Sphenoid "drill-out" for chronic sphenoid rhinosinusitis

• Published in: International forum of allergy & rhinology Vol. 1; no. 1; p. 64
• Main Authors: Leight, W Derek, Leopold, Donald A
• Format: Journal Article
• Language: English
• Published: United States 01.01.2011
• Subjects: Adult; Chronic Disease; Endoscopy - methods; Female; Humans; Male; Middle Aged; Radiography, Interventional; Recurrence; Reoperation; Retrospective Studies; Rhinitis - diagnostic imaging; Rhinitis - surgery; Sphenoid Bone - diagnostic imaging; Sphenoid Bone - surgery; Sphenoid Sinus - diagnostic imaging; Sphenoid Sinusitis - diagnostic imaging; Sphenoid Sinusitis - surgery; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 2042-6984
• DOI: 10.1002/alr.20006

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. 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. 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. 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. 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.