Comprehensive review on endonasal endoscopic sinus surgery
BACKGROUND Chronic sphenoid rhinosinusitis (CSR) refractory to both medical management and 1 or more sphenoidotomies is a difficult entity to treat. In contrast to the surgical hierarchy that exists for the frontal sinus, there is no systematic approach for addressing persistent disease in the sphenoid. Sphenoid marsupialization has been advocated as a method of addressing recurrent sphenoid sinusitis. OBJECTIVE We present a new technique called the sphenoid drill-out, which we place between traditional sphenoidotomy and sphenoid marsupialization in the surgical hierarchy for management of CSR. METHODS We performed a retrospective review on all patients undergoing sphenoidotomy between 2005 and 2009. We studied demographics, procedure type, diagnoses, comorbidities, efficacy, revision rate, and endoscopic outcomes using Lund-Kennedy scores. RESULTS A total of 10 patients underwent sphenoid drill-out for CSR. Average follow up was 17 months. Patients had an average of 5 prior sinus surgeries with 2.6 prior sphenoidotomies. One patient required a revision drill-out procedure. The mean preoperative and postoperative Lund-Kennedy scores were 6.67 and 1.78, which was a statistically significant difference. CONCLUSION The sphenoid drill-out procedure is safe and effective for the management of recalcitrant CSR. It should be considered as an intermediate procedure between sphenoidotomy and sphenoid marsupialization.