Use of computer-aided surgery for frontal sinus ventilation.

OBJECTIVES

To review our experience and evaluate the utility of computer-aided surgery for frontal sinus and frontal recess disease.

STUDY

DESIGN

A retrospective review of 31 consecutive patients undergoing computer-aided surgery for frontal sinus ventilation.

METHODS

The hospital charts of 31 patients were reviewed. Previous sinonasal procedures, etiology of sinonasal disease, preoperative computed tomography (CT) scan findings, preoperative symptoms, endoscopic and intraoperative findings, type of frontal sinus ventilation procedure, complications, imaging system registration method or accuracy, and postoperative course were noted.

RESULTS

In all 31 patients the surgery was successfully completed, and no intracranial or orbital complications were encountered during or after surgery. Six patients required additional surgery including revision transnasal endoscopic frontal sinus ventilation or osteoplastic flaps with fat obliteration. In the six cases requiring additional surgery, disease severity, most commonly, aspirin triad disease, predisposed to failure of frontal sinus ventilation.

CONCLUSIONS

Computer-aided surgery is a useful adjunctive device for safe, efficient identification and surgery of the frontal sinus. However, it is not a replacement for sound surgical technique, anatomical knowledge, and experience. In particular, patients with aspirin triad disease with frontal recess and frontal sinus involvement are highly suited for computer-aided surgery and thorough removal of disease, although failures occur despite this technique. The long-term benefit of computer-aided surgery of the frontal sinus has not yet been demonstrated by this or other studies.