title: Contemporary management of frontal sinus mucoceles: a meta-analysis.
abstract: OBJECTIVE
  To analyze trends in the surgical management of frontal and fronto-ethmoid mucoceles through meta-analysis.
  
  
  METHODS
  Meta-analysis and case series.
  
  
  METHODS
  A systematic literature review on surgical management of frontal and fronto-ethmoid mucoceles was conducted. Studies were divided into historical (1975-2001) and contemporary (2002-2012) groups. A meta-analysis of these studies was performed. The historical and contemporary cohorts were compared (surgical approach, recurrence, and complications). To study evolution in surgical management, a senior surgeon's experience over 28 years was analyzed separately.
  
  
  RESULTS
  Thirty-one studies were included for meta-analysis. The historical cohort included 425 mucoceles from 11 studies. The contemporary cohort included 542 mucoceles from 20 studies. More endoscopic techniques were used in the contemporary versus historical cohort (53.9% vs. 24.7%; P = <0.001). In the authors' series, a higher percentage was treated endoscopically (82.8% of 122 mucoceles). Recurrence (P = 0.20) and major complication (P = 0.23) rates were similar between cohorts. Minor complication rates were superior for endoscopic techniques in both cohorts (P = 0.02 historical; P = <0.001 contemporary). In the historical cohort, higher recurrence was noted in the external group (P = 0.03).
  
  
  CONCLUSIONS
  Results from endoscopic and open approaches are comparable. Although endoscopic techniques are being increasingly adopted, comparison with our series shows that more cases could potentially be treated endoscopically. Frequent use of open approaches may reflect efficacy, or perhaps lack of expertise and equipment required for endoscopic management. Most contemporary authors favor endoscopic management, limiting open approaches for specific indications (unfavorable anatomy, lateral disease, and scarring).
  
  
  METHODS
  N/A.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Hospital, Phoenix, Arizona.
authors.forename: Andy M
authors.initials: AM
authors.lastname: Courson
authors.forename: James A
authors.initials: JA
authors.lastname: Stankiewicz
authors.forename: Devyani
authors.initials: D
authors.lastname: Lal
mesh_terms: D005626:Frontal Sinus; D006801:Humans; D009078:Mucocele / Q000601:surgery*; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods; D010254:Paranasal Sinus Diseases / Q000601:surgery*
keywords: Mucocele; endoscopic sinus surgery; frontal sinus; meta-analysis; open approach