A Clinical Analysis of Revision Endoscopic Sinus Surgery: Single-Center 10-Year Experience

BACKGROUND AND OBJECTIVES: Endoscopic sinus surgery (ESS) has become a popular procedure for treating chronic sinusitis. Despite recent developments in medical and surgical techniques, primary ESS can still fail. Although revision ESS is one solution to the problem of recurrent sinusitis, revision surgery is stressful for patients and otolaryngologists. Therefore, we examined the causes of ESS failure and sought to find ways to prevent the failure of primary ESS. MATERIALS AND METHODS: All patients who underwent revision ESS in our department between April 2003 and March 2012 were studied retrospectively. RESULTS: During this period, revision ESS was performed 40 times to treat chronic sinusitis. We analyzed the preoperative computed tomographic (CT) findings of primary and revision ESS cases using the Lund-Mackay and Kennedy CT staging scores to compare disease severity. In our cases, the failure of ESS was not affected by the extent of disease, asthma, or allergy. Polyposis was the only useful predictor of revision ESS. CONCLUSION: Polyposis is an important predictor of revision ESS. We recommend that patients be followed frequently and carefully, especially those with polyps.

CT Findings in Revision Endoscopic Sinus Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: When performing a revision endoscopic sinus surgery, operators should pay close attention due to the altered sinonasal anatomy or defects of anatomical landmarks. Careful preoperative evaluation of altered anatomy is important, however, little has been reported on its structural changes. We investigated status of anatomical structures and mucosal pathology by reviewing OMU CT in revision sinus surgeries. MATERIALS AND METHODS: A total of 117 operated sides (right: 59, left: 58) from 62 patients who received revision endoscopic sinus surgeries were evaluated. They had history of previous sinus surgeries such as Caldwell-Luc operation, polypectomy, or endoscopic sinus surgery. We investigated the following 5 parameters by reviewing preoperative OMU CT; Sinus mucosal pathology, bony thickening, absence of superior or middle turbinate, structural changes of superior or middle turbinate, and defects of anatomical landmarks. RESULTS: Sinus mucosal pathology was most commonly found in the maxillary sinuses, and was followed by the anterior ethmoid, the posterior ethmoid, the frontal, and the sphenoid sinuses. Out of 117 sides, 47 showed bony thickening and 7 showed absence of superior or middle turbinate. Eleven revealed structural changes in the superior or middle turbinate, and three showed defects in the lamina papyracea. However, there was no complete absence of the middle or superior turbinates, all of which were partially preserved. CONCLUSION: Significant bony thickening, defects or changes of anatomical structures and associated mucosal pathology were frequently found in revision endoscopic sinus surgeries. Preoperative review of OMU CT, identification of structural changes, and close attention during surgery would be necessary.