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The prognostic variables affecting the frontal sinusotomy patency outcome and how to manage: A prospective study
Author(s) -
Khafagy Yasser,
Ghonim Mohamed,
Elgendy Ahmed,
Elzayat Saad
Publication year - 2021
Publication title -
clinical otolaryngology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.914
H-Index - 68
eISSN - 1749-4486
pISSN - 1749-4478
DOI - 10.1111/coa.13761
Subject(s) - medicine , ostium , prospective cohort study , frontal sinus , sinusitis , surgery , sinus (botany) , synechia , botany , biology , genus
Objectives The study aimed to assess the factors affecting the frontal sinus patency after endoscopic frontal sinusotomy. Design A prospective cohort study. Setting Tertiary centre hospital. Main outcome measures Fifty patients with refractory chronic frontal sinusitis (83 operated frontal sinuses) had frontal sinusotomy and followed up for six months. Multiple operative factors were included the type of the procedure, intraoperative sinus findings, degree of mucosal preservation and middle turbinate stability. Other factors were also assessed, including smoking, the presence of allergic rhinitis, asthma, gastroesophageal reflux and other associated medical comorbidities. Results The sinus patency success rate was 75.9%. There was a significant difference regarding the intraoperative anteroposterior sinus ostium diameter (5.36 ± 1.45 mm vs 8.88 ± 2.38 mm, P ‐value: .001* in the failed group and the success group, respectively). There was a significant association between the patency outcome and the presence of associated medical comorbidities ( P ‐value: .001*), the presence of allergic rhinitis ( P ‐value: .001*), the degree of sinus mucosal preservation ( P ‐value: .012*) and the degree of middle turbinate stability ( P ‐value: .001*). The multivariate analysis showed that the intraoperative anteroposterior diameter of the sinus ostium, middle turbinate stability and presence of allergic rhinitis were significant predictors ( P ‐value: .012*, .042* and .013*, respectively). Conclusion Sinuses with anteroposterior ostium diameters less than 5.36 mm are more susceptible to restenosis. The flail middle turbinate increases the risk of postoperative middle meatus synechia and frontal sinus patency failure. The presence of allergic rhinitis has a negative impact on the patency outcome.