Tomographical Findings in Adult Patients Undergoing Endoscopic Sinus Surgery Revision
11 October 2016
22 January 2017
24 April 2017 (eFirst)
Introduction Many patients undergoing functional endoscopic sinus surgery still have an uncontrolled clinical disease in the late post-operative period. Up to 11.4% of the patients will require a revision surgery. Findings such as the residual uncinated process and the lateralization of the middle turbinate were considered by some studies as being responsible for failure in the primary surgery.
Objectives To describe the tomographical findings in adult patients undergoing revision endoscopic sinus surgery, the profile of those patients, and verify the mucosal thickening level of the paranasal sinus.
Methods Data were collected from medical records and computed tomography reports of 28 patients undergoing revision sinus surgery on a private service in the city of Blumenau between 2007 and 2014. The score of Lund-Mackay was used to verify the mucosal thickening level.
Results Among the 28 patients, 23 were reoperated once, 3 were reoperated twice, and 2 were reoperated 3 times. The most relevant findings were mucosal thickening of the maxillary sinus (89.28%), deviated septum (75%), thickening of the ethmoid (50%) and sphenoidal sinuses (39.28%), and pneumatization of the middle turbinate (39.28%). The average obtained in the Lund-Mackay score was 5.71, with most patients classified in the lower range of punctuation.
Conclusion The analysis of the computed tomography scans showed persistent structures that may be responsible for the failure of the primary surgery. Computed tomography is a useful tool to plan the surgery and quantify the post-operative success.
- 1 Brasileiras de Rinossinusites D Rev Bras Otorrinolaringol [Internet]. 2008; 74 (2 Suppl): 6-59 . Available in: http://dx.doi.org/10.1590/S0034-72992008000700002 . Acessed in May 14, 2015
- 2 Huang BY, Lloyd KM, DelGaudio JM, Jablonowski E, Hudgins PA. Failed endoscopic sinus surgery: spectrum of CT findings in the frontal recess. Radiographics 2009; 29 (01) 177-195
- 3 Govindaraj S, Agbetoba A, Becker S. Revision sinus surgery. Oral Maxillofac Surg Clin North Am 2012; 24 (02) 285-293 , ix
- 4 Masterson L, Agalato E, Pearson C. Image-guided sinus surgery: practical and financial experiences from a UK centre 2001-2009. J Laryngol Otol 2012; 126 (12) 1224-1230
- 5 Cohen NA, Kennedy DW. Revision endoscopic sinus surgery. Otolaryngol Clin North Am 2006; 39 (03) 417-435 , vii
- 6 Mascarenhas JG, da Fonseca VM, Chen VG. , et al. Long-term outcomes of endoscopic sinus surgery for chronic rhinosinusitis with and without nasal polyps. Rev Bras Otorrinolaringol (Engl Ed) 2013; 79 (03) 306-311
- 7 Kountakis SE, Jacobs J, Gosepath J. Revision Sinus Surgery. 1st ed. Berlin: Springer; 2008
- 8 Hopkins C, Browne JP, Slack R. , et al. The national comparative audit of surgery for nasal polyposis and chronic rhinosinusitis. Clin Otolaryngol 2006; 31 (05) 390-398
- 9 Okushi T, Nakayama T, Morimoto S. , et al. A modified Lund-Mackay system for radiological evaluation of chronic rhinosinusitis. Auris Nasus Larynx 2013; 40 (06) 548-553
- 10 Lund VJ, Kennedy DW. Staging for rhinosinusitis. Otolaryngol Head Neck Surg 1997; 117 (3 Pt 2): S35-S40
- 11 Khalil HS, Eweiss AZ, Clifton N. Radiological findings in patients undergoing revision endoscopic sinus surgery: a retrospective case series study. BMC Ear Nose Throat Disord 2011; 11: 4
- 12 Kennedy DW. Prognostic factors, outcomes and staging in ethmoid sinus surgery. Laryngoscope 1992; 102 (12 Pt 2, Suppl 57) 1-18
- 13 Lazar RH, Younis RT, Long TE, Gross CW. Revision functional endonasal sinus surgery. Ear Nose Throat J 1992; 71 (03) 131-133
- 14 Musy PY, Kountakis SE. Anatomic findings in patients undergoing revision endoscopic sinus surgery. Am J Otolaryngol 2004; 25 (06) 418-422
- 15 Figueroa RE. Imaging Anatomy in Revision Sinus Surgery. Kountakis S, Jacobs J, Gosepath J. Revision Sinus Surgery. Berlin: Springer; 2008: 1-10
- 16 Parsons DS, Stivers FE, Talbot AR. The missed ostium sequence and the surgical approach to revision functional endoscopic sinus surgery. Otolaryngol Clin North Am 1996; 29 (01) 169-183
- 17 Nayak DR, Balakrishnan R, Murty KD. Functional anatomy of the uncinate process and its role in endoscopic sinus surgery. Indian J Otolaryngol Head Neck Surg 2001; 53 (01) 27-31
- 18 Lund VJ, Mackay IS. Staging in rhinosinusitus. Rhinology 1993; 31 (04) 183-184
- 19 Ashraf N, Bhattacharyya N. Determination of the “incidental” Lund score for the staging of chronic rhinosinusitis. Otolaryngol Head Neck Surg 2001; 125 (05) 483-486
- 20 Hopkins C, Browne JP, Slack R, Lund V, Brown P. The Lund-Mackay staging system for chronic rhinosinusitis: how is it used and what does it predict?. Otolaryngol Head Neck Surg 2007; 137 (04) 555-561