Mucoceles of the Frontal Sinus: Munich Experience with Drill-Out Procedures

Background and Aim: The purpose of this study is to analyze the symptoms, pain, and quality of life following drill-out procedures in patients with frontal sinus mucoceles.

Material and Methods: In the years 2007 and 2008, patients with frontal sinus mucoceles requiring drill-out procedures at the Department of Otorhinolaryngology at the LMU Munich (Germany) were asked to complete questionnaires to assess the patient-based measure of health status and the quality of life before and after surgery (using SNOT-20 and VAS to rate their symptoms and pain). Postsurgery, the patients were followed up with regular examinations, the questionnaires, and nasal endoscopies (at 10 days, 3 months, 6 months, and 1 year).

Results: A total of 20 patients (16 male and 4 female) underwent navigation-controlled, endoscopic drill-out procedures in the observed period, of whom 11 required drainage type III and 9 type IIB, according to Draf. The indications for surgery were based on chronic frontal sinus symptoms refractory to medical treatment, post-trauma status, and frontal sinus mucoceles. All patients received revision surgeries (with an average of three previous endo- and/or external surgical procedures). The mean headache score evaluated from the VAS improved significantly from 6.3 preoperatively to 1.2 at 3 months postoperatively and 0.6 at 6 months postoperatively. The SNOT-20 scores improved from 36.4 +/− 4.3 points before surgery to 15.5 +/− 3.8 points 6 months after surgical treatment.

Conclusions: Navigation-controlled drill-out procedures are safe and efficient in the endonasal treatment of frontal sinus mucoceles and significantly improve symptoms with less postoperative pain and better quality of life.