Comprehensive management of failed frontal sinus obliteration.
BACKGROUND
Treatment of patients with failed frontal sinus (FS) obliteration (FSO) remains an important challenge in the endoscopic era. Advances in endoscopic techniques have facilitated the application of minimally invasive approaches for clinical scenarios that previously required open procedures.


METHODS
A retrospective chart review of patients presenting with failed FSO from January 1, 2001 to June 30, 2007 was performed.


RESULTS
Seventeen patients (mean age, 52.8 years; 10 men and 7 women) presented at an average of 9.7 years from initial FSO. The most common primary presenting symptoms included headache (41.2%) and forehead swelling (23.5%). Seven patients had prior craniotomies and 10 patients had prior endoscopic sinus surgery. All patients underwent surgical exploration; revision procedures were required in 5 patients. Definitive procedures included endoscopic frontal sinusotomy (EFS; 10 patients), endoscopic frontal drill-out (3 patients), revision osteoplastic frontal sinusotomy with obliteration reversal (2 patients), and repeat FSO (2 patients). One patient required revision EFS twice. Initial intraoperative findings included mucocele (13 cases), bone wax (3 cases), fibrous tissue (2 cases), and polypoid mucosa (1 case). All patients had resolution or improvement of their primary presenting signs/symptoms. All FSO reversal patients achieved functional FS patency documented by endoscopy and/or CT scan with mean follow-up of 9.5 months (range, 1.5-30.8 months).


CONCLUSIONS
Operative exploration should be considered in all patients with persistent or recurrent symptoms and/or signs of failed FSO. In most instances, repeat FSO can be avoided, and a minimally invasive endoscopic strategy can be used successfully.
Kanowitz
Seth J
SJ
Private Practice, Morristown Memorial Hospital, Morristown, New Jersey, USA.
Batra
Pete S
PS
Citardi
Martin J
MJ
D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005626:Frontal Sinus / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D015522:Frontal Sinusitis / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009078:Mucocele / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure