Assessment of the necessity of frontal sinostomy in cases of frontal sinusitis associated with fungus ball of the maxillary sinus.

PURPOSE: This study was conducted to evaluate outcomes in patients presenting with fungus ball of the maxillary sinus (MSFB) and frontal sinusitis who were treated via middle meatal antrostomy alone. METHODS: This was a randomized, controlled study with a parallel group design. Patients with MSFB and frontal sinusitis were randomly assigned to the maxillary middle meatal antrostomy (MMMA) or control (MMMA + frontal sinusotomy) groups. Patient demographics, complaints, imaging findings were analyzed, and surgical outcomes were evaluated using the Lund-Kennedy endoscopic score (LKES) and the 22-item Sino-Nasal Outcome Test (SNOT-22) questionnaire. RESULTS: In total, 40 patients were separated into two groups, with similar symptoms including nasal obstruction, mucopurulent rhinorrhea, maxillary or frontal pain, blood stained nasal discharge, nasal cacosmia and orbital pain being observed in both groups. Total LKES and SNOT-22 scores were significantly improved in both groups at 6 months post-treatment, with no significant differences in these scores between groups within a mean 6.8-month follow-up. CONCLUSION: These results suggest that frontal sinusotomy is not required to resolve frontal sinusitis associated with MSFB. As such frontal sinusitis appears to be a reactive process caused by fungal ball obstruction, it regresses spontaneously following fungus ball removal, drainage of the maxillary sinus, and middle meatal antrostomy.

Assessment of International Frontal Sinus Anatomy Classification among senior residents through inter- and intra-rater reliability.

OBJECTIVES: To evaluate the International Frontal Sinus Anatomy Classification (IFAC) reliability among Saudi board otorhinolaryngology senior residents. METHODS: This cross-sectional study was carried out at King Abdulaziz University Hospital, Riyadh, Saudi Arabia between April 2019 and December 2019, included 32 senior residents. Questionnaires with 4 computed tomography images showing the different frontal cell types were used in this survey. All scans included 3 planes (axial, sagittal, coronal) and the tested cell was marked with arrows. Residents chose the answer from multiple choices according to the IFAC system. All residents filled the same questionnaire twice with 2 weeks interval. RESULTS: Approximately 68.8% of residents agreed that the classification was applicable clinically. The resident's attitude toward the importance of understanding IFAC was 65.6%. Residents' correct classification of the marked cells increased significantly for most of the questions from baseline to 2 weeks. CONCLUSION: The frontal sinus is not easy to treat surgically, and its inadequate treatment causes the failure of drainage, as in the case of chronic rhinosinusitis. Therefore, surgeons must fully understand the IFAC system to avoid major and minor complications.

Sinus balloon dilators: one surgeon's experience and proposed indications for their use.

From October 2006 through September 2007, balloon sinusotomies were attempted on 89 sinuses in 45 patients with chronic sinus disease. Ninety-eight percent of sinuses were successfully dilated, 3.4% required revision surgery, and one complication (unlikely related to use of the balloon) occurred. Forty-four percent had previous conventional endoscopic sinus surgery (ESS), 87% were hybrid cases (combination of balloon and conventional ESS instruments used), 33% had nasal polyposis, and 1.98 sinuses per patient were dilated. Preoperative Lund-Mackay radiographic sinus-staging scores averaged 12.62. Sinus balloon dilators (SBDs) were used on the frontal sinuses 81% of the time, sphenoids 13%, and maxillary sinuses 6%. SBDs were found to be efficacious and safe. The devices were useful in identifying and dilating the frontal recess, especially in cases with altered anatomy or limited visibility. When compared to conventional ESS instrumentation, however, SBDs were found to offer little advantage in opening the maxillary or sphenoid sinuses. In frontal sinus hybrid cases, using the author's proposed surgical algorithm reduces operative time, costs and, in some cases, the need for balloon dilatation. SBDs have limited indications in a select group of patients.

Assessment of symptomatic patients after endoscopic sinus surgery with special reference to the frontal sinus: comparative radiologic analysis.

PURPOSE: To reveal the role of potential risk factors in frontal recess dissection (FRD), middle turbinate resection (MTR), sinonasal polyposis, and extension of disease in postoperative frontal sinus opacification by determining radiologic changes after endoscopic sinus surgery (ESS) in symptomatic cases using computed tomography (CT). STUDY DESIGN: Retrospective analysis of prospectively collected data from symptomatic patients after ESS. METHODS: Postoperative CT scans were taken in all symptomatic patients during their least symptomatic period or after maximal medical therapy. The radiologic findings of each sinus were compared, and the outcome of ESS was statistically evaluated. Furthermore, FRD, MTR, sinonasal polyposis, and extension of disease were analyzed for postoperative frontal sinus opacification. RESULTS: In our study, 101 sinuses of 61 symptomatic patients were examined. A significant improvement in opacification in all sinuses was detected postoperatively. Multivariate analysis of all potential risk factors revealed that postoperative frontal sinus opacification was affected only by sinonasal polyposis (odds ratio [OR] 3.32; 95% confidence interval [CI] 1.04-10.58) and extension of disease (OR 16.93; 95% CI 4.33-66.23). CONCLUSIONS: Our study revealed that surgical procedures such as FRD and/or MTR may not directly affect postoperative frontal sinus opacification. On the contrary, sinonasal polyposis and extension of disease seemed to be the main risk factors of this issue.