Endoscopic Sinus Surgery in Pediatric Patients

  • Cem Saka
  • Hakan Korkmaz
  • Tania Sih


Endoscopic sinus surgery (ESC) is a surgical technique that has been safely performed on children since the 1980s. Although the anatomical structures are similar to those of the adult anatomy, the small size of the area involved, the anatomical structures and barriers being thinner and fragile, and various surgical indications all mean that these require special surgical equipment, scrupulous anatomical investigation, and good surgical experience. Endoscopic surgery in children is difficult and it is more difficult to establish surgical indication. The inability to perform regular symptomatic questioning in children and difficulty of examination also make the decision to operate problematic. The possibility of comprehensive surgery inside the nose causing impairment to the developing facial skeletal structure also highlighted the need to reconsider the relevant indications. Indications for ESC at the 1998 consensus agreement in Belgium in 1998 are as follows: (1) Complete nasal obstruction due to cystic fibrosis-related massive polyposis and excessive medialization of the lateral nasal wall, (2) antrochoanal polyps, (3) intracranial complications of sinus diseases, (4) mucocele and mucopyocele, (5) orbital abscess, (6) traumatic injury of the optic canal, (7) dacryocystorhinitis secondary to sinusitis, (8) fungal sinusitis, (9) some meningoencephaloceles, (10) some skull base tumors such as angiofibroma, and (11) chronic sinusitis resistant to medical treatment.


Endoscopic sinus surgery Pediatric Developing facial skeletal structure Relevant indications Safely 


  1. 1.
    Basu SK, Bandyopadhyay SN, Bora H. Bilateral antrochoanal polyps. J Laryngol Otol. 2001;115:561–2.PubMedCrossRefGoogle Scholar
  2. 2.
    El Sharkawy AA, Elmorsy SM, Eladl HM. Functional endoscopic sinus surgery in children: predictive factors of outcome. Eur Arch Otorhinolaryngol. 2012;269:107–11.PubMedCrossRefGoogle Scholar
  3. 3.
    Maldonado M, Martinez A, Alobid I, Mullol J. The antrochoanal polyp. Rhinology. 2004;43:178–82.Google Scholar
  4. 4.
    Carron J, Derkay C. Pediatric rhinosinusitis; is it a surgical disease? Curr Opin Otolaryngol Head Neck Surg. 2001;9:61–6.CrossRefGoogle Scholar
  5. 5.
    Hong SK, Min YG, Kim CN, Byun SW. Endoscopic removal of the antral portion of antrochoanal polyp by powered instrumentation. Laryngoscope. 2001;111:1774–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Özdek A, Samim E, Bayiz U, Meral I, Safak MA, Oğuz H. Antrochoanal polyps in children. Int J Pediatr Otorhinolaryngol. 2003;65(3):213–8.CrossRefGoogle Scholar
  7. 7.
    Orvidas LJ, Beatty CW, Weaver AL. Antrochoanal polyps in children. Am J Rhinol. 2001;15:321–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Kennedy CA, Adams GL, Neglia JP, Giebink GS. Impact of surgical treatment on paranasal fungal infections in bone marrow transplant patients. Otolaryngol Head Neck Surg. 1997;116(6 Pt 1):610–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Ardeshirpour F, Bohm LA, Belani KK, Sencer SF, Lander TA, Sidman JD. Surgery for pediatric invasive fungal sinonasal disease. Laryngoscope. 2013;124:1008–12. Scholar
  10. 10.
    Ferguson BJ. Mucormycosis of the nose and paranasal sinuses. Otolaryngol Clin N Am. 2000;33:9–65.Google Scholar
  11. 11.
    Groppo ER, El-Sayed IH, Aiken AH, Glastonbury CM. Computed tomography and magnetic resonance imaging characteristics of acute invasive fungal sinusitis. Arch Otolaryngol Head Neck Surg. 2001;137:1005–10.CrossRefGoogle Scholar
  12. 12.
    Davis WE, Barbero GJ, LaMear WD, Templer JW, Konig P. Paranasal sinus mucoceles in cystic fibrosis. Am J Rhinol. 1993;7:31–5.CrossRefGoogle Scholar
  13. 13.
    Al-Dousary S, Al-Kharashi S. Maxillary sinus mucopyocele in children: a case report and review of the literature. Int J Ped Otorhinolaryngol. 1996;36:53–60.CrossRefGoogle Scholar
  14. 14.
    Khong JJ, Malhotra R, Selva D, Wormald PJ. Efficacy of endoscopic sinus surgery for paranasal sinus mucocele including modified endoscopic Lothrop procedure for frontal sinus mucocele. J Laryngol Otol. 2004;118(5):352–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Crockett DJ, Wilson KF, Meier JD. Perioperative strategies to improve sinus surgery outcomes in patients with cystic fibrosis: a systematic review. Otolaryngol Head Neck Surg. 2013;149(1):30–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Baroody MF. Pediatric chronic rhinosinusitis. In: Cummings pediatric otolaryngology. Philadelphia, PA: Elsevier; 2015.Google Scholar
  17. 17.
    Goldsmith A, Rosenfeld R. Treatment of pediatric sinusitis. Pediatr Clin N Am. 2003;50:413–26.CrossRefGoogle Scholar
  18. 18.
    Adappa ND, Coticchia JM. Management of refractory chronic rhinosinusitis in children. Am J Otolaryngol Head Neck Med Surg. 2006;27:384–9.Google Scholar
  19. 19.
    Lieser JD, Derkay VS. Pediatric sinusitis: when do we operate? Curr Opin Otolaryngol Head Neck Surg. 2005;13:60–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Brietzke SE, Brigger MT. Adenoidectomy outcomes in pediatric rhinosinusitis: a meta-analysis. İnt J Pediatr Otorhinolaryngol. 2008;72:1541–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Deckard NA, Kruper GJ, Bui T, Coticchia J. Comparison of two minimally invasive techniques for treating chronic rhinosinusitis in the pediatric population. Int J Ped Otorhinolaryngol. 2011;75:1296–300.CrossRefGoogle Scholar
  22. 22.
    Lee D, Rosenfeld R. Sinonasal symptoms and adenoid bacteriology. Otolaryngol Head Neck Surg. 1997;116:301–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Tuncer U, Aydoğan B, Soylu L, Şimşek M, Ackali C, Cucuckan A. Chronic rhinosinusitis and adenoid hypertrophy in children. Am J Otolaryngol. 2004;25:5–10.PubMedCrossRefGoogle Scholar
  24. 24.
    Bhattacharyya N, Jones DT, Hill M, Shapiro NL. The diagnostic accuracy of computed tomography in pediatric chronic rhinosinusitis. Arch Otolaryngol Head Neck Surg. 2004;130(9):1029–32.PubMedCrossRefGoogle Scholar
  25. 25.
    Bothwell M, Piccirillo J, Lusk R. Long-term outcome of facial growth after functional endoscopic sinus surgery. Otolaryngol Head Neck Surg. 2002;126:628–34.PubMedCrossRefGoogle Scholar
  26. 26.
    Ramadan HH. Relation of age to outcome after endoscopic sinus surgery in children. Arch Otolaryngol Head Neck Surg. 2003;129(2):175–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Vlastarakos PV, Fetta M, Segas JV, Maragoudakis P, Nikolopoulos TP. Functional endoscopic sinus surgery improves sinus-related symptoms and quality of life in children with chronic rhinosinusitis: a systematic analysis and meta-analysis of published interventional studies. Clin Pediatr. 2013;52(12):1091–7.CrossRefGoogle Scholar
  28. 28.
    Ramadan HH. Surgical management of chronic sinusitis in children. Laryngoscope. 2004;114:2103–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Tsukidate T, Haruna S, Fukami S, Nakajima I, Konno W, Moriyama H. Long-term evaluation after endoscopic sinus surgery for chronic pediatric sinusitis with polyps. Auris Nasus Larynx. 2012;39:583–7.PubMedCrossRefGoogle Scholar
  30. 30.
    Ragab SM, Hassanin MZ. Optimizing the surgical field in pediatric functional endoscopic sinus surgery: a new evidence-based approach. Otolaryngol Head Neck Surg. 2010;142:48–54.PubMedCrossRefGoogle Scholar
  31. 31.
    Siedek V, Stelter K, Betz CS, Berghaus A, Leunig A. Functional endoscopic sinus surgery—a retrospective analysis of 115 children and adolescents with chronic rhinosinusitis. Int J Ped Otorhinolaryngol. 2009;73:741–5.CrossRefGoogle Scholar
  32. 32.
    Hengerer AS, Strome M. Choanal atresia: embryologic analysis and evolution of treatment, a 30 year experience. Laryngoscope. 2008;118(5):862–6.PubMedCrossRefGoogle Scholar
  33. 33.
    Kwong KM. Current updates on choanal atresia. Front Pediatr. 2015;3:52.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Burrow TA, Saal HM, de Alarcon A, Martin LJ, Cotton RT, Hopkin RJ. Characterization of congenital anomalies in individuals with choanal atresia. Arch Otolaryngol Head Neck Surg. 2009;135(6):543–7.PubMedCrossRefGoogle Scholar
  35. 35.
    Riepl R, Scheithauer M, Hoffmann TK, Rotter N. Transnasal endoscopic treatment of bilateral choanal atresia in newborns using balloon dilatation: own results ant review of literature. Int J Ped Otorhinolaryngol. 2014;78:459–64.CrossRefGoogle Scholar
  36. 36.
    Nogueira JF Jr, Stamm AC, Vellutini E, Santos FP. Endoscopic management of congenital meningo-encephalocele with nasal flaps. Int J Ped Otorhinolaryngol. 2009;73:133–7.CrossRefGoogle Scholar
  37. 37.
    Emanuelli E, Bossolesi P, Borsetto D, D’Avella E. Endoscopic repair of cerebrospinal fluid leak in pediatric patients. Int J Ped Otorhinolaryngol. 2014;78:1898–902.CrossRefGoogle Scholar
  38. 38.
    Kassam A, Thomas AJ, Snyderman C, Carrau R, Gardner P, Mintz A. Fully endoscopic expanded endonasal approach treating skull base lesions in pediatric patients. J Neurosurg. 2007;106(2 Suppl):75–86.PubMedGoogle Scholar
  39. 39.
    Kinis V, Ozbay M, Bakır S, Yorgancılar E, Gun R, Akdağ M, Sahin M, Topcu I. Management of orbital complications of sinusitis in pediatric patients. J Craniofac Surg. 2013;24:1706–10.PubMedCrossRefGoogle Scholar
  40. 40.
    Ryan JT, Preciado DA, Bauman N. Management of pediatric orbital cellulitis in patients with radiographic findings of subperiosteal abscess. Otolaryngol Head Neck Surg. 2009;140:907–11.PubMedCrossRefGoogle Scholar
  41. 41.
    Younis RT, Lazar RH, Bustillo A. Orbital infection as a complication of sinusitis: are diagnostic and treatment trends changing? Ear Nose Throat J. 2002;81:771–5.PubMedCrossRefGoogle Scholar
  42. 42.
    Khoueir N, Nicolas N, Rohayem Z, Haddad A, Hamad WA. Exclusive endoscopic resection of juvenile nasopharyngeal angiofibroma: a systematic review of the literature. Otolaryngol Head Neck Surg. 2014;150(3):350–8.PubMedCrossRefGoogle Scholar
  43. 43.
    Fyrmpas G, Konstantinidis I, Constantinidis J. Endoscopic treatment of juvenile nasopharyngeal angiofibromas: our experience and review of the literature. Eur Arch Otorhinolaryngol. 2012;269:523–9.PubMedCrossRefGoogle Scholar
  44. 44.
    Garofalo P, Pia F, Policarpo M, Tunesi S, Valletti PA. Juvenile nasopharyngeal angiofibroma: comparison between endoscopic and open operative approaches. J Craniofac Surg. 2015;26:918–21.PubMedCrossRefGoogle Scholar
  45. 45.
    Kopec T, Borucki L, Szyfter W. Fully endoscopic resection of juvenile nasopharyngeal angiofibroma—own experience and clinical outcomes. Int J Ped Otorhinolaryngol. 2014;78:1015–8.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Cem Saka
    • 1
  • Hakan Korkmaz
    • 2
  • Tania Sih
    • 3
  1. 1.Department of OtorhinolaryngologyUniversity of Health Sciences, Dıskapı Yıldırım Beyazit Training and Research HospitalAnkaraTurkey
  2. 2.Department of Otorhinolaryngology, Medical FacultyYıldırım Beyazıt UniversityAnkaraTurkey
  3. 3.Medical School at University of Sao PauloSao PauloBrazil

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