scholarly journals Tomographical Findings in Adult Patients Undergoing Endoscopic Sinus Surgery Revision

2017 ◽  
Vol 22 (01) ◽  
pp. 073-080
Author(s):  
Jan Socher ◽  
Jonas Mello ◽  
Barbara Baltha
Keyword(s):  
Computed Tomography ◽  
Endoscopic Sinus Surgery ◽  
Middle Turbinate ◽  
Adult Patients ◽  
Sinus Surgery ◽  
Primary Surgery ◽  
Computed Tomography Scans ◽  
Revision Sinus Surgery ◽  
The City ◽  
Mucosal Thickening

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.

scholarly journals Computed Tomography and Anatomical Findings Encountered During Revision Endoscopic Sinus Surgery

2020 ◽  
Vol 27 (2) ◽  
pp. 117-121
Author(s):  
Akanksha Ajay Saberwal ◽  
Haritosh Velankar ◽  
Yogesh Dabholkar ◽  
Adip K Shetty ◽  
Sharad Bhalekar ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Revision Surgery ◽  
Endoscopic Sinus Surgery ◽  
Randomized Study ◽  
Adhesion Formation ◽  
Disease Recurrence ◽  
Sinus Surgery ◽  
Mucosal Inflammation ◽  
Primary Surgery ◽  
Revision Sinus Surgery

Background and Objectives: Functional endoscopic sinus surgery (FESS) is a well-established strategy for the treatment of rhinosinusitis. However, some patients do not respond to primary surgery and may require revision surgery. Anatomic alterations due to prior sinus surgery, scarring and adhesions as well as associated chronic mucosal inflammation can make revision procedures challenging. In order to shed more light on the difficulties faced by surgeons performing revision FESS, a study was performed to identify areas of recurrent disease on computed tomography in patients undergoing revision surgery, as well as to evaluate intraoperative findings during revision FESS.Materials and Method: A hospital-based, interventional, non-randomized study was undertaken in 40 patients who underwent revision FESS. Multiple clinical parameters were recorded including number and type of previous surgeries, latest CT scans of the nose and paranasal sinuses, as well as intraoperative findings.Results: Our findings demonstrated the diffuse nature of mucosal disease on CT in our patient population. Fibrosis and adhesion formation were the most common intraoperative findings on revision sinus surgery along with residual air cells, polypoid mucosal regrowth, and middle meatal antrostomy stenosis.Conclusion: A careful evaluation of the patient is needed while contemplating revision surgery. A recent high-resolution CT scan is of paramount importance. The most common areas of disease recurrence are the ostiomeatal complex and residual ethmoids, and these areas should be given careful attention.

Functional Endoscopic Sinus Surgery in Patients with Normal Computed Tomography Scans

1994 ◽  
Vol 110 (6) ◽  
pp. 505-509 ◽  
Author(s):  
Paul R. Cook ◽  
Gary J. Nishioka ◽  
William E. Davis ◽  
Joel P. McKinsey
Keyword(s):  
Computed Tomography ◽  
Endoscopic Sinus Surgery ◽  
Facial Pain ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Select Group ◽  
Computed Tomography Scans ◽  
The Impact ◽  
Tomography Scan

Eighteen patients were operated on by functional endoscopic sinus surgery who had no ostiomeatal unit obstruction on computed tomography scan and had unremarkable paranasal sinuses. These patients also had no apparent ostiomeatal unit obstruction on diagnostic nasal endoscopy. Data were collected on these patients regarding the impact of very limited functional endoscopic sinus surgery on their principal complaint of recurrent sinusitis with facial pain/headache thought to be of sinogenic origin. Sixteen patients (88.9%) had a reduction in the number of sinus infections requiring antibiotic therapy. This reduction was significant at p < 0.0001. Twelve of 14 patients whose facial pain/headache was believed to be of sinogenic origin had a significant reduction in severity (95% confidence interval, 49.2% to 95.3%). We discuss the role of reversible nasal mucosal disease in the pathophysiology of recurrent rhinosinusifts in this patient population. This was a very small, select group of patients who had specific complaints and had had medical treatment failures. This therapy Is not recommended for every patient, but only a select few with classic complaints of sinus headaches or recurrent sinusitis and negative computed tomography scans.

Odontogenic chronic rhinosinusitis patients undergoing tooth extraction: oral surgeon and otolaryngologist viewpoints and appropriate management

2020 ◽  
Vol 134 (3) ◽  
pp. 241-246
Author(s):  
K Tsuzuki ◽  
K Kuroda ◽  
K Hashimoto ◽  
K Okazaki ◽  
K Noguchi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Chronic Rhinosinusitis ◽  
Endoscopic Sinus Surgery ◽  
Tooth Extraction ◽  
Functional Endoscopic Sinus Surgery ◽  
Adult Patients ◽  
Sinus Surgery ◽  
Oroantral Fistula ◽  
Improvement Ratio

AbstractObjectiveThis study aimed to propose appropriate management for odontogenic chronic rhinosinusitis.MethodThirty-one adult patients with odontogenic chronic rhinosinusitis undergoing maxillary extraction were retrospectively analysed. Patients with (n = 21) and without (n = 10) oroantral fistula on computed tomography were classified. Functional endoscopic sinus surgery was performed when sinusitis did not improve after extraction. The critical indicators for surgical requirement in the management of odontogenic chronic rhinosinusitis were analysed.ResultsSinusitis significantly improved after extraction in both groups. Patients without oroantral fistula had significantly more severe remnant sinusitis than those with oroantral fistula after extraction on computed tomography (p = 0.0037). The requirement for functional endoscopic sinus surgery was statistically significant for patients without orofacial fistula over those with orofacial fistula (p < 0.0001). The surgical improvement ratio was 93 per cent.ConclusionThe absence of oroantral fistula and severe sinusitis can be critical indicators for the requirement of functional endoscopic sinus surgery after extraction in the management of odontogenic chronic rhinosinusitis.

scholarly journals Endoscopic Visualization of the True Maxillary Ostium Following Uncinectomy

2019 ◽  
Vol 99 (6) ◽  
pp. 384-387 ◽  
Author(s):  
Omar H. Ahmed ◽  
Marissa P. Lafer ◽  
Ilana Bandler ◽  
Elcin Zan ◽  
Binhuan Wang ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Retrospective Study ◽  
Chronic Rhinosinusitis ◽  
Study Design ◽  
Endoscopic Sinus Surgery ◽  
Nasolacrimal Duct ◽  
Sinus Surgery ◽  
Academic Hospital ◽  
Preoperative Ct

Objectives: To examine the frequency in which angled endoscopes are necessary to visualize the true maxillary ostium (TMO) following uncinectomy and prior to maxillary antrostomy. Additionally, to identify preoperative computed tomography (CT) measures that predict need for an angled endoscope to visualize the TMO. Study Design: Retrospective study. Setting: Tertiary academic hospital. Patients and Methods: Patients who underwent endoscopic sinus surgery (ESS) between December of 2017 and August of 2018 were retrospectively identified. Cases were reviewed if they were primary ESS cases for chronic rhinosinusitis without polyposis and if they were at least 18 years of age. Results: Sixty-three maxillary antrostomies were reviewed (82.5% were from bilateral cases). Thirty-five cases (55.6%) required an angled endoscope in order to visualize the TMO. Of the preoperative CT measures examined, a smaller sphenoid keel-caudal septum-nasolacrimal duct (SK-CS-NL) angle was significantly associated with need for an angled endoscope intraoperatively to visualize the TMO (17.1° SD ± 3.2 vs 15.0° SD ± 2.9; P = .010). Conclusion: Angled endoscopes are likely required in the majority of maxillary antrostomies to visualize the TMO. This is important to recognize in order to prevent iatrogenic recirculation. The SK-CS-NL angle may help to identify cases preoperatively which require an angled endoscope to identify the TMO during surgery.

scholarly journals Chronic rhinosinusitis in adult patients with cystic fibrosis: clinical manifestation and therapeutic approaches

2019 ◽  
Vol 29 (3) ◽  
pp. 311-320
Author(s):  
G. L. Shumkova ◽  
E. L. Amelina ◽  
V. M. Svistushkin ◽  
E. V. Sin’kov ◽  
S. A. Krasovskiy ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Surgical Treatment ◽  
Treatment Group ◽  
Chronic Rhinosinusitis ◽  
Paranasal Sinuses ◽  
Endoscopic Sinus Surgery ◽  
Nasal Polyps ◽  
Adult Patients ◽  
Sinus Surgery ◽  
Markers Of Inflammation

The aim of this study was to evaluate prevalence of chronic rhinosinusitis (CRS) and nasal polyps in adult patients with cystic fibrosis (CF) in Russian Federation. Additionally, we investigated the clinical course of CRS and developed the optimal therapeutic strategy.Methods. Three hundred and forty eight CF patients were involved in the study. Physical examination, computed tomography (CT) of paranasal sinuses and audiometry, if needed, were used. CRS and bilateral nasal polyps were diagnosed in 28 patients. Nasal endoscopy, SNOT-20 questionnaire, rhinomanometry, micro - biological examination of sputum and mucus from paranasal sinuses (obtained during puncture or surgery), spirometry, and measurement of serum markers of inflammation were used. Endoscopic sinus surgery was used in 14 patients (the group 1) and others were treated non-surgically (the group 2). Both group were treated during 6 months using intranasal mometasone, mucolytics and antibiotics via PARI SINUSTM nebulizer.Results. An improvement in symptoms, CT signs, rhinomanometry parameters and endoscopic signs was seen in both groups after treatment and was more prominent in the surgical treatment group compared to the non-surgical treatment group. Bacterial load reduction in nasal sinuses, decrease in the rate of pulmonary disease exacerbations, and an improvement in oxygen blood saturation were found in the surgical treatment group only. Treatment of CRS did not affect lung function, sputum microbiology and serum inflammatory markers.Conclusion. Endoscopic sinus surgery followed by intranasal mucolytics and antibacterials is an effective and well-tolerated treatment in adult CF patients with CRS. 

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