Muaid I Aziz Baban1, Baidaa Mirza2, Paolo Castelnuovo3,4. 1. Unit of Otorhinolaryngology-Head and neck surgery, Department of Surgery, College of Medicine, Sulaymaniyah Teaching Hospital, University of Sulaimani, Sulaymaniyah, Kurdistan, Iraq. muaident@gmail.com. 2. Unit of Otorhinolaryngology-Head and neck surgery, Department of Surgery, College of Medicine, Sulaymaniyah Teaching Hospital, University of Sulaimani, Sulaymaniyah, Kurdistan, Iraq. 3. Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, Ospedale Di Circolo E Fondazione Macchi, University of Insubria, Varèse, Italy. 4. Department of Biotechnology and Life Sciences, Head and Neck Surgery and Forensic Dissection Research Center (HNS and FDRc), University of Insubria, Varèse, Italy.
Abstract
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.
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.
Authors: Benjamin Philipp Ernst; Manuel René Reissig; Sebastian Strieth; Jonas Eckrich; Jan H Hagemann; Julia Döge; Christoph Matthias; Haralampos Gouveris; Johannes Rübenthaler; Roxanne Weiss; Wieland H Sommer; Dominik Nörenberg; Thomas Huber; Phillipp Gonser; Sven Becker; Matthias F Froelich Journal: PLoS One Date: 2020-11-30 Impact factor: 3.240