ENDONASAL FRONTAL SINUSOTOMY IN SURGICAL-MANAGEMENT OF CHRONIC SINUSITIS - A CRITICAL-EVALUATION

Frontal sinusotomy was performed on 110 patients undergoing routine en doscopic endonasal ethmoidectomy and the minimum diameter of the front al sinus neo-ostium was determined intraoperatively. A total of 82 pat ients could be subjected to follow-up and redetermination of the neo-o stium diameter 13 months later A postoperative CT was scheduled in 62 cases. The average minimum diameter of the frontal sinus neo-ostium, m easured intraoperatively, was 5.6 mm (0-11 mm). After completion of wo und healing, 81% of the frontal sinuses could be explored by probing o r even inspected by rigid endoscopy. The average minimum diameter of t he neo-ostia determined postoperatively was 3.5 mm (0-11 mm). Patients exhibiting aspirin sensitivity or diffuse nasal polyposis showed a mo re pronounced scarred constriction of the frontal sinus access compare d to other cases. Neo-ostia exceeding 5 mm intraoperatively were prese rved with a considerably higher percentage than those with diameters o f less than 5 mm. Radiologically, the fenestrated frontal sinuses freq uently showed continued or even increasing mucosal congestion. No conc lusive relationship was found to exist between such post-operative clo uding and frontal sinus accessibility (endoscopy and/or probing) or pa tient complaints. The investigations confirm the safety and reliabilit y of frontal sinusotomy in surgical management of chronic paranasal si nusitis. The mucosa of the frontal sinus often reacts to surgery in th e form of persistent or even newly developing mucosal swelling to whic h a specific pathophysiological significance cannot always be attribut ed.