Feasibility and safety of Carolyn’s window approach in frontal sinus surgery: a prospective single-arm cohort study

Abstract Background Access to the frontal sinus is limited by the anteroposterior depth of the frontal recess. Carolyn’s window, described by Seresirikachorn, Harvey, and colleagues, is a direct-access Draf IIa frontal sinusotomy designed to overcome this limitation. We evaluated its feasibility, safety, and short-term outcomes. Methods A prospective, single-arm cohort study was conducted in adults with frontal sinus pathology—chronic rhinosinusitis (CRS) with or without nasal polyps, or frontal sinus mucocele—that was not treatable with simple endoscopic sinusotomy. All procedures were performed by a single surgeon using Carolyn’s window, and an independent surgeon performed postoperative endoscopic assessments. The primary outcome was complete intraoperative access to the frontal sinus pathology; secondary outcomes were early and late morbidity, neo-ostium patency, and the Sinonasal Outcome Test-22 (SNOT-22). Results Twenty patients (60% male; mean age 48.3 ± 6.82 years) were included. All had diffuse CRS; 70% had type 2 disease, 40% had undergone previous sinus surgery, and 5 (25%) had a frontal mucocele. The procedure was bilateral in 14 patients. Carolyn’s window alone was performed in 15 patients; the opening was extended to a Draf IIb in 3 and beyond a Draf IIb, with removal of the interfrontal septum, in 2. Complete access was achieved in all patients (100%; 95% CI 83.2–100%). Early morbidity was minor: bleeding requiring intervention and severe pain occurred in one patient each (5%), and crusting and adhesions in two patients each (10%). No cerebrospinal fluid leak, periorbital edema or hematoma, flap necrosis, epiphora, reduction in smell from baseline, or cosmetic deformity occurred. The neo-ostium was patent in all patients at a mean follow-up of 55.9 ± 6.3 weeks, and no patient was lost to follow-up. The mean SNOT-22 score decreased from 92.63 ± 10.54 to 37.85 ± 5.66 ( p < 0.001). Conclusions In experienced hands, Carolyn’s window was a safe and feasible approach for selected patients with frontal sinus disease, with low morbidity and marked symptomatic improvement. These findings are limited by the small, single-surgeon, uncontrolled design, and comparative multicenter studies are needed to define the indications for the technique and its role relative to Draf IIa and IIb procedures.