The Preoperative Radiological Findings Associated with Failure of Frontal Sinusotomy: A Prospective Study.

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The study aimed to assess the association between the preoperative CT findings and the patency outcome of the frontal sinus after endoscopic frontal sinusotomy in the early follow-up period.A prospective cohort study SETTING: Tertiary hospital centre MAIN OUTCOME MEASURES: The study measures the association between the frontal sinusotomy outcome and the standard preoperative radiological scores, including Harvard, Kennedy, and Lund Mackay. It also measures the impact of the degree of sinus mucosal thickness on the outcome. Furthermore, it measures the effect of the anteroposterior lengths of both the frontal sinus ostium and the frontal recess on postoperative frontal sinus patency.Harvard, Kennedy, and Modified Lund Mackay scores showed no evidence of association with the frontal sinusotomy patency outcome (p values 0.397, 0.487, and 0.501), respectively. Still, the Lund Mackay score showed a negative correlation with symptom improvement. Sinuses with a high-grade mucosal thickness on CT scan were associated with high failure rates (p-value: 0.009*). The anteroposterior length of the frontal sinus ostium significantly affects the outcome (p-value: 0.001*). In contrast, there was no association between the anteroposterior length of the frontal recess and the outcome (p-value: 0.965).The Harvard, Kennedy, and Lund Mackay scores could not predict the frontal sinusotomy patency outcome. Failed cases were associated with advanced degrees of mucosal pathology in the preoperative CT scan. Sinuses ostia with anteroposterior diameters less than 5.36 mm showed more susceptibility for sinus restenosis postoperatively. The variability of the anteroposterior length of the frontal recess did not affect the surgical outcome.

View the full article @ Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery
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Authors: Yasser Khafagy, Mohamed Ghonim, Ahmed Elgendy, Saad Elzayat