Anatomical margins of uncinectomy in endoscopic sinus surgery

Awad, Zaid; Bhattacharyya, Manoj K.; Jayaraj, Samuel

doi:10.1016/j.ijsu.2013.01.001

Cited by 7 publications

(6 citation statements)

References 5 publications

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“…The variations in uncinate anatomy should be considered by using radiologic examination before resection, with particular reference to its superior attachment and its relationship to the orbit. 11 Sixty-four percent of patients in this study had residual uncinate; although the residual components varied, this echoed radiologic findings in a previous revision ESS series. 12 One patient in our cohort had previous visual loss after intraorbital hemorrhage; on this occasion, the uncinate was found laterally fractured into the maxillary sinus.…”

Section: Incomplete Uncinectomysupporting

confidence: 84%

Anatomic Findings in Revision Endoscopic Sinus Surgery: Case Series and Review of Contributory Factors

Bewick

Egro

Masterson

et al. 2016

Allergy�Rhinol (Providence)

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Background:It is recognized that patients who undergo endoscopic sinus surgery (ESS) do not always achieve control of their disease. The causes are multifactorial; variations in surgical practice have been identified as possible factors in refractory disease.Objective:To reflect on the frequent anatomic findings of patients with chronic rhinosinusitis (CRS) who require revision ESS.Methods:A retrospective review of patients who required revision ESS at a tertiary institution over a 3-year period. Patients for whom maximal medical therapy failed for CRS underwent computed tomography of the paranasal sinuses and image-guided surgery. Surgical records of anatomic findings were reviewed and analyzed.Results:Over 3 years, a total of 75 patients underwent revision procedures, 28% of all ESS performed in the unit. The most frequent finding was a residual uncinate process in 64% of the patients (n = 48); other findings included a maxillary antrostomy not based on the natural ostium of the maxillary sinus in 47% (n = 35), an oversized antrostomy in 29% (n = 22), resected middle turbinates in 35% (n = 26), middle meatal stenosis in 15% (n = 11), synechiae in 29% (n = 22), and osteitic bone that required drilling in 13% (n = 10).Conclusion:Surgical technique can give rise to anatomic variations that may prevent adequate mucociliary clearance and medication delivery, which leads to failure in ESS in patients with CRS. This study demonstrated the surgical findings encountered in revision ESS that should be highlighted in the training of Ear, Nose and Throat surgeons to help prevent primary failure and reduce health care costs.

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Section: Incomplete Uncinectomysupporting

confidence: 84%

Anatomic Findings in Revision Endoscopic Sinus Surgery: Case Series and Review of Contributory Factors

Bewick

Egro

Masterson

et al. 2016

Allergy�Rhinol (Providence)

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“…The variations in uncinate anatomy should be considered by using radiological examination before resection, with particular reference to its superior attachment and its relationship to the orbit. 11 Figure 1 demonstrates the three common sites of attachment of the uncinate process: In a recent study of anatomical findings at revision surgery for CRS, 64% of patients had a residual uncinate process; this was in keeping with a radiological study looking at findings from previous revision endoscopic sinus surgery (ESS). 12 Figure 2 shows an example of a residual uncinate process in the presence of continued inflammatory changes (red arrow).…”

Section: Ijhnsmentioning

confidence: 54%

Endonasal Approaches to Maxillary Sinus

Philpott¹,

Sama²

2018

International Journal of Head and Neck Surgery

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Operating on the maxillary sinus has been a part of the otorhinolaryngologist's surgical repertoire being perceived as the most accessible sinus. Following the advent of endoscopic sinus surgery and advances in angled endoscopes and surgical instruments, approaches to the maxillary sinus have evolved leaving open approaches largely redundant. This review article will guide the readers through the key anatomical principles and techniques available for endoscopic approaches to the maxillary sinus.

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“…Multiple other studies emphasise FESS to be superior to the Caldwell Luc procedure in the subjective improvement of OMS 37,38 . Uncinectomy followed by middle meatal antrostomy was completed in every case, allowing for clearing the osteomeatal complex, improved access and widening of the maxillary ostium 39 . In the original case series, none of the flaps used in this study failed and on examination of the patients' clinical notes, no mention of problems resulting from reduced vestibular height was documented.…”

Section: Discussionmentioning

confidence: 87%

“…37,38 Uncinectomy followed by middle meatal antrostomy was completed in every case, allowing for clearing the osteomeatal complex, improved access and widening of the maxillary ostium. 39 In the original case series, none of the flaps used in this study failed and on examination of the patients' clinical notes, no mention of problems resulting from reduced vestibular height was documented. The BFPF has proven to be successful in closing fistulae of up to 20 mm.…”

Section: Discussionmentioning

confidence: 92%

Closure of oro‐antral fistulae in conjunction with functional endoscopic sinus surgery: A systematic review and retrospective analysis

2022

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Aim An oro‐antral communication (OAC) is a recognised potential complication of maxillary tooth extraction. If it does not resolve, a pathological epithelialised tract or oro‐antral fistula (OAF) can develop. The aim of this systematic review was to determine whether OAF closure with functional endoscopic sinus surgery (FESS) provides an effective approach for total closure and relief of sinusitis. Material and Methods The systematic review followed the PRISMA format. An electronic database search was performed to identify publications in English between 2010 and 2020, containing human subjects with radiographic evidence of sinus pathology, relating to OAF formation following extraction, and simultaneous OAF closure with FESS. Success was measured as total closure and relief of symptoms after 3 weeks. A retrospective analysis of patients within the Cwm Taf Morgannwg University Health Board that fit the eligibility criteria over a 5‐year period was conducted and compared with the results of the review. Results Five papers were included in the review, covering 86 OAFs, with an overall success rate of 97.7% (84/86). Two patients required revision surgery, due to recurrent OAFs, who were both diabetic and smokers. A total of 13 patients met the case series' inclusion criteria, and 100% success was achieved. A minor complication of post‐operative nasal synechia arose in 4/99 (4.0%) patients. Evidence‐based guidance was created for local dentists encountering an acute OAC. Conclusions OAF closure with FESS can be considered a highly effective approach, leaving patients symptom‐free. It is important that protocols are in place for dentists suspecting an OAC to expedite patient management.

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Anatomical margins of uncinectomy in endoscopic sinus surgery

Abstract: It is essential to carefully examine the area on a CT scan especially when performing front-to-back uncinectomy during endoscopic sinus surgery. The variation between the right and left sides should be considered to avoid unsafe assumptions.

Cited by 7 publications

References 5 publications

Anatomic Findings in Revision Endoscopic Sinus Surgery: Case Series and Review of Contributory Factors

Anatomic Findings in Revision Endoscopic Sinus Surgery: Case Series and Review of Contributory Factors

Endonasal Approaches to Maxillary Sinus

Closure of oro‐antral fistulae in conjunction with functional endoscopic sinus surgery: A systematic review and retrospective analysis

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