Outcome and Complications of Frontal Sinus Stenting: A Case
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A 16-year-old male reported with a history of allergic fungal rhinosinusitis (AFRS) and functional endoscopic sinus surgery (FESS) one year ago. The operative report included left frontal sinus stenting using a biliary T-tube stent. The patient complained of bilateral nasal obstruction and decreased smell sensation along with left ocular symptoms. Ophthalmic symptoms included left eye pain, discomfort, and redness without eye movement restriction.

On examination, recurrent grade 3 nasal polyps were found bilaterally. The CT report showed a migrating frontal stent that pushes against the left lamina papyracea. The patient underwent extended endoscopic sinus surgery with the Draf III procedure performed by the senior author (I.R.H.). Intraoperatively, granulation tissue was forming around the stent, which was removed, and the specimen was sent for histopathological analysis. The latter was initially interpreted as possible granulomatous invasive fungal sinusitis, but then proved to be foreign body granulation tissue in reaction to the stent. Complications of frontal sinus stenting are not uncommon and thus necessitate regular follow-up. The stent was kept in the patient for 12 months and was complicated by ocular symptoms as well as granulation tissue formation.

On examination, the patient had recurrent grade 3 nasal polyp, and obviously the presence of frontal sinus stent was not helpful in providing the appropriate irrigation to the frontal recess. Instead of keeping the patency of the ostium, the stent resulted in unwanted outcome. As well, the granulation tissue formed around the stent was histopathologically misinterpreted as a granulomatous invasive fungal sinusitis. Further studies are strongly needed to judge the effectiveness of using the stent.

source: https://www.hindawi.com/journals/criot/2020/8885870/