Frontal Sinusitis Management: Intact Ethmoidal Bulla Technique Vs Ethmoidal Bullectomy

Abstract

Introduction Conventional functional endoscopic sinus surgery (FESS) for frontal sinusitis treatment involves ethmoidal bullectomy, that is associated with damage to the surrounding structures. These complications can be overcome by minimally invasive FESS anterior to the ethmoidal bulla that allows ease in locating the sinus ostium, eliminating risk of injury to anterior skull base and nearby structures. This study aims to compare the efficacy of ethmoidal bullectomy versus intact ethmoidal bulla technique as an adjunct to FESS in frontal sinusitis management. Materials and Methods Forty patients, clinically and radiologically diagnosed with frontal sinusitis, were randomly divided into 2 groups: Group A (n=20; treated with FESS keeping the ethmoidal bulla intact) and Group B (n=20; treated using FESS with ethmoidal bullectomy). After detailed history and clinico-radiological examinations, diagnostic nasal endoscopy was performed, followed by FESS. Pre- and post-operative endoscopic and clinical assessment was done using Modified Lund-Kennedy Endoscopy (MLKE) Score and Sino-Nasal Outcome Test-22 (SNOT-22) Questionnaire, respectively. Data was analyzed using software R version 3.6.3. Results Significant reductions in SNOT-22 (clinical improvement) and MLKE scores (endoscopic improvement) were seen within the groups from baseline to each follow-up visit and between the successive recall visits (p0.05). Complications were seen only in Group B. Conclusion Both, ethmoidal bullectomy and intact ethmoidal bulla technique, when used as adjuncts to FESS, showed similar improvements in frontal sinusitis patients. However, bullectomy was associated with greater risk of intra-operative complications.

Keywords

• Frontal Sinus
• Frontal Sinusitis
• Endoscopy
• Sino-Nasal Outcome Test
• Ethmoid Bone