OBJECTIVE: To report the anatomic findings that contribute to persistent sinusitis in patients requiring revision functional endoscopic sinus surgery (FESS). METHODS: Data were collected prospectively on consecutive patients requiring revision FESS at a tertiary institution over a 2-year period. Patients were evaluated with endoscopic examination of the sinonasal cavities, and computed tomography of the sinuses was performed after patients failed prolonged medical therapy for sinusitis. Information was also collected during the revision surgery. RESULTS: The most common anatomic factor associated with primary surgery failure was lateralization of the middle turbinate (78%) followed by incomplete anterior ethmoidectomy (64%), scarred frontal recess (50%), incomplete posterior ethmoidectomy (41%), and middle meatal antrostomy stenosis (39%). In addition, retained agger nasi and retained uncinate process were identified in 49% and 37% of the patients, respectively. Recurrent polyposis was seen in 37% of the patients. Other factors such as persistent sphenoid disease and sphenoid ostium stenosis were less frequent. CONCLUSION: Failure of primary FESS is most often associated with anatomic obstruction in the area of the ostiomeatal complex. Meticulous attention in this area during surgery with ventilation of obstructed anatomy as well as avoidance of scarring and turbinate destabilization may reduce the failure rate after primary FESS.
OBJECTIVE: To report the anatomic findings that contribute to persistent sinusitis in patients requiring revision functional endoscopic sinus surgery (FESS). METHODS: Data were collected prospectively on consecutive patients requiring revision FESS at a tertiary institution over a 2-year period. Patients were evaluated with endoscopic examination of the sinonasal cavities, and computed tomography of the sinuses was performed after patients failed prolonged medical therapy for sinusitis. Information was also collected during the revision surgery. RESULTS: The most common anatomic factor associated with primary surgery failure was lateralization of the middle turbinate (78%) followed by incomplete anterior ethmoidectomy (64%), scarred frontal recess (50%), incomplete posterior ethmoidectomy (41%), and middle meatal antrostomy stenosis (39%). In addition, retained agger nasi and retained uncinate process were identified in 49% and 37% of the patients, respectively. Recurrent polyposis was seen in 37% of the patients. Other factors such as persistent sphenoid disease and sphenoid ostium stenosis were less frequent. CONCLUSION: Failure of primary FESS is most often associated with anatomic obstruction in the area of the ostiomeatal complex. Meticulous attention in this area during surgery with ventilation of obstructed anatomy as well as avoidance of scarring and turbinate destabilization may reduce the failure rate after primary FESS.
Authors: James G Krings; Dorina Kallogjeri; Andre Wineland; Kenneth G Nepple; Jay F Piccirillo; Anne E Getz Journal: Laryngoscope Date: 2013-10-09 Impact factor: 3.325
Authors: Nikita Chapurin; Adam Honeybrook; Sean Johnson; Cynthia Wang; David W Jang Journal: Int Forum Allergy Rhinol Date: 2016-06-21 Impact factor: 3.858
Authors: Zi Zhang; Nithin D Adappa; Ebbing Lautenbach; Alexander G Chiu; Laurel Doghramji; Timothy J Howland; Noam A Cohen; James N Palmer Journal: Int Forum Allergy Rhinol Date: 2014-01-10 Impact factor: 3.858