Long‐term results after primary frontal sinus surgery

Abstract

The objectives of this study were to evaluate the long-term frontal ostium patency rate and symptom improvement in patients undergoing primary endoscopic frontal sinusotomy (Draf 2A) and to assess the impact of patient factors, disease factors, and frontal ostium size on surgical outcomes. Retrospective chart review was used. Endoscopic assessment of frontal ostium patency and patient-reported symptoms were prospectively collected on patients who underwent primary frontal sinusotomy between January 2003 and December 2009. A total of 109 patients underwent primary endoscopic surgery on 210 frontal sinuses over the study period. The overall patency rate was 92%. Complete resolution of symptoms was noted in 85 patients (78%). Stenosis of the frontal sinus ostium correlated significantly with persistence of symptoms, infection, or polyp recurrence (p = 0.0066), and frontal ostium size (p < 0.03). No significant correlation could be found between the presence of eosinophilic mucin, asthma, polyposis, and smoking on patency or resolution of symptoms. To our knowledge, this is the largest study of primary endoscopic frontal sinus surgery in the literature. The technical and subjective measures of success are high. Frontal ostium size correlates with risk of stenosis of the frontal sinus. Patients with a stenosed frontal ostium and residual frontal sinus disease are more likely to be symptomatic or have endoscopic evidence of polyp recurrence or endoscopic evidence of persistent infection. Asthma, eosinophilic mucin chronic rhinosinusitis (EMCRS), allergy, and smoking do not appear to affect outcomes.