Surgical techniques for the removal of frontal recess cells obstructing the frontal ostium

BACKGROUND: Cells pneumatizing through the frontal ostium may vary in the degree of frontal sinus penetration. This series describes the use of the axillary flap technique and the endoscopic modified Lothrop procedure (EMLP) for the removal of cells that pneumatize to a varying degree through the frontal ostium into the frontal sinus. METHODS: Out of a total of 204 patients undergoing endoscopic sinus surgery, 31 patients had a cell on one side and 7 patients had bilateral obstructive cells resulting in 38 sides undergoing an axillary flap approach for the removal of the obstructing cell. In 13 patients, the obstructing cell was deemed inaccessible by conventional technique and these patients underwent an EMLP for removal of the obstructing cell. RESULTS: All patients who underwent both the axillary flap approach and the EMLP had a patent frontal ostium confirmed endoscopically at the last follow-up visit. However, 8 of the 38 sides (21%) that underwent the axillary flap procedure had residual minor symptoms with four patients (30%) who underwent an EMLP having a recurrence of minor symptoms CONCLUSION: The axillary flap and the EMLP can be used to remove successfully ethmoidal cells that have pneumatized through the frontal ostium