Radiological findings in patients undergoing revision endoscopic sinus surgery: a retrospective case series study

BMC Ear, Nose and Throat Disorders

Nicholas Clifton¹  Ahmed Z Eweiss²  Hisham S Khalil² 

[1] Department of Otolaryngology, Derriford Hospital, Plymouth, UK;Department of Otolaryngology, Derriford Hospital, Plymouth, U.K. and Faculty of Medicine, University of Alexandria, Egypt

关键词: uncinate process;    sinus C.T scan;    revision FESS;    rhinosinusitis;    Functional endoscopic sinus surgery;   

Others  :  862865
DOI  :  10.1186/1472-6815-11-4

 received in 2010-08-19, accepted in 2011-05-07,  发布年份 2011

【 摘 要 】

Background

Functional endoscopic sinus surgery (FESS) is now a well-established strategy for the treatment of chronic rhinosinusitis which has not responded to medical treatment. There is a wide variation in the practice of FESS by various surgeons within the UK and in other countries.

Objectives

To identify anatomic factors that may predispose to persistent or recurrent disease in patients undergoing revision FESS.

Methods

Retrospective review of axial and coronal CT scans of patients undergoing revision FESS between January 2005 and November 2008 in a tertiary referral centre in South West of England.

Results

The CT scans of 63 patients undergoing revision FESS were reviewed. Among the patients studied, 15.9% had significant deviation of the nasal septum. Lateralised middle turbinates were present in 11.1% of the studied sides, and residual uncinate processes were identified in 57.1% of the studied sides. There were residual cells in the frontal recess in 96% of the studied sides. There were persistent other anterior and posterior ethmoidal cells in 92.1% and 96% of the studied sides respectively.

Conclusions

Analysis of CT scans of patients undergoing revision FESS shows persistent structures and non-dissected cells that may be responsible for persistence or recurrence of rhinosinusitis symptoms. Trials comparing the outcome of conservative FESS techniques with more radical sinus dissections are required.

【 授权许可】

   
2011 Khalil et al; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Khalil h, Nunez DA: Functional endoscopic sinus surgery for chronic rhinosinusitis. Cochrane Database of Systematic Reviews 2006, (3):CD004458.
• [2]Musy PY, Kountakis SE: Anatomic findings in patients undergoing revision functional endoscopic sinus surgery. Am J Otolaryngol 2004, 25:418-422.
• [3]King JM, Caldarelli DD, Pigato JB: A review of revision functional endoscopic sinus surgery. Laryngoscope 1994, 104:404-408.
• [4]Hopkins C, Browne JP, Slack R, Lund V, Topham J, Reeves B, Copley L, Brown P, Vander Meulen J: The national comparative audit of surgery for nasal polyposis and chronic rhinosinusitis. Clin Otol 2006, 31:390-398.
• [5]Chiu AG, Kennedy DW: Tips and pearls in revision sinus surgery. In Revision sinus surgery. Edited by Kountakis SE, Jacobs J, Gosepath J. Verlag Berlin Heidelberg: Springer; 2008:79-89.
• [6]Stankiewicz JA, Donzelli JJ, Chow JM: Failures of functional endoscopic sinus surgery and their surgical correction. Oper Tech Otolaryngol Head Neck Surg 1996, 7:297-304.
• [7]Lund V, Mackay I: Staging in rhinosinusitis. Rhinology 1993, 31:183-184.
• [8]Kennedy DW: Prognostic factors, outcomes and staging in ethmoids sinus surgery. Laryngoscope 1992, 102:1-18.
• [9]Lazar RH, Younis RT, Long TE, Gross CW: Revision functional endonasal sinus surgery. Ear Nose Throat J 1992, 71:131-133.
• [10]Ramadan HH: Surgical causes of failure in endoscopic sinus surgery. Laryngoscope 1999, 109:27-29.
• [11]Nayak DR, Balakrishnan R, Murty KD: Functional anatomy of the uncinate process and its role in endoscopic sinus surgery. Indian J Otolaryngol Head Neck Surg 2001, 53:27-31.
• [12]Nayak DR, Balakrishnan R, Murty KD: Endoscopic physiologic approach to allergy associated chronic rhinosinusitis: A preliminary study. Ear Nose Throat J 2001, 80:390-403.
• [13]Catalano PJ: Minimally invasive sinus technique: What is it? Should we consider it? Curr Opin Otolaryngol Head Neck Surg 2004, 12:34-37.
• [14]Catalano PJ, Strouch M: The minimally invasive sinus technique: theory and practice. Otolaryngol Clin North Am 2004, 37:401-409.
• [15]Chiu AG, Kennedy DW: Disadvantages of minimal techniques for surgical management of chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg 2004, 12:38-42.
• [16]Klossek JM, Peloquin L, Friedman WH, Ferrier JC, Fontanel JP: Diffuse nasal polyposis: postoperative long term results after endoscopic sinus surgery and frontal irrigation. Otolaryngol Head Neck Surg 1997, 117:355-361.
• [17]Jankowski R, Pigret D, Decroocq F: Comparison of functional results after ethmoidectomy and nasalization for diffuse and severe nasal polyposis. Acta Otolaryngol 1997, 117:601-608.
• [18]Jankowski R, Bodino C: Olfaction in patients with nasal polyposis: effect of systemic steroids and radical ethmoidectomy with middle turbinate resection (nasalization). Rhinology 2003, 41:220-230.
• [19]Marchioni D, Alicandri-Ciufelli M, Mattioli F, Marchetti A, Jovic G, Massone F, Presutti L: Middle turbinate preservation versus middle turbinate resection in endoscopic surgical treatment of nasal polyposis. Acta Otolaryngol 2008, 128:1019-1026.