Causes and management of failure in endoscopic middle meatus antrostomies

ABSTRACT

The aim of this study is to analyse the causes and the management of failed endoscopic middle meatus antrostomies [EMMA] in chronic sinusitis and benign sinonasal lesions or tumors. We carried a retrospective study about 257 EMMA cases performed in our department for 201 patients between 1996 and 2006. All patients had complete ORL examination and preoperative sinonasal CT. After surgery, preoperative and postoperative symptoms were compared and nasal endoscopy was performed in all cases. Persistent rhinologic and radiological symptoms were considered as a failure of surgery. In these cases, revision surgery was performed, either by endoscopic approach or by Caldwell-Luc procedure. Mean follow-up period was 2 years. The indication of surgery was the presence of chronic sinusitis, benign lesions or benign tumors in 53.2%, 41.8% and 5% of cases respectively. Seventy-one EMMA procedures failed [27.6%]. Causes of failure were mainly represented by the presence of synechia [38%], ostium stenosis [24%], medical causes and comorbidity [15.5%], persistent or recurrent lesions [15.5%] and missed natural ostium [7%]. Nineteen patients [9.4%] required revision surgery because of persistent symptoms after medical therapy. Either endoscopic or vestibular approaches were performed. Seventy-three percent of the revision cases respond to surgical treatment with complete resolution of symptoms. Failure of EMMA can be due to numerous and variable causes. The management of failed EMMA includes medical therapy, revision endoscopic surgery or vestibular approaches