Otorhinolaryngology, Faculty of Medicine, Mansoura University, Egypt.
Otorhinolaryngology, Faculty of Medicine, Mansoura University, Egypt.
Am J Otolaryngol. 2021 Sep-Oct;42(5):102998. doi: 10.1016/j.amjoto.2021.102998. Epub 2021 Mar 24.
Frontal sinusotomy is a challenging procedure that needs meticulous handling due to its unique anatomical position. Postoperative middle turbinate lateralization is critical comorbidity for the success rate, and many techniques are adopted to prevent it. The study aimed to compare the effect of middle turbinate bolgerization and partial resection on the postoperative endoscopic scores and assess their impact on the middle meatus and the frontal recess outcome.
This prospective study was conducted on forty-one patients undergoing bilateral frontal sinusotomy for chronic frontal sinusitis. Nasal cavities were randomized so that partial middle turbinate resection technique was done alternately with bolgerization approach in every patient. Each participant acted as their control. Both sides were compared using Lund Kennedy Endoscopic Score (LKES) and Perioperative Sinus Endoscopy Score (POSE) at the baseline, 1st, 3rd, and 12th-month intervals postoperatively. Also, middle turbinate status was assessed at the end of the 12th-month interval using POSE score.
The total frontal sinus patency rate was 82.9% (63/76 operated sinus). Baseline scores, LKES (3.79 ± 0.777 vs 4.05 ± 0.769, p = 0.142, for the side of resection and the side for bolgerization respectively) and POSE (1.79 ± 0.413 vs 1.82 ± 0.393, p = 0.777, for the side of resection and the side for bolgerization respectively). Regarding LKES, the differences between both operated sides were fluctuating with p values: 0.001*, 0.171, and 0.044* for the 1st, 3rd, and 12th months follow-up intervals, respectively. Regarding the POSE score of the frontal sinus, the difference between both groups was steadily increasing with p values: 0.318, 0.119, and 0.017* for the 1st, 3rd and 12th months follow-up intervals. The middle turbinate's POSE score at the 12th month was significantly higher in the side allocated for bolgerization (p-value = 0.008*).
Partial middle turbinate resection showed favorable endoscopic outcomes than bolgerization at the 12th month follow up period in patients undergoing primary ESS for chronic frontal sinusitis.
由于额窦独特的解剖位置，额窦切开术是一项具有挑战性的手术，需要精细处理。术后中鼻甲外侧化是影响成功率的关键合并症，为此采用了许多技术来预防。本研究旨在比较中鼻甲bolgerization 和部分切除术对术后内镜评分的影响，并评估它们对中鼻甲和额窦结果的影响。
这项前瞻性研究共纳入 41 例慢性额窦炎患者，行双侧额窦切开术。鼻腔随机分组，使部分中鼻甲切除术技术与 bolgerization 方法交替应用于每位患者。每位患者都互为对照。使用 Lund Kennedy 内镜评分（LKES）和围手术期鼻窦内镜评分（POSE）分别在基线、术后第 1、3 和 12 个月对双侧鼻腔进行比较。此外，还在术后第 12 个月使用 POSE 评分评估中鼻甲的状况。
总额窦通畅率为 82.9%（63/76 个手术鼻窦）。基线时，中鼻甲切除术侧的 LKES（3.79±0.777）和 bolgerization 侧的 LKES（4.05±0.769）分别为（p=0.142）。中鼻甲切除术侧的 POSE（1.79±0.413）和 bolgerization 侧的 POSE（1.82±0.393）分别为（p=0.777）。关于 LKES，两侧之间的差异波动较大，p 值分别为：0.001*、0.171 和 0.044*，分别在术后第 1、3 和 12 个月随访时。关于额窦的 POSE 评分，两组之间的差异逐渐增加，p 值分别为：0.318、0.119 和 0.017*，分别在术后第 1、3 和 12 个月随访时。在第 12 个月时，bolgerization 侧的中鼻甲 POSE 评分明显更高（p 值=0.008*）。
在因慢性额窦炎行原发性 ESS 的患者中，与 bolgerization 相比，部分中鼻甲切除术在第 12 个月的随访中具有更好的内镜结果。
