Utility of the axillary flap approach to the frontal recess in patients with chronic rhinosinusitis

BACKGROUND: The frontal recess and sinus are the most likely areas for sinus surgery failure. A significant difference between races in the anatomical structure of paranasal sinuses has been reported. The axillary flap approach is one of the surgical techniques of endoscopic sinus surgery (ESS) that can improve access to the frontal recess. In this study, we examined the usefulness of the axillary flap approach to accessing the frontal recess and sinus by identifying the frontal ostium during ESS in Japanese patients. METHODS: We performed ESS with the axillary flap approach on 38 patients (59 sides). Demographic data, identification of the frontal ostium, surgical findings, preoperative and postoperative symptoms, incidence of revision surgery, and postoperative complications were collected. RESULTS: The frontal sinus ostium was identified in 96.6% (57 of 59) of the sides. All of the frontal sinus cells detected in a preoperative CT scan were identified during ESS with the axillary flap approach without using a 70-degree endoscope. The symptoms significantly improved after ESS. Three sides had middle meatal adhesions after ESS that required surgical repair under local anesthesia. There was no major postoperative complication such as cerebrospinal fluid leak, orbital injury, or hemorrhage requiring blood transfusion. No patient required revision ESS. CONCLUSIONS: The axillary flap technique is a safe and simple surgical procedure that provides excellent access to the frontal recess without using a 70-degree endoscope, even in Japanese patients. It allows clearance of cells in the recess with identification of the frontal ostium, leading to successful ESS.