Management of Chronic Frontal Sinusitis Using the Axillary Flap Approach
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- Category: Vol. 85, December 2017
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Management of Chronic Frontal Sinusitis Using the Axillary Flap Approach, AYMAN SAMIR, NASSIM T. GHOBRIAL, FADI M. GHARIB, ADEL S. EL-ANTABLY and MOHAMED AL-AYADI
Abstract
Background: Surgery of the frontal recess continues to provide several challenges which include understanding the gross and endoscopic anatomy of the frontal recess and the frontal outflow pathway, several approaches have been described, the axillary flap approach is based on the dissection on the close relationship of the agger nasi with the frontal recess.
Objective: To evaluate the access to the frontal recess using the axillary flap approach by identifying the frontal ostium during endoscopic sinus surgery.
Patients and Methods: Prospective study applied on thirty patients (54 sides) with Computerized Tomography (CT) evidence of frontal sinus disease underwent axiilary flap exposure of the frontal recess between May 2014 and August 2015. Demographic data, identification of the frontal ostium, the presence of post-operative symptoms and revision surgery were collected. The operative technique is presented.
Results: The frontal sinus ostium was identified in 98% of patients (53 of the 54 sides). After six months of follow-up, recurrence of frontal sinus symptoms was encountered in only 3 sides (5.6%) and minimal disease recurrence in postoperative CT in 6 sides (11.1%), 2 patients have required revision surgery. 3 sides (5.6%) had adhesions in the frontal recess requiring division under local anesthesia.
Conclusion: The axiflary flap approach to the frontal recess provides excellent access to the frontal recess and allows clearance of cells in the recess with identification of the frontal ostium in the vast majority of cases. Also, coverage of the raw area of bone using axinary flap prevents scarring and adhesions in the frontal recess.