The axillary flap is a safer but tedious technique for Agger nasi cell removal compared to punch out procedures
Youssef, M., Sadek, A., Talaat, M. (2018). The axillary flap is a safer but tedious technique for Agger nasi cell removal compared to punch out procedures. EKB Journal Management System, 22(2), 61-68. doi: 10.21608/smj.2018.34947
Maysara A Youssef; Ahmed A Sadek; Moustafa Talaat. "The axillary flap is a safer but tedious technique for Agger nasi cell removal compared to punch out procedures". EKB Journal Management System, 22, 2, 2018, 61-68. doi: 10.21608/smj.2018.34947
Youssef, M., Sadek, A., Talaat, M. (2018). 'The axillary flap is a safer but tedious technique for Agger nasi cell removal compared to punch out procedures', EKB Journal Management System, 22(2), pp. 61-68. doi: 10.21608/smj.2018.34947
Youssef, M., Sadek, A., Talaat, M. The axillary flap is a safer but tedious technique for Agger nasi cell removal compared to punch out procedures. EKB Journal Management System, 2018; 22(2): 61-68. doi: 10.21608/smj.2018.34947

The axillary flap is a safer but tedious technique for Agger nasi cell removal compared to punch out procedures

Sohag Medical Journal
Article 9, Volume 22, Issue 2, July 2018, Page 61-68  XML PDF (79.75 K)
Document Type: Original Article
DOI: 10.21608/smj.2018.34947
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Authors
Maysara A Youssef1; Ahmed A Sadek2; Moustafa Talaat3
1Department of Otorhinolaryngology., Faculty of Medicine, Minia University, Minia 61511, Egypt.
2department of Otorhinolaryngology ., Faculty of Medicine, Minia University, Minia 61511, Egypt.
3Department of Otorhinolaryngology ., Faculty of Medicine, Minia University, Minia 61511, Egypt.
Abstract
Objective:This study prospectively assessed the axillary flap approach versus punch-out procedure for agger nasi cell (ANC) removal.This is akey for successful frontal sinus surgery and its implication on the patency of the frontal ostium and middle turbinate lateralization(MTL).
Subjects and Methods: The study subjects consisted of 50 patients of whom 30 patients were males (80 frontal sinuses; 30 patients with bilateral disease and 20 patients with unilateral disease) with proven chronic frontal sinusitis, with pneumatized ANC according to CT findings.All patients undergone Endoscopic Sinus Surgery (ESS) with dissection of frontal recess. Group I included 40 sides that undergone removal of ANC using the axillary flap procedure (procedure 1), Group II included 40 sides that undergone removal of ANC using the punch out procedure (procedure 2). Adelaide chronic rhinosinusitis (CRS) symptom scoring questionnaires was used to all patients during their last follow-up visit 3 months after surgery.
Results: ANC were the most common variation and were observed in all the patients (20 patients unilaterally and 30 patients bilaterally). MTL following ANC removal has been found in 7.5% ofGroup I and 25% in Group II patients. Association between Adelaide symptoms severity score of postoperative symptoms and MTL was significant for nasal obstruction and rhinorrhea in both procedures (1 and 2). Non visualization of the frontal ostium following ANC removal has been found in 7.5% of Group I and 15% in Group II.Comparison between both procedures on MTL and non-visualization shows that the number of patients with MTL-positive using procedure 1 was significantly less than procedure 2 while there was a non-significant difference between procedure 1 and 2 regarding non-visualization.
Conclusions: The axillary flap technique is a safer procedure for resection of the ANC with perfect healing and less incidence of intraoperative and postoperative complications.However, it is a relatively difficult procedure and very time consuming while punch out procedure is a relatively easy, less time consuming procedure.
Supplementary Files
References

1. Bassiouni A, Chen PG, Naidoo Y, Wormald PJ (2015) Clinical significance of middle turbinate lateralization after endoscopic sinus surgery. The Laryngoscope 125:36-41

2. Bolger WE, Parsons DS, Butzin CA (1991) Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. The Laryngoscope 101:56-64

3. Bolger WE, Kuhn FA, Kennedy DW (1999) Middle turbinate stabilization after functional endoscopic sinus surgery: the controlled synechiae technique. The Laryngoscope 109:1852-1853

4. Chan Y, Melroy CT, Kuhn CA, Kuhn FL, Daniel WT, Kuhn FA (2009) Long‐term frontal sinus patency after endoscopic frontal sinusotomy. The Laryngoscope 119:1229-1232

5. Chandra RK, Palmer JN, Tangsujarittham T, Kennedy DW (2004) Factors associated with failure of frontal sinusotomy in the early follow-up period. Otolaryngology—Head and Neck Surgery 131:514-518

6. Chen PG, Bassiouni A, Wormald PJ (2014) Incidence of middle turbinate lateralization after axillary flap approach to the frontal recess. In: International forum of allergy & rhinology. Wiley Online Library, pp 333-338

7. Chiu AG, Vaughan WC (2004) Revision endoscopic frontal sinus surgery with surgical navigation. Otolaryngology–Head and Neck Surgery 130:312-318

8. Cho JH, Citardi MJ, Lee WT, Sautter NB, Lee H-M, Yoon J-H, Hong S-C, Kim JK (2006) Comparison of frontal pneumatization patterns between Koreans and Caucasians. Otolaryngology—Head and Neck Surgery 135:780-786

9. Dutton JM, Hinton MJ (2011) Middle turbinate suture conchopexy during endoscopic sinus surgery does not impair olfaction. American journal of rhinology & allergy 25:125-127

10. Friedman M, Landsberg R, Schults RA, Tanyeri H, Caldarelli DD (2000) Frontal sinus surgery: endoscopic technique and preliminary results. American journal of rhinology 14:393-404

11. Han D, Zhang L, Ge W, Tao J, Xian J, Zhou B (2008) Multiplanar computed tomographic analysis of the frontal recess region in Chinese subjects without frontal sinus disease symptoms. ORL 70:104-112

12. Lee JY, Lee SW (2007) Preventing lateral synechia formation after endoscopic sinus surgery with a silastic sheet. Archives of Otolaryngology–Head & Neck Surgery 133:776-779

13. Lien CF, Weng HH, Chang YC, Lin YC, Wang WH (2010) Computed tomographic analysis of frontal recess anatomy and its effect on the development of frontal sinusitis. The Laryngoscope 120:2521-2527

14. Moukarzel N, Nehme A, Mansour S, Yammine FG, Moukheiber A (2000) Middle trubinate medialization technique in functional endosocpic sinus surgery. Journal of Otolaryngology-Head & Neck Surgery 29:144

15. Musy PY, Kountakis SE (2004) Anatomic findings in patients undergoing revision endoscopic sinus surgery. American journal of otolaryngology 25:418-422

16. Perez-Pinas I, Sabate J, Carmona A, Catalina-Herrera C, Jimenez-Castellanos J (2000) Anatomical variations in the human paranasal sinus region studied by CT. The Journal of Anatomy 197:221-227

17. Schaitkin B, May M, Shapiro A, Fucci M, Mester SJ (1993) Endoscopic sinus surgery: 4‐year follow‐up on the first 100 patients. The Laryngoscope 103:1117-1120

18. Thawley SE, Deddens AE (1995) Transfrontal endoscopic management of frontal recess disease. American Journal of Rhinology 9:307-312

19. Wormald PJ (2002) The axillary flap approach to the frontal recess. The Laryngoscope 112:494-499

20. Wormald PJ, Xun Chan SZ (2003) Surgical techniques for the removal of frontal recess cells obstructing the frontal ostium. American journal of rhinology 17:221-226.

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