Related Experiment Video
Updated: Aug 1, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Intact Bulla Versus Trans-Axillary: Which is a Better Approach to Frontal Sinus?
Jaskaran Singh1, Bhanu Bhardwaj1, Dhanwant Aulakh2
1Sri Guru Ram Das University of Health Sciences, 27-C, Sant Avenue, The Mall, Amritsar, Punjab 143001 India.
Background:
Frontal sinus is one of the most difficult sinuses to approach endoscopically because of its anatomical location. Challenges and difference in opinions still exist in terms of its surgical management. Endoscopic approach to frontal sinus commonly involves either trans-axillary or intact bulla technique. Trans-axillary technique gives a direct access to the frontal sinus even with a 0° endoscope whereas Intact bulla technique warrants the use of 70° scope. Despite both the techniques now existing for quite some time; literature is still controversial regarding the superiority of one technique over the other.
Methods And Materials:
A randomised prospective study of 40 patients of frontal sinusitis. Patients were randomly allocated into two groups. In approaching frontal sinus, groupA patients underwent trans-axillary technique and group B patients underwent intact bulla technique. Both the groups were statistically compared in terms of time taken for surgery, post operative results and improvement in symptom score.
Results:
The pre-operative endoscopic Lund -Kennedy score in group A was 7.1 ± 1.57 while in group B was 6.95 ± 1.1. The mean post -operative endoscopic Lund Kennedy score in group A was 1.25 ± 0.93. and in group B was 1.05 ± 0.89. The mean pre& SNOT-22 score in group A was 79.85 ± 19.1 and in group B was 80.55 ± 16.94. The mean postoperative SNOT-22 Score in Group A was 4.450 ± 2.136 and group B was 2.579 ± 1. 714.The average time taken in group A to reach frontal sinus was 21.1 ± 5.44 min while in group B it was15.9 ± 3.6 min. At 12 weeks follow up recurrence was seen in 4/20 cases in group A and 3/20 Cases in group B. Ostial Stenosis was seen in 3/20 cases in group A and 2/20 cases in group B. Nasal adhesions were seen in 7/20 cases in group A and 1/20 cases in group B. Middle turbinate lateralization was seen in 8/20 cases in group A and 1/19 cases in group B. Lamina Papyracea injury was seen in 1 case in group B but in 3 cases of group A.
Conclusion:
Both the techniques were highly efficacious in improving post-operative endoscopic as well as symptom scores. However, some post operative complications like middle turbinate lateralization were more with trans-axillary technique as compared to intact bulla technique.
Related Concept Videos
01:14Cranial Bones: Superior and Posterior View
The frontal bone is the single bone that forms the forehead. At its anterior midline, between the eyebrows, there is a slight depression called the glabella. The frontal bone also forms the supraorbital margin of the orbit. Near the middle of this margin is the supraorbital foramen, the opening that provides passage for a sensory nerve to the forehead. The frontal bone is thickened just above each supraorbital margin,...
01:27Cranial Bones: Lateral View
The temporal bone forms the lower lateral side of the skull. The temporal bone is subdivided into several regions. The flattened upper portion is the squamous portion of the temporal bone. Below this area and projecting anteriorly is the zygomatic process of the temporal bone, which forms the posterior portion of the zygomatic arch. Posteriorly is the mastoid portion of the temporal bone. Projecting...
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management