Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
Int Forum Allergy Rhinol. 2011 Jan-Feb;1(1):64-9. doi: 10.1002/alr.20006. Epub 2011 Feb 8.
Chronic sphenoid rhinosinusitis (CSR) refractory to both medical management and 1 or more sphenoidotomies is a difficult entity to treat. In contrast to the surgical hierarchy that exists for the frontal sinus, there is no systematic approach for addressing persistent disease in the sphenoid. Sphenoid marsupialization has been advocated as a method of addressing recurrent sphenoid sinusitis.
We present a new technique called the sphenoid drill-out, which we place between traditional sphenoidotomy and sphenoid marsupialization in the surgical hierarchy for management of CSR.
We performed a retrospective review on all patients undergoing sphenoidotomy between 2005 and 2009. We studied demographics, procedure type, diagnoses, comorbidities, efficacy, revision rate, and endoscopic outcomes using Lund-Kennedy scores.
A total of 10 patients underwent sphenoid drill-out for CSR. Average follow up was 17 months. Patients had an average of 5 prior sinus surgeries with 2.6 prior sphenoidotomies. One patient required a revision drill-out procedure. The mean preoperative and postoperative Lund-Kennedy scores were 6.67 and 1.78, which was a statistically significant difference.
The sphenoid drill-out procedure is safe and effective for the management of recalcitrant CSR. It should be considered as an intermediate procedure between sphenoidotomy and sphenoid marsupialization.
慢性蝶窦鼻窦炎（CSR）对药物治疗和 1 次或多次蝶窦切开术均无反应，是一种难以治疗的疾病。与存在于额窦的手术分级不同，对于蝶窦的持续性疾病，目前还没有系统的治疗方法。蝶窦切开术已被提倡作为治疗复发性蝶窦炎的一种方法。
我们提出了一种新的技术，称为蝶窦钻孔术，我们将其置于传统的蝶窦切开术和蝶窦切开术之间，作为治疗 CSR 的手术分级中的一种方法。
我们对 2005 年至 2009 年间所有接受蝶窦切开术的患者进行了回顾性研究。我们研究了人口统计学、手术类型、诊断、合并症、疗效、翻修率和使用 Lund-Kennedy 评分的内镜结果。
共有 10 例 CSR 患者接受了蝶窦钻孔术。平均随访时间为 17 个月。患者平均有 5 次鼻窦手术，其中 2.6 次为蝶窦切开术。1 例患者需要进行翻修钻孔术。术前和术后的平均 Lund-Kennedy 评分分别为 6.67 和 1.78，有统计学显著差异。
蝶窦钻孔术是治疗难治性 CSR 的一种安全有效的方法。它应被视为蝶窦切开术和蝶窦切开术之间的一种中间手术。
