Long-term outcome after frontal sinus operations: Comparison between extranasal and endonasal operation techniques.

Background: During the last decades rhinosurgery largely developed up to endonasal accesses. Meanwhile many of the new techniques are established, so that the outcome of traditional extranasal methods should be compared with those of endonasal accesses, in order to estimate the status and for critical consideration. Methods: A retrospective analysis recorded the results of 236 patients, operated on primary frontal sinus disease 1985-1993. The records were consulted concerning inpatient treatment and outpatient aftercare during standardized paranasal sinus consulting hours. Results: During the follow-up period (3 - 10 years) 8% of the patients underwent resurgery. The lowest revision rate was found after using endonasal technique (5.9%), compared with osteoclastic methods (Ritter-Jansen, Riedel: 10.6%). The domain of osteoplastic operations with a revision rate of 9.4% were fractures, osteomas and mucoceles, because of an impossible endonasal access. In decision on osteoclastic procedures, the already osteoclastically operated site was of prime importance, especially since 1990. Conclusion: Already during the early years endonasal techniques of paranasal sinus surgery showed better outcome than osteoclastic accesses. The analysis indicates that the change to endonasal functional paranasal sinus surgery is justified and should be kept up. The traditional methods still have their rare authorization in case of special indications, especially if an osteoclastic procedure has been carried out already.