Factors Influencing Outcome After Frontal Beak Reduction-Does the Surgical Tool Matter?

Introduction: Chronic rhinosinusitis (CRS) with frontal sinus outflow tract (FSOT) obstruction frequently requires frontal beak reduction during endoscopic sinus surgery (ESS). While technical approaches such as rotary drilling or piezoelectric osteotomy may differ in precision and tissue preservation, it is unclear whether surgical instrument choice or patient-specific clinical characteristics influence postoperative quality of life (QoL). Methods: In this prospective cohort study, 49 adult CRS patients undergoing ESS with frontal beak reduction were enrolled (28 males, mean age 50 ± 15 years). Osteotomy was performed using either a conventional drill (n = 25) or piezoelectric knife (n = 24). Baseline clinical data included presence of nasal polyps, asthma, and radiologic severity (Lund-Mackay and Zinreich CT scores). Outcomes included patient-reported symptoms with the 22-item Sino-Nasal Outcome Test (SNOT-22) and visual analogue scale (VAS), and endoscopic Lund-Kennedy scores, recorded preoperatively and at 1, 4, and 24 weeks postoperatively. Results: Both groups demonstrated significant postoperative improvement in SNOT-22 and VAS scores. No significant correlation was observed between SNOT-22 changes and Lund-Kennedy scores in either tool group. Presence of nasal polyps was associated with higher pre- and postoperative Zinreich and Lund-Mackay scores (p < 0.05). Asthma was linked to higher early postoperative symptom burden (nasal blockage, clear discharge; p < 0.05). Tool choice did not significantly influence QoL recovery or modify the effect of clinical characteristics on outcomes. Conclusions: Postoperative QoL improvement was driven primarily by baseline disease phenotype-particularly nasal polyposis and asthma-while the choice of osteotomy instrument did not significantly influence recovery trajectories. The Zinreich score provided additional phenotypic stratification in CRS with FSOT obstruction.