Causes of failure in endoscopic frontal sinus surgery in chronic rhinosinusitis patients

Valdés, Constanza J.; Bogado, Mariana; Samaha, Mark

doi:10.1002/alr.21307

Cited by 53 publications

(40 citation statements)

References 15 publications

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“…Endoscopic sinus surgery (ESS) is largely successful in treating CRS . However, frontal sinusotomy has been shown to have a lower success rate depending on the preoperative conditions, extent of frontal sinusotomy, and postoperative medical management of the frontal recess . Reasons for failure of frontal ESS include persistent or recurrent inflammation and circumferential scarring at the frontal recess, leading to restenosis and occlusion of the frontal sinus opening (FSO), which may lead to the need for revision …”

Section: Introductionmentioning

confidence: 99%

Randomized controlled trial of a bioabsorbable steroid‐releasing implant in the frontal sinus opening

et al. 2016

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Section: Introductionmentioning

confidence: 99%

Randomized controlled trial of a bioabsorbable steroid‐releasing implant in the frontal sinus opening

et al. 2016

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“…A recent study showed that, although lateralization of the middle turbinate is not associated with increased symptoms, it is associated with the need for revision ESS. 16 Valdes et al 17 also found it to be a common finding (48% of revision cases) in patients undergoing revision frontal sinus procedures. In 35% of patients in our study, the middle turbinate had been resected.…”

Section: Discussionmentioning

confidence: 93%

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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“…17 Retained frontal cells and cicratricial scarring after instrumentation of narrow frontal recesses are both common causes of frontal sinus surgery failure and need for revision. 18 Draf II surgery is an effective technique to maximally augment the frontal recess to the natural limits of a hand instrument: the lamina paparycea, the frontal beak and the skull base. These fundamental limits lead to a range of cross-sectional areas of the frontal sinus outflow depending upon individual patient anatomy.…”

Section: Discussionmentioning

confidence: 99%

Can sinus anatomy predict quality of life outcomes and operative times of endoscopic frontal sinus surgery?

DeConde

Barton

Mace

et al. 2015

American Journal of Otolaryngology

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Purpose Endoscopic sinus surgery (ESS) can manipulate sinus anatomy, but with limitations due to skull base and orbit anatomy. These anatomical structures dictate the maximal extent of ESS in the frontal recess and may limit surgical extent or operative duration. This study investigates the impact of these anatomical constraints on operative time and quality-of-life (QOL) outcomes. Materials&Methods Patients with medically refractory chronic rhinosinusitis undergoing Draf IIa frontal sinus surgery were prospectively enrolled. Anatomic measurements of the frontal sinus anatomy were collected during computed tomography review and included: widest distance between the frontal beak and posterior table, narrowest point in the ethmoid bed, Keros height, presence of an anterior ethmoid artery on a mesentery, and presence of inter-sinus septal cells. Primary outcomes included mean operative time and improvement in SinoNasal Outcome Test (SNOT-22) survey scores. Results 63 adult participants were enrolled and followed 13.8 (5.2) months on average. The ethmoid bed mean width was 7.2 (1.4) mm, the mean distance from frontal beak to the posterior table at widest was 9.0 (2.7) mm, and mean Keros height 5.1 (1.8) mm. 49/63 (77.8%) of participants had inter-sinus septal cells and 30/63 (47.6%) had anterior ethmoid arteries on a mesentery. Mean operative time was 121.5 (44.0) minutes while SNOT-22 scores significantly (p<0.001) improved 26.1 (21.6) on average. Anatomic measurements were not predictive of operative time or mean QOL change (p>0.050). Conclusions Frontal sinus surgery is an effective treatment for a range of frontal and ethmoid sinus anatomy. Further study with larger sample size and measures of more restricted anatomy might elucidate treatment limitations of ESS.

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Causes of failure in endoscopic frontal sinus surgery in chronic rhinosinusitis patients

Cited by 53 publications

References 15 publications

Randomized controlled trial of a bioabsorbable steroid‐releasing implant in the frontal sinus opening

Randomized controlled trial of a bioabsorbable steroid‐releasing implant in the frontal sinus opening

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

Can sinus anatomy predict quality of life outcomes and operative times of endoscopic frontal sinus surgery?

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