Radiological and endoscopic findings in patients undergoing revision endoscopic sinus surgery

• Published in: Surgical and radiologic anatomy (English ed.) 2020-09, Vol.42 (9), p.1003-1012
• Main Authors: Baban, Muaid I. Aziz, Mirza, Baidaa, Castelnuovo, Paolo
• Format: Article
• Language: English
• Subjects: Adult; Anatomic Variation; Anatomy; Chronic Disease - therapy; Clinical trials; Computed tomography; Cross-Sectional Studies; Endoscopy; Etiology; Female; Humans; Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Mucosa; Original Article; Orthopedics; Osteitis; Paranasal Sinuses - abnormalities; Paranasal Sinuses - diagnostic imaging; Paranasal Sinuses - surgery; Patients; Prospective Studies; Radiology; Recurrence; Reoperation; Rhinitis; Rhinitis - diagnosis; Rhinitis - surgery; Rhinosinusitis; Severity of Illness Index; Sinuses; Sinusitis; Sinusitis - diagnosis; Sinusitis - surgery; Surgery; Tomography, X-Ray Computed; Variation; Young Adult
• ISSN: 0930-1038; 1279-8517
• DOI: 10.1007/s00276-020-02427-5

Over the last three decades, functional endoscopic sinus surgery (FESS) has become one of the most common surgical techniques, with significant data supporting its efficacy in treating chronic rhinosinusitis (CRS). However, despite this initial published success rate, approximately 10–15% of them will require a subsequent revision surgery. The severity of the disease, the comorbidities and the anatomical variation that are not addressed adequately in the primary surgery, are considered the main factors that cause the failure of the primary surgery. Our objective is to report anatomical findings that may contribute to recurrent disease to improve the success rate in the primary surgery. Patients and methods A prospective cross sectional study was conducted for 24 patients presenting for revision functional endoscopic sinus surgery (FESS). Lund-kennedy and Lund–Mackay score systems, pre and intraoperative CT scan and endoscopic assessments utilized, respectively, to delineate the causes of the primary surgery’s failure. The most common finding was persistent frontoethmoidal cell, anterior and posterior ethmoid cell: 81.2%, 72.9%, 70.8%, respectively. Bony osteitis and scarred frontal recess were visible in 66.7%. Recirculation phenomena, resected concha bullosa and persistent Onodi cell, were the least noticeable findings: 6.25%, 8.3%, 8.30% consecutively Conclusions The recurrence of the CRS that needs revision FESS is multifactorial in etiology ranging from sever mucosal disease to anatomical variations that is not addressed precisely in primary surgery. Trials of studies with a larger number of patient series comparing the anatomical variations that impact on recurrence of CRS with and without polyp are required.