Bioabsorbable steroid-eluting implants in high-risk primary and revision frontal sinus surgery: real-world outcomes at a UK tertiary centre.

INTRODUCTION: Endoscopic frontal sinus surgery frequently poses significant technical challenges due to the complex anatomy of the frontal recess, and carries a substantial risk of restenosis and revision surgery. Removable frontal sinus stents have been used to maintain postoperative patency, but their limitations and complications are well recognised. Bioabsorbable steroid-eluting implants have emerged as an alternative designed to support wound healing and reduce postoperative scarring and restenosis. The aim of this study was to describe real-world utilisation patterns and clinical outcomes of bioabsorbable steroid-eluting implants in high-risk primary and revision frontal sinus surgery cases at a UK tertiary centre, extending existing data to a European setting. METHODS: A retrospective review was undertaken at a tertiary rhinology centre, including consecutive patients undergoing endoscopic frontal sinusotomy with intraoperative placement of a PROPEL™ implant delivering mometasone furoate (370 µg) into the frontal sinus outflow tract. Standardised postoperative care included saline irrigations and intranasal corticosteroids. Outcomes were assessed at predefined intervals using the 22-item Sino-Nasal Outcome Test (SNOT-22) and endoscopic evaluation of frontal neo-ostium patency. RESULTS: Seventy patients (median age 45.5 years, range 17–72 years) were included between 1 April 2019 and 31 December 2024, the majority undergoing revision procedures. Mean SNOT-22 scores improved from 49.2 ± 23.7 at baseline to 32.9 ± 27.9 at 6 months postoperatively (p < 0.001), exceeding the minimal clinically important difference. Frontal sinus patency at last review was observed in 58/70 patients (82.9%) at a median follow-up of 18.2 months (IQR 8.0–26.5 months), and no further frontal intervention was required in these cases. No implant-related adverse events were documented over the follow-up period. CONCLUSION: In this single-centre, real-world European cohort, bioabsorbable corticosteroid-eluting implants were associated with sustained frontal sinus patency and clinically meaningful symptom improvement in high-risk primary and revision frontal sinus surgery, with a favourable safety profile. These findings support the selective use of bioabsorbable steroid-eluting implants in complex frontal disease, while highlighting the need for comparative and multicentre European studies to better define their relative effectiveness.