Beyond the “central sinus”: radiographic findings in patients undergoing revision functional endoscopic sinus surgery

Gore, Mitchell R.; Ebert, Charles S.; Zanation, Adam M.; Senior, Brent A.

doi:10.1002/alr.21079

Cited by 34 publications

(41 citation statements)

References 32 publications

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“…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 …”

Section: Discussionmentioning

confidence: 99%

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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“…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 …”

Section: Discussionmentioning

confidence: 99%

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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“…There may be multiple reasons underlying this finding – there is an increasing body of evidence suggesting that diseased sinuses, if left untreated, may lead to failure of the entire surgery. Over the study period, surgeons may therefore have elected to treat patients more comprehensively 20. Others have also pointed to financial incentives for variability in surgical practice 19.…”

Section: Discussionmentioning

confidence: 99%

The impact of balloon catheter dilation on frequency of sinus surgery in the United States

Holy¹,

Ellison²,

Schneider³

et al. 2014

MDER

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PurposeEndoscopic sinus surgery for patients with chronic rhinosinusitis (CRS) unresponsive to medical therapy has traditionally been performed under general anesthesia and in the operating room. Balloons for catheter dilation of paranasal sinuses were introduced in 2005, allowing sinus surgery to be safely performed either in the operating room or the office care setting, under local anesthesia. This change in care setting has raised concerns of overuse or expanded indications for sinus surgery. This study was thus designed to evaluate changes in surgical volumes in the United States, for the period 2006–2011, and to evaluate the impact of the sinus balloons on surgical practice.MethodsThe MarketScan® Commercial Claims and Encounter Database was queried for the period 2006 to 2011 using CRS International Classification of Diseases, Ninth Revision codes (473.X) and sinus surgery US-based Common Procedural Terminology (CPT) codes (endoscopic sinus surgery: CPT codes 31254–31294 and 31299; balloon catheter dilation: CPT codes 31295–31297). MarketScan’s projection methodology was applied to estimate the nationwide prevalence of CRS and the incidence of sinus surgery. Procedural case mix and total average payment per surgery were analyzed.ResultsFrom 2006 to 2011, the yearly prevalence of CRS and sinus surgery volume remained flat with ~430 patients with CRS per 100,000 in the employer-sponsored insured population, of which ~117/100,000 underwent surgery. In 2006, 2.69 paranasal sinuses (95% confidence interval [95% CI]: 2.65–2.71) were treated during each individual sinus surgery, with an additional 1.11 nasal procedures (95% CI: 1.08–1.13) performed concurrently. By 2011, the procedural case mix had expanded to 2.90 sinus (95% CI: 2.87–2.93) and 1.16 nasal procedures (95% CI: 1.14–1.85) per surgery. Payments increased from $7,011.06 (α=$6,378.30; β=3.1490) in 2006 to $9,090.11 (α=$8,350.20; β=2.9535) in 2011, in line with US medical inflation.ConclusionIn the study population, approximately 1 in 3.7 patients diagnosed with CRS underwent sinus surgery. This ratio remained constant from 2006 to 2011. There was no evidence that the number of distinct sinus surgeries per 100,000 people increased despite the introduction and utilization of balloon catheter dilation tools that enabled migration of sinus surgery to the office.

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“…19,20 On the other hand, residual unopened ethmoid cells at the LP is a common finding in patients requiring revision ESS even in most recent studies. 21,22 Detailed knowledge of the radiological and endoscopic sinonasal anatomy is a key to safe and effective ESS. In fact, avoiding complications begins with preoperative preparation.…”

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confidence: 99%

“…31 This observation was again highlighted in similar studies over the past decade. 22,31,32 In 2013, Gore et al 21 found residual ethmoid air cells on the LP in 79% of 55 patients undergoing revision ESS. These data clearly signify that efficient clearance of ethmoid air cells on the LP remains challenging in certain cases and probably for some surgeons.…”

mentioning

confidence: 99%

“…Similarly, residual ethmoid cells on the LP remain 1 of the most common findings in revision ESS. 21 Our description of the variable positions of LP can help surgeons predict its location during preoperative evaluation, as well as intraoperatively, which should allow safer and more effective surgery while acquiring more experience in the learning curve. Figure 8 presents the radiologic and endoscopic views of a type II LP in which accidental intraoperative injury was documented.…”

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confidence: 99%

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Variations of lamina papyracea position from the endoscopic view: a retrospective computed tomography analysis

Herzallah

Marglani

Shaikh

2014

Int Forum Allergy Rhinol

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Beyond the “central sinus”: radiographic findings in patients undergoing revision functional endoscopic sinus surgery

Cited by 34 publications

References 32 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

The impact of balloon catheter dilation on frequency of sinus surgery in the United States

Variations of lamina papyracea position from the endoscopic view: a retrospective computed tomography analysis

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