The axillary flap is a safer but tedious technique for Agger nasi cell removal compared to punch out procedures

Abstract

Objective:This study prospectively assessed the axillary flap approach versus punch-out procedure for agger nasi cell (ANC) removal.This is akey for successful frontal sinus surgery and its implication on the patency of the frontal ostium and middle turbinate lateralization(MTL). Subjects and Methods: The study subjects consisted of 50 patients of whom 30 patients were males (80 frontal sinuses; 30 patients with bilateral disease and 20 patients with unilateral disease) with proven chronic frontal sinusitis, with pneumatized ANC according to CT findings.All patients undergone Endoscopic Sinus Surgery (ESS) with dissection of frontal recess. Group I included 40 sides that undergone removal of ANC using the axillary flap procedure (procedure 1), Group II included 40 sides that undergone removal of ANC using the punch out procedure (procedure 2). Adelaide chronic rhinosinusitis (CRS) symptom scoring questionnaires was used to all patients during their last follow-up visit 3 months after surgery. Results: ANC were the most common variation and were observed in all the patients (20 patients unilaterally and 30 patients bilaterally). MTL following ANC removal has been found in 7.5% ofGroup I and 25% in Group II patients. Association between Adelaide symptoms severity score of postoperative symptoms and MTL was significant for nasal obstruction and rhinorrhea in both procedures (1 and 2). Non visualization of the frontal ostium following ANC removal has been found in 7.5% of Group I and 15% in Group II.Comparison between both procedures on MTL and non-visualization shows that the number of patients with MTL-positive using procedure 1 was significantly less than procedure 2 while there was a non-significant difference between procedure 1 and 2 regarding non-visualization. Conclusions: The axillary flap technique is a safer procedure for resection of the ANC with perfect healing and less incidence of intraoperative and postoperative complications.However, it is a relatively difficult procedure and very time consuming while punch out procedure is a relatively easy, less time consuming procedure.