Articles Vol. 67 No. 10 30/10/2026

OUTCOMES OF EXTENDED ENDOSCOPIC FRONTAL SINUS SURGERY USING THE OUTSIDE-IN APPROACH FOR SECONDARY FRONTAL SINUS MUCOCELE

Nguyen Quang Tu, Tran Viet Luan
DOI: 10.52163/yhc.v67i10.6923
0 Views
0 Downloads
Abstract

Objective: To evaluate the outcomes of extended endoscopic frontal sinus surgery (Draf IIB and Draf III) using the outside-in approach in the treatment of secondary frontal sinus mucocele at the Ho Chi Minh city ENT Hospital.

Materials and methods: A prospective, descriptive case series of 19 patients with secondary frontal sinus mucocele who underwent extended endoscopic frontal sinus surgery using the outside-in approach (Draf IIB 3 patients; Draf III patients 16) at Ho Chi Minh city ENT Hospital from January 2022 to December 2025.

Results: Mean age was 46.8 ± 12.8 years; 57.9% were male. Prior sinonasal surgery was reported in 73.7% and prior trauma in 21.1%. Mean operative time was 241.8 ± 58.9 minutes (Draf IIB: 188.3 ± 62.1; Draf III: 251.9 ± 54.5), with a median blood loss of 300 mL (IQR, 200-400). No major intraoperative complications occurred. Median total SNOT-22 score decreased from 35.0 (IQR, 34.0-37.5) preoperatively to 3.0 (IQR, 3.0-5.0) at 6 months (p < 0.001). At 6 months, the mean anteroposterior ostium diameter was 10.0 ± 3.2 mm and the mean area was 2.2 ± 0.9 cm². Wide patency was observed in 89.5%, partial/mild stenosis in 10.5%, with no obstruction. No disease recurrence was observed during follow-up (10/19 followed beyond 12 months, 7/19 beyond 24 months).

Conclusion: Extended endoscopic frontal sinus surgery using the outside-in approach is safe and effective for secondary frontal sinus mucocele, achieving high patency rates and marked symptomatic improvement.

Keywords
Secondary frontal sinus mucocele, Draf IIB, Draf III, outside-in approach.
References
[1]
[1] du Mayne D.M et al. Sinus mucocele: natural history and long-term recurrence rate. Eur Ann Otorhinolaryngol Head Neck Dis, 2012, 129 (3): 125-30. doi: 10.1016/j.anorl.2011.10.002 Google Scholar
[2]
[2] Aladeyelu O.S et al. Paranasal sinus mucoceles and its distortion of craniofacial-orbital anatomy: a narrative synthesis. Eur Arch Otorhinolaryngol, 2025, 282 (6): 2799-810. doi: 10.1007/s00405-024-09174-y Google Scholar
[3]
[3] Lê Minh Hùng. Đánh giá kết quả phẫu thuật Draf 2 lấy u xương xoang trán (qua cửa sổ Carolyn). Luận văn bác sĩ nội trú, Trường Đại học Y khoa Phạm Ngọc Thạch, 2025. Google Scholar
[4]
[4] Knisely A et al. Outside-in frontal drill-out: how i do it. Am J Rhinol Allergy, 2015, 29 (5): 397-400. doi: 10.2500/ajra.2015.29.4175 Google Scholar
[5]
[5] Chin D et al. The outside-in approach to the modified endoscopic Lothrop procedure. Laryngoscope, 2012, 122 (8): 1661-9. doi: 10.1002/lary.23319 Google Scholar
[6]
[6] Ye T et al. Mucosal flaps prevent neo-osteogenesis after frontal drill-out procedures: a computer-assisted study. Laryngoscope Investig Otolaryngol, 2023, 8 (4): 816-823. doi: 10.1002/lio2.1104 Google Scholar
[7]
[7] Alicandri-Ciufelli M et al. Influence of pre-operative estimation of Draf III expected diameter on surgical outcome. J Pers Med, 2024, 14 (9): 951. doi: 10.3390/jpm14090951 Google Scholar
[8]
[8] He C, Zhen H.T. Value of a lateral inferior pedicle flap in Draf IIb for recurrent frontal sinus diseases: a prospective study. Eur Arch Otorhinolaryngol, 2022, 279 (10): 4935-4942. doi: 10.1007/s00405-022-07302-0 Google Scholar
[9]
[9] Spielman D.B et al. Zero-degree endoscopic visualization of the frontal sinus predicts improved topical irrigation delivery. Laryngoscope, 2021, 131 (2): 250-254. doi: 10.1002/lary.28654 Google Scholar
[10]
[10] Nomura K et al. Outcomes of frontal mucoceles treated with conventional endoscopic sinus surgery. Acta Otolaryngol (Stockh), 2015, 135 (8): 819-23. doi: 10.3109/00016489.2015.1021933 Google Scholar
[11]
[11] Kim S et al. Endoscopic treatment of huge sinus mucoceles causing orbital symptoms. J Craniofac Surg, 2020, 31 (6): e565-8. doi: 10.1097/SCS.0000000000006541 Google Scholar
[12]
[12] Chowdhury R et al. Paranasal sinus mucoceles with intraorbital and intracranial involvement: a case series analysis and surgical outcomes assessment. Ann Otol Rhinol Laryngol, 2025, 134 (3): 225-233. doi: 10.1177/00034894241300806 Google Scholar
[13]
[13] Plantier D et al. Mucocele: clinical characteristics and outcomes in 46 operated patients. Int Arch Otorhinolaryngol, 2019, 23 (01): 088-91. doi: 10.1055/s-0038-1668126 Google Scholar