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Efficacy of the modified endoscopic frontal sinus surgery for recurrent chronic frontal sinusitis
Yanhong Ma1, Tiansheng Wang1, Xiaowei Zhang1
1Department of Otolaryngology-Head Neck Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013 China.
Abstract:
To modify the endoscopic frontal sinus surgery and improve the therapeutic effect of recurrent chronic frontal sinusitis (RCFS). Eighty-five patients with RCFS were divided into two groups. Endoscopic frontal sinus surgery through an approach of Frontomaxillary Process-Agger Nasi, a modified Draf IIb procedure, was carried out in 51 patients (Group A), and conservative medication was applied in 34 patients as control (Group B). The therapeutic effect was prospectively evaluated with statistically validated measures of sinusitis-specific quality of life, sino-nasal outcome test-20 questionnaire (SNOT-20). Compared with pre-treatment, the average total score of SNOT-20 in RCFS patients was significantly decreased at the time of 6, 12 months after modified endoscopic frontal sinus surgery and medical treatments (p < 0.05). However, the total score of SNOT20 was significantly lower in group A than group B at the same period of the follow-up after treatments (p < 0.05). The overall efficacy evaluated by patients' self showed that the rate of "much improved" and "improved" was respectively 68.6 and 17.6 % in group A, and significantly better than group B (p < 0.001). Furthermore, the frontal sinus patency rate in group A was 85 %, and significantly higher than group B (p < 0.001). Endoscopic frontal sinus surgery through an approach of Frontomaxillary Process-Agger Nasi, a modified Draf IIb procedure, is an effective procedure to treat the RCFS.
Insights
A modified endoscopic frontal sinus surgery, the Frontomaxillary Process-Agger Nasi approach (a modified Draf IIb procedure), effectively treats recurrent chronic frontal sinusitis (RCFS). This surgical method significantly improves patient quality of life and frontal sinus patency compared to medication alone.
Area of Science:
- Otolaryngology
- Surgical Innovation
- Rhinosinusitis Research
Background:
- Recurrent chronic frontal sinusitis (RCFS) presents significant challenges in treatment.
- Existing endoscopic frontal sinus surgeries may require optimization for improved therapeutic outcomes.
- Patient-reported outcomes and objective measures are crucial for evaluating treatment efficacy.
Purpose of the Study:
- To modify endoscopic frontal sinus surgery for enhanced treatment of RCFS.
- To evaluate the therapeutic effectiveness of a modified Draf IIb procedure using the Frontomaxillary Process-Agger Nasi approach.
- To compare the outcomes of the modified surgical technique with conservative medical management.
Main Methods:
- Eighty-five patients with RCFS were enrolled and divided into two groups.
- Group A (51 patients) underwent modified endoscopic frontal sinus surgery (Frontomaxillary Process-Agger Nasi approach, modified Draf IIb).
- Group B (34 patients) received conservative medical treatment as a control.
- Therapeutic effects were assessed using the sino-nasal outcome test-20 (SNOT-20) questionnaire and patient self-evaluation at 6 and 12 months post-treatment.
Main Results:
- Both the modified surgery and medical treatments significantly decreased SNOT-20 scores post-treatment (p < 0.05).
- Group A demonstrated significantly lower SNOT-20 scores compared to Group B at follow-up (p < 0.05).
- Patient self-evaluation showed higher rates of improvement in Group A (87.2% "much improved" or "improved") versus Group B (p < 0.001).
- Frontal sinus patency rates were significantly higher in Group A (85%) compared to Group B (p < 0.001).
Conclusions:
- Endoscopic frontal sinus surgery via the Frontomaxillary Process-Agger Nasi approach (modified Draf IIb) is an effective procedure for RCFS.
- The modified surgical technique offers superior outcomes in terms of quality of life and sinus patency compared to conservative treatment.
- This approach represents a valuable advancement in managing recurrent chronic frontal sinusitis.
