Endoscopic frontal sinus drillout in 100 patients.

OBJECTIVE To determine the efficacy of frontal sinus drillout surgery for the treatment of chronic frontal sinusitis. DESIGN Retrospective case-control study. Mean +/- SD follow-up was 4.1 +/- 1.53 years (range, 1.4-6.9 years). SETTING Academic medical center. PATIENTS One hundred consecutive patients with chronic sinusitis who underwent frontal sinus drillout surgery. Indications were failed previous frontal sinusotomy (n = 88) and frontal sinus mucocele (n = 12). INTERVENTIONS Endoscopic removal of the floor of the frontal sinus (unilateral, n = 34; bilateral, n = 66) with a surgical drill. An intraoperative image-guidance system was used in 65 patients. MAIN OUTCOME MEASURES Frontal sinus patency and improvement of symptoms associated with frontal sinusitis. RESULTS Frontal sinus patency with control of symptoms was achieved in 80% of patients. There were no intraoperative complications. Postoperative epistaxis occurred in 4% of patients. Of the 20 patients who developed restenosis of the frontal sinus ostium, 11 underwent revision frontal sinus drillout and 9 proceeded to frontal sinus obliteration. The success rate was comparable for the image-guidance and non-image-guidance groups (83.1% vs 74.3%, respectively; P =.56). CONCLUSIONS Frontal sinus drillout performed with or without an image-guidance system appears to be a safe and effective surgery for the treatment of patients with advanced disease of the frontal sinus. This procedure provides a reasonable alternative to frontal sinus obliteration, which remains a treatment option for patients who fail frontal drillout.