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- Title
Zero-Degree Endoscopic Visualization of the Frontal Sinus Predicts Improved Topical Irrigation Delivery.
- Authors
Spielman, Daniel B.; Kim, Matthew; Overdevest, Jonathan; Gudis, David A.
- Abstract
<bold>Objective: </bold>Management of chronic frontal rhinosinusitis is challenging with high rates of treatment failure, exacerbated by limitations of topical irrigation delivery. We hypothesize that intraoperative zero-degree visualization of the frontal sinus predicts improved postoperative irrigation penetration. Extending a Draf IIa frontal sinusotomy with a limited resection of the middle turbinate axilla-agger nasi complex can allow zero-degree endoscopic visualization of the frontal sinus. This study investigates the change in frontal sinus irrigation delivery after standard Draf IIa frontal sinusotomy versus further resection to achieve zero-degree visualization.<bold>Study Design: </bold>This is a prospective cohort study conducted in a surgical skills laboratory.<bold>Methods: </bold>The extent of irrigant penetration into the frontal sinuses was evaluated in 10 cadaveric frontal sinuses following Draf IIa sinusotomy using a standardized trephine visualization model. Irrigant penetration was assessed by three blinded reviewers using the following scale: 0 = irrigation restricted to nasal cavity; 1 = irrigation reaches frontal recess; 2 = irrigation reaches frontal sinus proper; 3 = irrigation fills entire frontal sinus. These results were compared to irrigation after achieving zero-degree endoscopic visualization by performing limited resection of the middle turbinate axilla-agger nasi complex.<bold>Results: </bold>Irrigant penetration following standard Draf IIa frontal sinusotomy improved after the axilla-agger nasi complex was resected to achieve zero-degree endoscopic visualization (median score 2 [interquartile range: 1-2] vs. 3 [interquartile range: 2-3], P < .01).<bold>Conclusion: </bold>This study demonstrates improved penetration of frontal sinus irrigation following limited resection of the middle turbinate axilla-agger nasi complex to achieve zero-degree endoscopic visualization of the frontal sinus as compared to standard Draf IIa frontal sinusotomy.<bold>Level Of Evidence: </bold>N/A Laryngoscope, 131:250-254, 2021.
- Subjects
FRONTAL sinus; VISUALIZATION; NASAL cavity; NASAL irrigation; IRRIGATION (Medicine); FRONTAL sinus surgery; RHINITIS treatment; SINUSITIS treatment; RHINITIS; SINUSITIS; TURBINATE bones; ENDOSCOPY; DEAD; LONGITUDINAL method
- Publication
Laryngoscope, 2021, Vol 131, Issue 2, p250
- ISSN
0023-852X
- Publication type
journal article
- DOI
10.1002/lary.28654