Novel use of an ultrasonic bone aspirator for extended endoscopic frontal sinusotomy: A feasibility study

Abstract

Introduction: Extended endoscopic frontal sinusotomy is often required for surgical management of anterior skull base pathology. Such approaches are necessary for access to pathology and maintenance of postoperative frontal sinus outflow tract drainage. Cold steel instrumentation and endoscopic high-speed microdrills are typically used for bony removal during extended frontal sinus approaches but are associated with certain drawbacks, such as thermal injury and obscuration of the surgical field with bone dust.

Objective: We investigated the ultrasonic bone aspirator (UBA) as an adjunctive tool for extended endoscopic frontal sinusotomy in the setting of skull base surgery.

Methods: Medical records of patients who underwent either Draf IIB or Draf III sinusotomies from 2011 to 2014 were reviewed. The patients were split into two cohorts based on instrumentation: those who received sinusotomy primarily with the UBA, and those who had sinusotomy performed with conventional instrumentation only. The patients were followed up after surgery with routine endoscopic examinations and imaging when indicated. Patient demographics, surgical approach, operative complications, and postoperative outcomes were evaluated.

Results: A total of 18 patients underwent endoscopic extended frontal sinusotomy for a variety of skull base pathologies with the UBA and the conventional instrumentation cohorts, which contained nine patients each. Five of the nine patients in the UBA cohort received Draf III sinusotomies compared with three of nine in the conventional cohort. Three patients in the UBA cohort experienced postoperative transient pressure hyperemia of the lip; this was seen in a single patient in the conventional cohort. All patients with postoperative endoscopic examinations maintained frontal sinus ostial patency to varying degrees, irrespective of cohort. Lund-Mackay scores and the need for operative revision of the frontal sinus were similar for both groups and seemed to be related to the use of postoperative radiation.

Conclusion: The UBA was a safe, effective tool for extended endoscopic frontal sinusotomy in endoscopic skull base surgery.