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Radiopathologic predictors of 1- and 2-year frontal sinusotomy outcomes in a southeast Asian chronic rhinosinusitis population

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Background

The frontal sinus and its drainage pathway are difficult spaces to navigate surgically. The complexity of the frontal recess anatomy as well as inflammatory factors may influence outcomes of endoscopic frontal sinusotomy. It is not clear which factors are more important in determining post-operative frontal ostium patency.

Objective

The objective is to investigate whether the distribution of fronto-ethmoidal cells, frontal recess dimensions and sinonasal inflammation predict frontal ostium patency at 1- and 2-years after endoscopic frontal sinusotomy.

Methods

A retrospective review of 94 chronic rhinosinusitis patients (185 sides) who had undergone endoscopic frontal sinusotomies between 2015 and 2019 was conducted. Computed tomography was used to evaluate the type of fronto-ethmoidal cells present and determine the dimensions of the frontal recess. The International Classification of the Radiological Complexity of frontal recess and frontal sinus was used to grade the complexity of frontal recess anatomy. Mucosal inflammation was graded according to a structured histopathology report. Frontal ostium patency at 1- and 2-years post-operatively was recorded.

Results

The frontal ostium patency rates were 80.9% and 73.4% at 1- and 2-years respectively. Eosinophilic predominance (adjusted OR 3.5, 95% CI 1.6–8.0, p = 0.003) and mucosal ulceration on histology (adjusted OR 4.5, 95% CI 1.1–17.9, p = 0.033) predicted ostial stenosis at 1 year. Smoking (adjusted OR 7.6, 95% CI 2.4–24.7, p = 0.001), aspirin exacerbated respiratory disease (AERD) (adjusted OR 7.6, 95% CI 1.9–30.1, p = 0.004) and histological findings of severe inflammation (adjusted OR 8.9, 95% CI 1.9–41.2, p = 0.005) were independent predictors of ostial stenosis at 2 years. Frontal cell patterns, frontal recess dimensions and frontal recess complexity did not predict frontal ostium stenosis at both 1- and 2-years post-operatively.

Conclusion

Post-operative control of sinonasal inflammation is important in maintaining frontal ostium patency, regardless of frontal cell patterns or frontal recess dimensions.

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Funding

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Authors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Singapore, Singapore

    Jeremy Chee, Yew Kwang Ong & Xinni Xu

  2. Department of Pathology, National University Hospital, Singapore, Singapore

    Ju Ee Seet

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  1. Jeremy Chee
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  2. Yew Kwang Ong
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  3. Ju Ee Seet
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  4. Xinni Xu
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Contributions

JC, XX, YKO designed the study; JC, XX, YKO and JES acquired and analyzed the data. All authors were involved in drafting, revision and approving of the manuscript. JC and XX agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Jeremy Chee.

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Conflict of interest

There are no funding sources or other conflicts of interest.

Ethical approval

This study was approved by the National Healthcare Group Domain Specific Review Board, reference number 2020/00219-SRF0002.

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Chee, J., Ong, Y.K., Seet, J.E. et al. Radiopathologic predictors of 1- and 2-year frontal sinusotomy outcomes in a southeast Asian chronic rhinosinusitis population. Eur Arch Otorhinolaryngol 280, 4915–4921 (2023). https://doi.org/10.1007/s00405-023-08048-z

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  • DOI: https://doi.org/10.1007/s00405-023-08048-z

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