Endoscopic Frontal Sinus Exploration in Children with Cystic Fibrosis

Abstract

Objectives: Frontal sinus exploration is uncommon in children. Delayed pneumatization of the frontal sinus, technical difficulties, and concerns for postoperative scarring and mucocele formation impact the incidence of this operation in the pediatric population. The objective of this study is to review outcomes after endoscopic frontal sinus exploration in children with cystic fibrosis (CF). Methods: Retrospective case series of children with CF undergoing endoscopic frontal sinus exploration at a tertiary children’s hospital from 2004 to 2012. Pre- and postoperative pulmonary function tests (PFT), surgical complications, and the rate of revision operations were evaluated. Outcomes were compared to a cohort of children without CF that underwent endoscopic frontal sinusotomy for chronic sinusitis. Results: Twenty-three children (12 with CF, 11 without CF) underwent endoscopic frontal sinusotomy. The average age was 11.3 years (range 7-14) in the CF group compared to 13.5 years (range 6-18) in the non-CF population. Four of the 12 CF patients (33%) required at least 1 revision operation, compared to 1 of 11 control patients without CF (not statistically significant). No significant improvement in PFT was noted after surgery (mean FEV1% predicted pre-operative: 97.3 ± 19.9, post-operative: 96.7 ± 27.6). The average time from initial surgery to revision operation was 20.3 months (range 8-30 months). No major surgical complications related to the procedure were identified. Conclusions: The revision rate for frontal sinus exploration in this series is similar to revision rates described in the literature for other sinuses in CF patients. PFT results did not change after the operation.