Frontal Sinusitis Management: Intact Ethmoidal Bulla Technique Vs Ethmoidal Bullectomy
Article Sidebar
Main Article Content
Abstract
Introduction
Conventional functional endoscopic sinus surgery (FESS) for frontal sinusitis treatment involves ethmoidal bullectomy, that is associated with damage to the surrounding structures. These complications can be overcome by minimally invasive FESS anterior to the ethmoidal bulla that allows ease in locating the sinus ostium, eliminating risk of injury to anterior skull base and nearby structures. This study aims to compare the efficacy of ethmoidal bullectomy versus intact ethmoidal bulla technique as an adjunct to FESS in frontal sinusitis management.
Materials and Methods
Forty patients, clinically and radiologically diagnosed with frontal sinusitis, were randomly divided into 2 groups: Group A (n=20; treated with FESS keeping the ethmoidal bulla intact) and Group B (n=20; treated using FESS with ethmoidal bullectomy). After detailed history and clinico-radiological examinations, diagnostic nasal endoscopy was performed, followed by FESS. Pre- and post-operative endoscopic and clinical assessment was done using Modified Lund-Kennedy Endoscopy (MLKE) Score and Sino-Nasal Outcome Test-22 (SNOT-22) Questionnaire, respectively. Data was analyzed using software R version 3.6.3.
Results
Significant reductions in SNOT-22 (clinical improvement) and MLKE scores (endoscopic improvement) were seen within the groups from baseline to each follow-up visit and between the successive recall visits (p<0.001). The SNOT-22 and MLKE scores were insignificant at any visit between the groups, along with age distribution, gender and intra-operative complications (p>0.05). Complications were seen only in Group B.
Conclusion
Both, ethmoidal bullectomy and intact ethmoidal bulla technique, when used as adjuncts to FESS, showed similar improvements in frontal sinusitis patients. However, bullectomy was associated with greater risk of intra-operative complications.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
References
Brook I. Acute and chronic frontal sinusitis. Curr Opin Pulm Med. 2003; 9:171-4
Goldberg AN, Oroszlan G, Anderson TD. Complications of frontal sinusitis and their management. Otolaryngol Clin North Am. 2001; 34:211-25
Kolsi N, Zrig A, Chouchène H, Bouatay R, Harrathi K, Koubaa J. Imaging of complicated frontal sinusitis. Pan Afr Med J. 2017; 26:209
Anon JB, Jacobs MR, Poole MD, Ambrose PG, Benninger MS, Hadley JA, et al. Antimicrobial treatment guidelines for acute bacterial rhinosinusitis. Otolaryngol Head Neck Surg. 2004; 130:1‐45
Kaliner M. Medical management of sinusitis. Am J Med Sci. 1998; 316:21-8
Metson R, Sindwani R. Endoscopic surgery for frontal sinusitis - a graduated approach. Otolaryngol Clin North Am. 2004; 37:411-22
Metson R, Gliklich RE. Clinical outcome of endoscopic surgery for frontal sinusitis. Arch Otolaryngol Head Neck Surg. 1998; 124:1090–6
Lal D, Hwang PH. Endoscopic techniques in frontal sinus surgery. In: Lal D, Hwang P, editors. Frontal sinus surgery. Springer, Cham; 2019; pp. 83-125.
Eloy P, Andrews P, Poirrier AL. Postoperative care in endoscopic sinus surgery: A critical review. Curr Opin Otolaryngol Head Neck Surg. 2017; 25:35-42
Ji JF, Cheng Y, Wang TY, Wu KM, Jiang MJ, Cheng W, et al. Isolated frontal sinusitis treated using an anterior-to-ethmoidal bulla surgical approach. Cell Biochem Biophys. 2014; 70:1153-7
Landsberg R, Segev Y, Friedman M, Fliss DM, Derowe A. A targeted endoscopic approach to chronic isolated frontal sinusitis. Otolaryngol Head Neck Surg. 2006; 134:28-32
Ethmoidectomy sinus surgery. Available at: https://www.medtronic.com/us-en/patients/treatments-therapies/sinus-surgery/functional-endoscopic-sinus-surgery/ethmoidectomy.html. Accessed Mar 26, 2020
Ji J, Zhou M, Li Z, Wang T, Cheng Y, Wang Q. Frontal sinus surgery anterior to the ethmoid bulla. Int Surg. 2013; 98:149‐55
Loury MC. Endoscopic frontal recess and frontal sinus ostium dissection. Laryngoscope 1993; 103:455-8
Lund VJ, Mackay IS. Staging in rhinosinusitis. Rhinology 1993; 107:183-4
Lund VJ, Kennedy DW. Staging for rhinosinusitis. Otolaryngol Head Neck Surg. 1997; 117:S35-40
Psaltis AJ, Li G, Vaezeafshar R, Cho KS, Hwang PH. Modification of the Lund-Kennedy endoscopic scoring system improves its reliability and correlation with patient-reported outcome measures. Laryngoscope 2014; 124:2216-23
Sino-Nasal Outcome Test (SNOT-22). Available at: https://www.canvasc.ca/pdf/SNOT22.pdf Accessed Mar 28, 2020
Browne J, Hopkins C, Slack R, van der Meulen J, Lund V, Topham J, et al. On behalf of the British Association of Otorhinolaryngologists – Head and Neck Surgeons Comparative Audit Group and the Clinical Effectiveness Unit at the Royal College of Surgeons of England. The National Comparative Audit of Surgery for Nasal Polyposis and Chronic Rhinosinusitis. Available at: https://www.rcseng.ac.uk/-/media/files/rcs/library-and-publications/non-journal-publications/national-comparative-audit-of-surgery-for-nasal-polyposis-and-chronic-rhinosinusitis.pdf Accessed Mar 26, 2020
Abuzeid WM, Mace JC, Costa ML, Rudmik L, Soler ZM, Kim Gs, et al. Outcomes of chronic frontal sinusitis treated with ethmoidectomy: A prospective study. Int Forum Allergy Rhinol. 2016; 6:597‐604
Kaluskar SK. Complications in FESS. In: Endoscopic Sinus Surgery, Springer, London; 1997. pp. 79-90
Stankiewiez JA. Complications of endoscopic intranasal ethmoidectomy. Laryngoscope 1987; 97:1270-3
Stankiewiez JA. Complications in endoscopic intranasal ethmoidectomy: An update. Laryngoscope 1989; 99:686-90
Wormald PJ. The agger nasi cell: The key to under- standing the anatomy of the frontal recess. Otolaryngology 2003; 129:497-507