Questioning the justification of frontal sinusotomy for odontogenic sinusitis

Abstract Background Odontogenic sinusitis (OS) may be caused by infectious conditions of the posterior maxillary teeth. The maxillary sinus is mostly involved, due to its proximity to those teeth. Not uncommonly, the anterior ethmoids and frontal sinuses are involved by the infective process. The underlying odontogenic condition must be addressed before or during sinus surgery. The role of frontal sinusotomy in the treatment of these patients is poorly described in the literature. Objective To present the surgical outcome of patients with OS involving the frontal sinus and who were managed by middle meatal antrostomy alone. Methods A prospective analysis of all patients operated in a single tertiary center due to frontal sinus involving OS between November 2015 and December 2018 was performed. Their pre-surgical assessment, surgical findings and post-operative outcomes were analyzed. Results Forty-five patients (male-to-female ratio 23:22) with a median age of 57 years (range 20–83) were enrolled. All anterior sinuses (frontal, anterior ethmoids and maxillary sinuses) were clinically and radiographically involved in each case. Each patient underwent endoscopic wide maxillary middle meatal antrostomy simultaneously with dental intervention. The average follow-up was 7 months. No signs of active frontal disease were detected by postoperative endoscopy in any patient, and revision surgeries were not required. Conclusion This study shows that there is no justification for frontal sinusotomy for the treatment of OS involving the frontal sinus. Frontal sinusitis is a secondary infectious and inflammatory process that is resolved once the underlying odontogenic condition has been healed and a wide middle meatal antrostomy has been performed.