ENDONASAL SURGERY WITH LONG-TERM STENTING OF THE FRONTAL-SINUS

Endonasal frontal sinus surgery is well established. It is not yet cle ar what degree of enlargement of the frontal sinus neoostium is requir ed to achieve permanent drainage or whether stenting improves the resu lts. Patients and methods: Prospective survey with two groups: Group 1 . included 10 patients (15 operations) who underwent endonasal sinus s urgery because of chronic polypoid sinusitis with stenting of the fron tal sinus neoostium for 6 months. Group 2. included 11 patients (21 op erations) without stenting. Intervention: Endonasal frontal sinus surg ery with extended drainage Draf Type II (NFA II according to May) with (group 1) and without (group 2) long-term stenting of the neoostium f or 6 months using a silicone stent. Main Outcome Measure: 12-16 months postoperatively: flexible endoscopy of nose and frontal sinus; comput ed tomography; magnetic resonance tomography; Wilcoxon-Mann Withney-Te st. Results: With stenting: neoostium endoscopically patent in 80% (in cluding 20% with edematous swelling only at the opening to the frontal sinus), occluded by scar tissue in 6.7%, occluded by polyps in 13.3%. Endoscopy and CT/MRT together: normal mucosa and aeration in 93.3%, c omplete opacification in 6.7%. Without stenting: neoostium endoscopica lly patent in 33%, occluded by scar tissue in 48%, occluded by polyps in 19%. Endoscopy and CT together: normal mucosa and aeration in 71.4% , aeration and mucosal swelling in 14.3%, complete opacification in 14 .3%. With stenting of the frontal sinus neoostium for six months endos copic evaluation of the frontal sinus was possible in a significantly higher proportion of cases (p=0.0416). Conclusion: Long-term stenting of the frontal sinus significantly reduces the rate of recurrent steno sis of the frontal neoostium and is recommended in all cases where an extended frontal sinus drainage is necessary. The optimal design for s uch a stent has not yet been clearly defined.