) were asymptomatic after surgery while 5 patients had residual symptoms.