Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-17T21:21:19.236Z Has data issue: false hasContentIssue false

Long-term stenting for chronic frontal sinus disease: case series and literature review

Published online by Cambridge University Press:  20 May 2010

B Hunter*
Affiliation:
Department of Otolaryngology/Head and Neck Surgery, Gloucestershire Royal Hospital, Gloucester, UK
S Silva
Affiliation:
Department of Otolaryngology/Head and Neck Surgery, Gloucestershire Royal Hospital, Gloucester, UK
R Youngs
Affiliation:
Department of Otolaryngology/Head and Neck Surgery, Gloucestershire Royal Hospital, Gloucester, UK
A Saeed
Affiliation:
Department of Otolaryngology/Head and Neck Surgery, Gloucestershire Royal Hospital, Gloucester, UK
V Varadarajan
Affiliation:
Department of Otolaryngology/Head and Neck Surgery, Gloucestershire Royal Hospital, Gloucester, UK
*
Address for correspondence: Mr B Hunter, Department of Otolaryngology/Head and Neck Surgery, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK. E-mail: benhunter@doctors.org.uk

Abstract

Objective:

The frontal sinus outflow tract consists anatomically of narrow channels prone to stenosis. Following both endonasal and external approach surgery, up to 30 per cent of patients suffer post-operative re-stenosis of the frontal sinus outflow tract, with recurrent frontal sinus disease. This paper proposes the surgical placement of a long-term frontal sinus stent to maintain fronto-nasal patency, as an alternative to more aggressive surgical procedures such as frontal sinus obliteration and modified Lothrop procedures.

Design:

We present a series of three patients with frontal sinus disease and significant co-morbidity, the latter making extensive surgery a significant health risk. We also review the relevant literature and discuss the use of long-term frontal sinus stenting.

Results:

These three cases were successfully treated with long-term frontal sinus stenting. Stents remained in situ for a period ranging from 48 to over 60 months.

Conclusion:

Due to the relatively high failure rates for both endonasal and external frontal sinus surgery, with a high post-operative incidence of frontal sinus outflow tract re-stenosis, long-term stenting is a useful option in carefully selected patients.

Type
Clinical Records
Copyright
Copyright © JLO (1984) Limited 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 Hoyt, WH 3rd. Endoscopic stenting of nasofrontal communication in frontal sinus disease. Ear Nose Throat J 1993;72:596–7CrossRefGoogle ScholarPubMed
2 Shikani, AH. A new middle meatal antrostomy stent for functional endoscopic sinus surgery. Laryngoscope 1994;104:638–41CrossRefGoogle ScholarPubMed
3 Rains, BM 3rd. Frontal sinus stenting. Otolaryngol Clin North Am 2001;34:101–10CrossRefGoogle ScholarPubMed
4 Benoit, CM, Duncavage, JA. Combined external and endoscopic frontal sinusotomy with stent placement: a retrospective review. Laryngoscope 2001;111:1246–9CrossRefGoogle ScholarPubMed
5 Neel, HB, Whicker, JH, Lake, CF. Thin rubber sheeting in frontal sinus surgery: animal and clinical studies. Laryngoscope 1976;86:524–36CrossRefGoogle ScholarPubMed
6 Weber, R, Hosemann, W, Draf, W, Keerl, R, Schick, B, Schinzel, S. Endonasal frontal sinus surgery with permanent implantation of a place holder. Laryngorhinootologie 1997;76:728–34CrossRefGoogle ScholarPubMed
7 Lynch, RC. The technique of a radical frontal sinus operation which has given me the best results. Laryngoscope 1921;21:15CrossRefGoogle Scholar
8 Barton, RT. Dacron prosthesis in frontal sinus surgery. Laryngoscope 1972;82:1799–805CrossRefGoogle ScholarPubMed
9 Yamasoba, T, Kikuchi, S, Higo, R. Transient positioning of a silicone T tube in frontal sinus surgery. Otolaryngol Head Neck Surg 1994;111:776–80CrossRefGoogle ScholarPubMed
10 Amble, FR, Kern, EB, Neel, HB. Nasofrontal duct reconstruction with silicone rubber sheeting for inflammatory frontal sinus disease: analysis of 164 cases. Laryngoscope 1996;106:809–15CrossRefGoogle ScholarPubMed
11 Schaefer, SD, Close, LG. Endoscopic management of frontal sinus disease. Laryngoscope 1990;100:155–60CrossRefGoogle ScholarPubMed
12 Weber, R, Mai, R, Hosemann, W, Draf, W, Toffel, P. The success of 6-month stenting in endonasal frontal sinus surgery. Ear Nose Throat J 2000;79:930–2, 934, 937, 938, 940, 941CrossRefGoogle ScholarPubMed
13 Freeman, SB, Blom, ED. Frontal sinus stents. Laryngoscope. 2000;110:1179–82 (Erratum in: Laryngoscope 2000;110:1976)CrossRefGoogle ScholarPubMed
14 Gross, WE, Gross, CW, Becker, D, Moore, D, Phillips, D. Modified transnasal endoscopic Lothrop procedure as an alternative to frontal sinus obliteration. Otolaryngol Head Neck Surg 1995;113:427–34CrossRefGoogle ScholarPubMed
15 Draf, W. Endonasal micro-endoscopic frontal sinus surgery: the Fulda concept. Oper Techn Otolaryn Head Neck Surg 1991;2:234–40CrossRefGoogle Scholar
16 Seth J, Kanowitz, Joseph B, Jacobs, Richard, A Lebowitz. Frontal sinus stenting. In: Kountakis, S, Senior, B, Draf, W. The Frontal Sinus. Berlin Germany: Springer, 2005:261266Google Scholar
17 Hosemann, W, Kuhnel, TH, Held, P, Wagner, W, Felderhoff, A. Endonasal frontal sinusotomy in surgical management of chronic sinusitis: a critical evaluation. Am J Rhinol 1997;11:119CrossRefGoogle ScholarPubMed
18 Casiano, RR, Livingston, JA. Endoscopic Lothrop procedure: the University of Miami experience. Am J Rhinol 1998;12:335–9CrossRefGoogle ScholarPubMed
19 Hosemann, W, Wigand, ME, Gode, U, Langer, F, Dunker, I. Normal wound healing of the paranasal sinuses – clinical and experimental investigations. Eur Arch Otorhinolaryngol 1991;248:390–4CrossRefGoogle ScholarPubMed
20 Beule, AG, Sharf, C, Biebler, KE, Gopferich, A, Steinmeier, E, Wolf, E et al. Effects of topically applied dexamethasone on mucosal wound healing using a drug-releasing stent. Laryngoscope 2008;118:2073–7CrossRefGoogle ScholarPubMed
21 Lin, D, Witterick, IJ. Frontal sinus stents: how long can they be kept in? J Otolaryngol Head Neck Surg 2008;37:119–23Google Scholar
22 Baron, SH, Dedo, HH, Henry, CR. The mucoperiosteal flap in frontal sinus surgery (the Sewall-Boyden-McNaught operation). Laryngoscope 1973;80:1266–80CrossRefGoogle Scholar
23 Orlandi, RR, Knight, J. Prolonged stenting of the frontal sinus. Laryngoscope 2009;119:190–2CrossRefGoogle ScholarPubMed
24 Perloff, JR, Palmer, JN. Evidence of bacterial biofilms on frontal recess stents in patients with chronic rhinosinusitis. Am J Rhinol 2004;18:377–80CrossRefGoogle ScholarPubMed
25 Chadwell, JS, Gustafson, LM, Tami, TA. Toxic shock syndrome associated with frontal sinus stents. Otolaryngol Head Neck Surg 2001;124:573–4CrossRefGoogle ScholarPubMed