Endoscopic trans-septal frontal sinusotomy: The rationale and results of an alternative technique

Endoscopic transseptal frontal sinusotomy (TSFS) represents an alternate ap proach to surgical treatment of chronic frontal sinus disease that is refra ctory to traditional modes of medical and surgical therapy. We retrospectiv ely reviewed our experience with endoscopic TSFS from 1995-1997. Twenty-one procedures were performed through a transseptal approach. One patient was excluded for failure to follow-up, Sol a total of 20 procedures. Patients w ere followed with serial endoscopic examinations and a telephone questionna ire with a mean follow-up of 12 months (Range 1-24 months) and 16 months (r ange 5-31), respectively. The primary indication for surgery was frontal re cess stenosis after previous endoscopic frontal sinusotomy in 17/20 (85%). Three patients were considered poor candidates for a primary endoscopic fro ntal sinusotomy. Patency was maintained in ail patients during the follow-l ip period. A diameter of greater than 3 mm was confirmed by passage of a cu rved suction in 19/20 (95%). Of the 19 patients that were evaluated via a t elephone questionnaire, 17 patients (89.5%) reported some degree of improve ment in their nasal/sinus symptoms, and 12/18 patients (67%) felt the frequ ency of medication requirements was less than that before undergoing endosc opic TSFS. We conclude that endoscopic TSFS represents an alternate approac h to the frontal sinus that may be used by the experienced endoscopist, to augment treatment of refractory frontal sinus disease. This procedure seems especially suited for revision surgery in those patients with acquired fro ntal sinus stenosis. In revision operations with distorted anatomical landm arks, localization of the frontal sinus may be improved with the aid of 3-d imensional computer assisted localization systems. Unlike traditional front al sinus obliteration, endoscopic TSFS does not preclude radiographic asses sment postoperatively, and allows for endoscopic evaluation of the frontal sinus in the office setting.