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.

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.

Evaluation of Prognostic Factors in Endoscopic Sinus Surgery

1997 ◽  
Vol 11 (3) ◽  
pp. 187-192 ◽  
Author(s):  
Steven C. Marks ◽  
Falah Shamsa
Keyword(s):  
Computed Tomography ◽  
Revision Surgery ◽  
Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Stage Of Disease ◽  
Surgery Outcome ◽  
Percent Improvement ◽  
Subsequent Revision ◽  
History Of ◽  
Poor Outcomes

A retrospective analysis of 115 consecutive patients who underwent endoscopic sinus surgery for chronic sinusitis was conducted to evaluate the effect on outcome of variables including previous sinus surgery, allergy, asthma, and computed tomography stage of disease. Outcome was assessed in each patient by a survey in which the patient rated the benefit of surgery in terms of percent improvement in different symptoms compared with symptoms before surgery. Outcome was also assessed by the need for revision surgery and the presence of endoscopic criteria for failure. The results indicate that allergy and previous sinus surgery are associated with lower individual symptom scores, but no variable was associated with overall symptomatic failure. Previous sinus surgery was strongly associated with the need for subsequent revision surgery. The computed tomography stage was strongly associated with endoscopic evidence of failure. In conclusion, both history of previous sinus surgery and computed tomography stage of disease are correlated to poor outcomes after endoscopic sinus surgery.

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.

The Effect of FloSeal on Mucosal Healing after Endoscopic Sinus Surgery: A Comparison with Thrombin-Soaked Gelatin Foam

2003 ◽  
Vol 17 (1) ◽  
pp. 51-55 ◽  
Author(s):  
Rakesh K. Chandra ◽  
David B. Conley ◽  
Robert C. Kern
Keyword(s):  
Granulation Tissue ◽  
Endoscopic Sinus Surgery ◽  
Adhesion Formation ◽  
Mucosal Healing ◽  
Nasal Packing ◽  
Sinus Surgery ◽  
Patient Comfort ◽  
Rapid Healing ◽  
Extent Of Surgery ◽  
High Degree

Background The optimal form of nasal packing after endoscopic sinus surgery (ESS) still has not been established. Although wide variations exist among sinus surgeons, the goals are adequate hemostasis, rapid healing, and patient comfort. Preliminary studies indicated that FloSeal (FS), a novel absorbable hemostatic paste used as a nasal pack, was associated with minimal postoperative discomfort and effective hemostasis. This study was designed to evaluate the effects of this agent on mucosal healing in ESS. Methods Twenty consecutive patients underwent bilateral ESS. For each patient, one ethmoid cavity was randomized to receive FS and the other received thrombin-soaked gelatin foam. The extent of granulation tissue and adhesion formation was evaluated at 6–8 weeks after surgery. Results No significant differences were observed between the FS and the thrombin-soaked gelatin foam groups with respect to the preoperative Lund-Mackay score, extent of surgery performed, or need for additional nasal packing. However, the FS group showed clear trends toward increased granulation tissue (p = 0.007) and adhesion (p = 0.006) formation. Conclusion: Absorbable hemostatic agents are associated with a high degree of patient comfort and provide hemostasis comparable with traditional techniques. Different materials may induce differential patterns of mucosal healing, potentially affecting the ultimate result of ESS.

scholarly journals Correlations and Comparison between Repeat Computed Tomography Scores, Endoscopy Scores and Symptomatic Improvement before and after Endoscopic Sinus Surgery: A Pilot Study

2013 ◽  
Vol 6 (1) ◽  
pp. 32-40 ◽  
Author(s):  
NV Deepthi ◽  
Indudharan R Menon
Keyword(s):  
Computed Tomography ◽  
Pilot Study ◽  
Endoscopic Sinus Surgery ◽  
Medical Center ◽  
Tertiary Care ◽  
Objective Evaluation ◽  
Symptomatic Improvement ◽  
Sinus Surgery ◽  
Tertiary Care Medical Center ◽  
Before And After

ABSTRACT Background Chronic rhinosinusitis (CRS) is diagnosed on the basis of symptoms, nasal endoscopic findings and computed tomography of the paranasal sinuses (CT PNS). Where indicated, functional endoscopic sinus surgery (FESS) is the surgical treatment. Objective To determine correlations between subjective symptom severity and objective endoscopic and radiologic findings in CRS and to compare these before and after FESS. Materials and methods Analysis of prospectively collected data of 20 patients undergoing FESS at a tertiary care medical center followed up for a minimum period of 6 months after surgery. RSI questionnaire-based symptom score, Lund-Mackay system-based endoscopic and CT finding scores were recorded preoperatively and at 8 weeks and 6 months postoperatively. Results Significant positive correlation was noted between the three parameters before surgery, especially endoscopic and radiological scores (r = 0.94 in the latter, p < 0.01 in all three). Postoperative improvement was statistically significant for all three parameters, even at the 6 months stage (p < 0.001). Postoperative correlations reduced significantly, especially between endoscopic and radiological scores. Conclusion This study showed the relevance of objective evaluation of routine parameters of CRS, preoperatively. It also confirmed the usefulness of FESS in indicated cases, in terms of statistical improvement of these parameters. However, repeat CT scans and the methods of scoring used by us may not be equally applicable in the long-term postoperative scenario. How to cite this article Deepthi NV, Menon UK, Menon IR. Correlations and Comparison between Repeat Computed Tomography Scores, Endoscopy Scores and Symptomatic Improvement before and after Endoscopic Sinus Surgery: A Pilot Study. Clin Rhinol An Int J 2013;6(1):32-40.

Sphenoid sinus mucocele: 10 cases and literature review

2009 ◽  
Vol 124 (1) ◽  
pp. 44-47 ◽  
Author(s):  
S R Soon ◽  
C M Lim ◽  
H Singh ◽  
D S Sethi
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Endoscopic Sinus Surgery ◽  
Sphenoid Sinus ◽  
Sinus Surgery ◽  
Nasal Discharge ◽  
Resonance Imaging ◽  
Presenting Symptoms ◽  
Singapore General Hospital

AbstractIntroduction:Sphenoid sinus mucoceles represent only 1–2 per cent of all paranasal sinus mucoceles. Patients may present with a myriad of symptoms. Pre-operative investigations include nasoendoscopy, computed tomography and/or magnetic resonance imaging. Treatment is by endoscopic sinus surgery.Methodology:A retrospective review of the archives of the Singapore General Hospital otolaryngology department (1999–2006) identified 10 cases of sphenoid sinus mucocele. Patient demographics, presenting symptoms, investigations and treatment were evaluated.Results:The 10 patients identified (three women and seven men) had a mean age of 54.5 years (range 24–70 years). Thirty per cent of patients had a history of nasopharyngeal carcinoma treated with radiotherapy. Presenting symptoms, in order of decreasing frequency, were: ocular symptoms (50 per cent), headaches (30 per cent), nasal discharge (30 per cent) and facial pain (10 per cent). All patients underwent pre-operative computed tomography or magnetic resonance imaging. Twenty per cent of patients had evidence of intracranial involvement on imaging. All patients underwent uncomplicated transnasal sphenoidotomy and drainage of the mucocele. There was no clinical or radiological evidence of recurrence at a mean follow up of 29 months (range 4–90 months).Conclusion:Sphenoid sinus mucocele is a rare condition. In this study, radiation to the head and neck appeared to be a predisposing factor, and eye symptoms were the commonest presentation. Endoscopic sinus surgery is a safe and effective treatment modality.

Revision Functional Endoscopic Sinus Surgery: Objective and Subjective Surgical Outcomes

2005 ◽  
Vol 19 (4) ◽  
pp. 344-347 ◽  
Author(s):  
K. Christopher McMains ◽  
Stilianos E. Kountakis
Keyword(s):  
Medical Therapy ◽  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Patient Symptom ◽  
Before And After ◽  
Revision Sinus Surgery ◽  
Preoperative Ct ◽  
The Mean

Background The aim of this study was to report objective and subjective outcomes after revision sinus surgery (RESS) for chronic rhinosinusitis (CRS). Methods We performed a retrospective analysis of prospectively collected data in 125 patients requiring revision functional endoscopic sinus surgery after failing both maximum medical therapy and prior sinus surgery for CRS. Patients were seen and treated over a 3-year period (1999–2001) in a tertiary rhinology setting. Computed tomography (CT) scans were graded as per Lund-MacKay and patient symptom scores were recorded using the Sinonasal Outcome Test 20 (SNOT-20) instrument. Individual rhinosinusitis symptoms were evaluated on a visual analog scale (0–10) before and after surgery. All patients had a minimum 2-year follow-up. Results The mean number of prior sinus procedures was 1.9 ± 0.1 (range, 1–7) and the mean preoperative CT grade was 13.4 ± 0.7. Patients with asthma and polyposis had higher CT scores than those without these processes. Preoperative mean SNOT-20 and endoscopy scores were 30.7 ± 1.3 and 7.3 ± 0.4, respectively. At the 2-year follow-up, mean SNOT-20 and endoscopy scores improved to 7.7 ± 0.6 and 2.1 ± 0.4, respectively (p < 2.8 X 10-10). At 12-month follow-up, each individual symptom score decreased significantly. Overall, 10 patients failed RESS and required additional surgical intervention for an overall failure rate of 8.0%. All patients who failed RESS had nasal polyposis. Conclusion Revision functional endoscopic sinus surgery benefits patients that fail maximum medical therapy and prior sinus surgery for CRS by objective and subjective measures.

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