Oregon Sinus Center, Division of Rhinology & Sinus/Skull Base Surgery, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR.
Int Forum Allergy Rhinol. 2019 Oct;9(10):1189-1195. doi: 10.1002/alr.22405. Epub 2019 Aug 12.
Frontal sinus trephination is traditionally performed through a small cutaneous incision and osteotomy, allowing irrigation of the frontal sinus. Utilizing the trephination osteotomy for endoscopic visualization and surgical manipulation requires a larger opening. This "mega-trephination" is thought to carry an increased risk of cosmetic deformity given the increased bony removal at the anterior table. The purpose of our study was to clarify the risks of frontal sinus mega-trephination and examine how this technique is incorporated into a modern, tertiary care rhinology practice.
Patients were identified through billing records and confirmed by retrospective chart review. All patients underwent frontal sinus mega-trephination, which is defined as an osteotomy large enough for insertion of a 4-mm endoscope and an operative instrument simultaneously. All patients had at least 2 years of follow-up. The primary outcome was complication rate, including cosmetic deformity.
Sixty-four patients underwent frontal sinus mega-trephination from 2006 to 2016. The most common surgical indications were chronic sinusitis (34%), mucocele (19%), osteoma (17%), acute sinusitis (11%), and inverting papilloma (9%). Ten patients (16%) underwent mega-trephination alone, whereas the others had mega-trephination with endoscopic sinus surgery. Twenty-one patients (33%) had minor complications. The most common complications were self-limited paresthesia (11%), infection (8%), and epistaxis (3%). No patient complained of permanent cosmetic deformity or required revision surgery for cosmesis.
Frontal sinus mega-trephination is a useful tool to augment the rhinologist's armamentarium in complex frontal sinus anatomy and pathology. This procedure is well tolerated, safe, and not associated with long-term cosmetic deformity.
传统的额窦钻孔术通过小的皮肤切口和截骨术进行，允许冲洗额窦。利用钻孔截骨术进行内镜可视化和手术操作需要更大的开口。由于在前额板处去除更多的骨，因此认为这种“超大钻孔”会增加美容畸形的风险。我们研究的目的是阐明额窦超大钻孔的风险，并研究如何将这种技术纳入现代三级护理鼻科学实践中。
通过计费记录识别患者，并通过回顾性图表审查进行确认。所有患者均接受额窦超大钻孔术，该手术定义为足以插入 4 毫米内镜和手术器械的截骨术。所有患者均有至少 2 年的随访。主要结果是并发症发生率，包括美容畸形。
2006 年至 2016 年间，有 64 例患者接受了额窦超大钻孔术。最常见的手术指征是慢性鼻窦炎（34%）、黏液囊肿（19%）、骨瘤（17%）、急性鼻窦炎（11%）和内翻性乳头状瘤（9%）。10 例患者（16%）仅接受超大钻孔术，而其他患者则接受了内镜鼻窦手术联合超大钻孔术。21 例患者（33%）有轻微并发症。最常见的并发症是自限性感觉异常（11%）、感染（8%）和鼻出血（3%）。没有患者抱怨永久性美容畸形或需要修复手术来改善美容。
额窦超大钻孔术是一种有用的工具，可增强鼻科医生在复杂的额窦解剖和病理学方面的技术手段。该手术耐受性好，安全，不会导致长期美容畸形。
