Maxillary Antrostomy Versus Complete Sinus Surgery for Odontogenic Sinusitis With Frontal Sinus Extension

Area of Science:

• Otolaryngology
• Surgical Innovation
• Sinus Disease Management

Background:

• Odontogenic sinusitis (ODS) often requires endoscopic sinus surgery (ESS).
• The optimal extent of ESS for ODS with extramaxillary sinus involvement, specifically frontal sinus disease, remains under investigation.
• This study addresses the comparative efficacy of different surgical approaches for ODS involving the frontal sinus.

Purpose of the Study:

• To compare surgical outcomes between wide maxillary antrostomy (MA) alone and complete ESS in patients with ODS and frontal sinus involvement.
• To evaluate the impact of surgical extent on symptom resolution and endoscopic findings.
• To determine the optimal surgical strategy for managing ODS with frontal sinus disease.

Main Methods:

• A multicenter prospective cohort study involving 70 patients with uncomplicated ODS and maxillary, anterior ethmoid, and frontal sinus opacification.
• Patients were divided into two groups: MA alone (n=35) and complete ESS (n=35).
• Outcomes measured included 22-item sinonasal outcome tests (SNOT-22) scores, endoscopic findings, and time to resolution of symptoms and endoscopic purulence.

Main Results:

• Complete ESS showed a higher initial resolution rate of anterior ethmoid (AE) purulence at the first postoperative visit (97.1% vs. 71.4%, p=0.006).
• However, the time to resolution of AE purulence was comparable between groups by 6 weeks postoperatively (p=0.158).
• No significant differences were observed in the time to resolution of foul smell or achieving a ≥9 point SNOT-22 reduction between the MA alone and complete ESS groups.

Conclusions:

• Both MA alone and complete ESS provide rapid and sustained symptomatic relief for ODS with frontal sinus involvement.
• While complete ESS may offer faster resolution of frontoethmoidal purulence in some cases, ultimate resolution of sinus purulence is equivalent between the two surgical approaches.
• The findings suggest that MA alone can be a viable option for managing ODS with frontal sinus involvement, with complete ESS providing a potential advantage in early purulence resolution.