Skip to main content

Advertisement

SpringerLink
Log in

Radiological and endoscopic findings in patients undergoing revision endoscopic sinus surgery

  • Original Article
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Abstract

Over the last three decades, functional endoscopic sinus surgery (FESS) has become one of the most common surgical techniques, with significant data supporting its efficacy in treating chronic rhinosinusitis (CRS). However, despite this initial published success rate, approximately 10–15% of them will require a subsequent revision surgery. The severity of the disease, the comorbidities and the anatomical variation that are not addressed adequately in the primary surgery, are considered the main factors that cause the failure of the primary surgery. Our objective is to report anatomical findings that may contribute to recurrent disease to improve the success rate in the primary surgery.

Patients and methods

A prospective cross sectional study was conducted for 24 patients presenting for revision functional endoscopic sinus surgery (FESS). Lund-kennedy and Lund–Mackay score systems, pre and intraoperative CT scan and endoscopic assessments utilized, respectively, to delineate the causes of the primary surgery’s failure. The most common finding was persistent frontoethmoidal cell, anterior and posterior ethmoid cell: 81.2%, 72.9%, 70.8%, respectively. Bony osteitis and scarred frontal recess were visible in 66.7%. Recirculation phenomena, resected concha bullosa and persistent Onodi cell, were the least noticeable findings: 6.25%, 8.3%, 8.30% consecutively

Conclusions

The recurrence of the CRS that needs revision FESS is multifactorial in etiology ranging from sever mucosal disease to anatomical variations that is not addressed precisely in primary surgery. Trials of studies with a larger number of patient series comparing the anatomical variations that impact on recurrence of CRS with and without polyp are required.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Albu S, Tomescu E, Mexca Z et al (2004) Recurrence rates in endo-nasal surgery for polyposis. Acta Otorhinolaryngol Belg 58:79–86

    CAS  PubMed  Google Scholar 

  2. Alexander G, Chiu AG, Kennedy DW (2008) Tips and pearls in revision sinus surgery. In: Kountakis SE, Jacobs J, Gosepath J (eds) Revision sinus surgery. Springer, Berlin Heidelberg, pp 79–89

    Google Scholar 

  3. Ashraf N, Bhattacharyya N (2001) Determination of the incidental Lund- Mackay score for the staging of chronic rhinosinusitis. Otolaryngol Head Neck Surg 125:483–486

    Article  CAS  Google Scholar 

  4. Bateman ND, Fahy C, Woolford TJ (2003) Nasal polyps: still more questions than answers. J Laryngol Otol 117:1–9

    Article  Google Scholar 

  5. Batra PS, Kern RC, Tripathi A, et al. (2003) Outcome analysis of endoscopic sinus surgery in patients with nasal polyps and asthma. Laryngoscope 113:1703–1706.

  6. Benniger MS (2008) Rhinosinusitis, Scott–Brown’s otolaryngology-head and neck surgery. Seventh edition 113:1439–1448

    Google Scholar 

  7. Briggs RD, Wright ST, Cordes S, Calhoun KH (2004) Smoking in chronic rhinosinusitis: a predictor of poor long-term outcome after endoscopic sinus surgery. Laryngoscope 114:126–128

    Article  Google Scholar 

  8. Castelnuovo P et al. (2014) Endoscopic cadaver dissection of the nose and paranasal sinuses. Silver Book; p23–25.

  9. Chandra RK, Palmer JN, Tangsujarittham T, Kennedy DW (2004) Factors associated with failure of frontal sinusotomy in the early follow-up period. Otolaryngol Head Neck Surg 131:514–518

    Article  Google Scholar 

  10. Chiu AG, Kennedy DW (2004) Disadvantages of minimal techniques for surgical management of chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg 12:38–42

    Article  Google Scholar 

  11. Cho SH, Min HJ, Han HX, Paik SS, Kim KR (2006) CT analysis and histopathology of bone remodeling in patients with chronic rhinosinusitis. Otolaryngol Head Neck Surg 135:404–408

    Article  Google Scholar 

  12. Cohen NA, Kennedy DW (2006) Revision endoscopic sinus surgery. Otolaryngol Clin North Am 39:417–435

    Article  Google Scholar 

  13. Davis WE, Templer JW, Lamear WR (1999) Middle meatus antrostomy: patency rates and risk factors. Otolaryngol Head Neck Surg 104:467–472

    Article  Google Scholar 

  14. Elwany S, Bassyouni M, Morad F (2002) Some risk factors for refractory chronic sinusitis: an immune histochemical and electron microscopic study. J Laryngol Otol 116:112–115

    Article  Google Scholar 

  15. Garrel R, Gardiner Q, Khudjadze M et al (2003) Endoscopic surgical treatment of Sino-nasal polyposis-medium term outcomes (mean Follow-up of 5 years). Rhinology 41:91–96

    CAS  PubMed  Google Scholar 

  16. Georgalas C, Videler W, Freling N, Fokkens W (2010) Global Osteitis Scoring Scale and chronic rhinosinusitis: a marker of revision surgery. Clin Otolaryngol 35:455–461

    Article  CAS  Google Scholar 

  17. Gore MR, Ebert CS, Zanation AM, Senior BA (2013) Beyond the “central sinus”: radiographic findings in patients undergoing revision functional endoscopic sinus surgery. Int Forum Allergy Rhinol 3(2):139–46. https://doi.org/10.1002/alr.21079

    Article  PubMed  Google Scholar 

  18. Hinohira Y, Yumoto E, Hyodo M et al (1995) Revision endoscopic sinus surgery—long-term follow up and operative findings. Nippon Jibiinkoka Gakkai Kaiho 98:1285–1290

    Article  CAS  Google Scholar 

  19. Hopkins C, Browne JP, Slack R, Lund VJ, Brown P (2007) The Lund-Mackay staging system for chronic rhinosinusitis: how is it used and what does it predict? Otolaryngol Head Neck Surg 137:555–561

    Article  Google Scholar 

  20. Kennedy DW, Senior BA, Gannon FH, Montone KT, Hwang P, Lanza DC (1998) Histology and histo-morphometry of ethmoid bone in chronic rhinosinusitis. Laryngoscope 108:502–507

    Article  CAS  Google Scholar 

  21. Kennedy DW (1992) Prognostic factors, outcomes and staging in ethmoid sinus surgery. Laryngoscope 102(suppl 57):1–18

  22. Khalil HS, Eweiss AZ, Clifton N (2011) Radiological findings in patients undergoing revision endoscopic sinus surgery: a retrospective case series study. BMC Ear Nose Throat Disorder 11:4

    Article  Google Scholar 

  23. Lawson W (1991) The intranasal ethmoidectomy: an experience with 1,077 procedures. Laryngoscope 105:367–371

    Article  Google Scholar 

  24. Lazar RH, Younis RT, Long TE, Gross CW (1992) Revision functional endonasal sinus surgery. Ear Nose Throat J 71:131–133

    Article  CAS  Google Scholar 

  25. Lee JT, Kennedy DW, Palmer JN, Feldman M, Chiu AG (2006) The incidence of concurrent osteitis in patients with chronic rhinosinusitis: a clinicopathological study. Am J Rhinol 20:278–282

    Article  Google Scholar 

  26. Lee JM, Chiu AG (2010) Role of maximal endoscopic sinus surgery techniques in chronic rhinosinusitis. Otolaryngol Clin North Am 43(3):579–589

    Article  CAS  Google Scholar 

  27. Levine C, Casiano R (2017) Revision functional endoscopic sinus surgery. Otolaryngol Clin N Am 50:143–164

    Article  Google Scholar 

  28. Mackay IS, Lund VJ. (2008) Classification and differential diagnosis of rhinosinusitis. In: Michael G, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, Lund VJ, Luxon LM, Watkinson JC (eds) Scott-Brown Otolaryngology-Head and Neck Surgery. 7th edn. vol 2, pp. 1380–1385

  29. Matsuwaki Y, Okushi T, Asaka D (2008) Chronic rhinosinusitis: risk factors for the recurrence of chronic rhinosinusitis based on 5-year follow-up after endoscopic sinus surgery. Int Arch Allergy Immunol 146:77–81

    Article  Google Scholar 

  30. Matthews BL, Smith LE, Jones R et al (1991) Endoscopic sinus surgery: outcome in 155 cases. Otolaryngol Head Neck Surg 104:244–246

    Article  CAS  Google Scholar 

  31. Musy PY, Kountakis SE (2004) Anatomic findings in patients undergoing revision functional endoscopic sinus surgery. Am J Otolaryngol 25:418–422

    Article  Google Scholar 

  32. Newman LJ, Platts-Mills TA, Phillips CD, Hazen KC, Gross CW (1994) Chronic sinusitis: relationship of computed tomographic findings to allergy asthma, and eosinophilia. JAMA 271:363–367

    Article  CAS  Google Scholar 

  33. Okushi T, Mori E, Nakayama T et al (2012) Impact of residual ethmoid cells on the postoperative course after endoscopic sinus surgery for chronic rhinosinusitis. Auris Nasus Larynx 39:484–489

    Article  Google Scholar 

  34. Orlandi RR, Lanza DC, Bolger WE, et al. (1999) The forgotten turbinate: the role of the superior turbinate in endoscopic sinus surgery Am J Rhinol 13:251–259

  35. Otto KJ, DelGaudio JM (2010) Operative findings in the frontal recess at the time of revision surgery. Am J Otolaryngol 31:175–180

    Article  Google Scholar 

  36. Palmer JN, Kennedy DW (2010) Concepts of Endoscopic Sinus Surgery: Causes of Failure. Cummings Otolaryngol Head Neck Surg 52:759–774

    Article  Google Scholar 

  37. Parsons DS, Stivers FE, Talbot AR (1996) The missed ostium sequence and the surgical approach to revision functional endoscopic sinus surgery. Otolaryngol Clin North Am 29:169–183

    CAS  PubMed  Google Scholar 

  38. Ramadan HH (1999) Surgical causes of failure in endoscopic sinus surgery. Laryngoscope 109:27

    Article  CAS  Google Scholar 

  39. Sacks PL, Snidvongs K, Rom D et al (2013) The impact of neo-osteogenesis on disease control in chronic rhinosinusitis after primary surgery. Int Forum Allergy Rhinol 3(10):823–827

    Article  Google Scholar 

  40. Sarafoleanu C (2013) Revision surgery in chronic rhinosinusitis—a point of view (Literature review). Rom J Rhinol 3(11)

  41. Schaitken B, May M, Shapiro A et al (1993) Endoscopic sinus surgery: 4-year follow-up on the first 100 patients. Laryngoscope 103:1117–1120

    Google Scholar 

  42. Senior BA, Kennedy DW, Tanabodee J, Kroger H, Hassab M et al (1998) Long-term results of functional endoscopic sinus surgery. Laryngoscope 108:151–157

    Article  CAS  Google Scholar 

  43. Sillers M, Lay K (2016) Principles of revision functional endoscopic sinus surgery. Op Tech Otolaryngol 17(1):6–12

    Article  Google Scholar 

  44. Snidvongs K, McLachlan R, Sacks R, Earls P, Harvey RJ (2013) Correlation of the Kennedy Osteitis Score to clinico-histologic features of chronic rhinosinusitis. Int Forum Allergy Rhinol 3:369–375

    Article  Google Scholar 

  45. Snidvongs K, McLachlan R, Chin D et al (2012) Osteitic bone: a surrogate marker of eosinophilia in chronic rhinosinusitis. Rhinology 50:299–305

    CAS  PubMed  Google Scholar 

  46. Telmesani LM, Al-Shawarby M (2010) Osteitis in chronic rhinosinusitis with nasal polyps: a comparative study between primary and recurrent cases. Eur Arch Otorhinolaryngol 267:721–724

    Article  Google Scholar 

  47. Valdes CJ, Bogado M, Samaha M (2014) Causes of failure in endoscopic frontal sinus surgery in chronic rhinosinusitis patients. Int Forum Allergy Rhinol 4(6):502–506. https://doi.org/10.1002/alr.21307

    Article  PubMed  Google Scholar 

  48. Wormald PJ (2007) Setup and ergonomics of endoscopic sinus surgery, endoscopic sinus surgery (anatomy, three-dimensional reconstruction, and surgical technique). Second edition; 1: 1–7

  49. Wu J, Jain R, Douglas R (2016) Effect of paranasal anatomical variants on outcomes in patients with limited and diffuse chronic rhinosinusitis. Auris Nasus Larynx. https://doi.org/10.1016/j.anl.2016.08.009

    Article  PubMed  Google Scholar 

  50. Zhang Z, Linkin DR, Finkelman BS, O’Malley BW Jr, Thaler ER, Doghramji L, Kennedy DW, Cohen NA, Palmer JN (2011) Asthma and biofilm-forming bacteria are independently associated with revision sinus surgeries for chronic rhinosinusitis. J Allergy Clin Immunol 128(1):221–223.e1. https://doi.org/10.1016/j.jaci.2011.02.022

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Unit of Otorhinolaryngology–Head and neck surgery, Department of Surgery, College of Medicine, Sulaymaniyah Teaching Hospital, University of Sulaimani, Sulaymaniyah, Kurdistan, Iraq

    Muaid I. Aziz Baban & Baidaa Mirza

  2. Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, Ospedale Di Circolo E Fondazione Macchi, University of Insubria, Varèse, Italy

    Paolo Castelnuovo

  3. Department of Biotechnology and Life Sciences, Head and Neck Surgery and Forensic Dissection Research Center (HNS and FDRc), University of Insubria, Varèse, Italy

    Paolo Castelnuovo

Authors
  1. Muaid I. Aziz Baban
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Baidaa Mirza
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paolo Castelnuovo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Muaid I. Aziz Baban.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent is obtained.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Baban, M.I.A., Mirza, B. & Castelnuovo, P. Radiological and endoscopic findings in patients undergoing revision endoscopic sinus surgery. Surg Radiol Anat 42, 1003–1012 (2020). https://doi.org/10.1007/s00276-020-02427-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00276-020-02427-5

Keywords

Search

Navigation