The Amsterdam Classification of Completeness of Endoscopic Sinus Surgery (ACCESS): a new CT-based scoring system grading the extent of surgery

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.

Download Full-text

Correlation of Complications during Endoscopic Sinus Surgery with Surgeon Skill Level and Extent of Surgery

American Journal of Rhinology ◽

10.1177/194589240501900311 ◽

2005 ◽

Vol 19 (3) ◽

pp. 274-281 ◽

Cited By ~ 21

Author(s):

Michael B. Soyka ◽

David Holzmann

Keyword(s):

Complication Rate ◽

Retrospective Review ◽

Classification System ◽

Endoscopic Sinus Surgery ◽

Skill Level ◽

Point Of View ◽

Sinus Surgery ◽

New Classification ◽

Great Range ◽

Extent Of Surgery

Background Endoscopic sinus surgery (ESS) produces a great range of potential complications. Rough segregation into “minor” and “major” complications seems insufficient. This study uses a recently published new classification system that is based more on the patient's point of view, with a greater variety of options. Methods A retrospective review was undertaken of 421 ESS procedures. Both, the surgeon's experience and the extent of surgery were correlated with the complication rate. Results The overall complication rate was 39.7% (grades A–D) and did not correlate significantly with either the experience of the surgeon or with the extent of surgery. Conclusion The new classification is simple, precise, and takes complications into account that used to be neglected. ESS is even safe in the hands of less skilled surgeons as long as the degree of difficulty stays highly adapted to his/her ability. Some complications (grade A) seem to be inherent to the procedure.

Download Full-text

Effects of Dexamethasone versus Saline-Impregnated Nasal Packing on the Postoperative Outcome of Patients with Chronic Rhinosinusitis and Nasal Polyps after Endoscopic Sinus Surgery: A Randomized Controlled Trial

Philippine Journal of Otolaryngology Head and Neck Surgery ◽

10.32412/pjohns.v31i1.301 ◽

2016 ◽

Vol 31 (1) ◽

pp. 10-13

Author(s):

Shella May A. Promentilla

Keyword(s):

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Scoring System ◽

Controlled Trial ◽

Postoperative Outcome ◽

Nasal Packing ◽

Sinus Surgery ◽

P Value ◽

Nasal Cavities ◽

Double Blinded

Objective: To evaluate the effects of Dexamethasone-impregnated absorbable nasal pack versus saline-impregnated nasal packing on postoperative outcome of nasal cavities after endoscopic sinus surgery using the Perioperative Sinus Evaluation Scoring System (POSE) and Lund and Kennedy Endoscopic Scoring System. Methods: Study Design: Prospective, randomized, double blinded, placebo-controlled trial Setting: Single Center Tertiary Government Hospital Population: Nineteen patients aged 15 years old and above, diagnosed with chronic rhinosinusitis, with nasal polyposis grade 3, who underwent endoscopic sinus surgery from January 2015 to August 2015 Results: Nasal cavities that received postoperative dexamethasone-impregnated nasal packs showed significantly lower POSE scores than placebo on post-op Days 14 (p value 0.0022; 95% CI: -2.113 to -0.5116) as well as lower Lund-Kennedy Scores on post-op day 14 (p value of 0.0180; 95% CI: -2.493 to – 0.2571) and day 28 (p value of 0.007; 95% CI: -1.56275 to -0.2832) Conclusion: Dexamethasone-impregnated absorbable nasal packing affords better postoperative outcomes: less edema, crusting, secretions, and synechiae, than saline-impregnated absorbable packing in later postoperative days. Keywords: Dexamethasone, endoscopy, nasal polyp, nasal cavity, intranasal absorption

Download Full-text

Postoperative Hemorrhage after Endoscopic Sinus Surgery

Otolaryngology ◽

10.1016/j.otohns.2008.05.257 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P80-P80

Author(s):

Troy D. Woodard ◽

James A Stankiewicz

Keyword(s):

Endoscopic Sinus Surgery ◽

Tertiary Care ◽

Care Facility ◽

Postoperative Hemorrhage ◽

Sinus Surgery ◽

Complication Rates ◽

Tertiary Care Facility ◽

Significant Difference ◽

Extent Of Surgery ◽

The Mean

Objective 1) Identify complication rates of patients that underwent endoscopic sinus surgery and developed postoperative hemorrhage. 2) Determine if there is a correlation of preoperative variables with the development of this complication. Methods Retrospectively review patients who had functional endoscopic sinus surgery and developed postoperative hemorrhage from 1987 to 2007 in an university tertiary care facility. Analyze baseline characteristics and preoperative clinical variables for significant correlations. Results 29 of 5000 endoscopic cases resulted in postoperative hemorrhage (.58% complication rate). The mean age of the patients was 50 years old and there were equal proportions of male and female patients. While the extent of surgery demonstrated no significant difference among the patients, hemorrhage was most likely to occur in patients with previous surgery. An overwhelming majority of patients required a surgical procedure to control the bleeding. Hemorrhage was primarily isolated on the patient's right side and involved the sphenopalatine or posterior septal arteries. Conclusions Endoscopic sinus surgery has vastly increased in popularity. However, there still is a paucity of information in the literature on complications associated with endoscopic sinus surgery, particularly postoperative hemorrhage. The results from this study provide identifying characteristics that predispose patients to develop this complication and what methods can be successfully utilized to treat this complication.

Download Full-text

A comparative study and correlation between preoperative computed tomogram and endoscopic sinus surgery in chronic rhinosinusitis

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20194943 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1652

Author(s):

Mithra Sara John ◽

N. Gopinathan Pillai

Keyword(s):

Ct Scan ◽

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Scoring System ◽

Pearson Correlation ◽

Middle Turbinate ◽

Sinus Surgery ◽

Common Disease ◽

Nasal Discharge ◽

Excellent Correlation

Background: Chronic rhinosinusitis (CRS) with its classical symptoms of nasal obstruction, nasal discharge, and headache is relatively a common disease in otorhinolaryngology practice. The objectives of the present study was to correlate the operative findings in such patients with the CT findings, using the Perioperative sinus endoscopy (POSE) scoring system and to correlate the maximum scores obtained in the POSE scoring system and Lund-Mackay scoring system.Methods: A prospective study was conducted from January 2014 to March 2015 in 50 patients suffering from chronic rhinosinusitis who underwent endoscopic sinus surgery in the age group of 36-60 years of age. Results: Agger nasi cells were the most common wandering ethmoid cell detected (90%) followed by various types of frontal cells (54%), Haller cells (26%) and least commonly Onodi cells (12%). Almost perfect agreement was obtained for rest of the criteria which included middle turbinate status, ethmoid cavity mucosal edema and ethmoid cavity polypoid change. Lund-Mackay scoring system was used to score findings in the CT scan and POSE scoring system used to score peroperative findings in the study and this study reveals excellent correlation (Pearson correlation value of 0.879).Conclusions: Novel POSE scoring is a new entity which has the potential to be a valid system to score preoperative and perioperative findings. In the current study POSE scoring shows excellent correlation with Lund Mackay scoring which is an established scoring system used in the evaluation CT scan.

Download Full-text

Identification of Onodi Cell and New Classification of Sphenoid Sinus for Endoscopic Sinus Surgery

Practica Oto-Rhino-Laryngologica ◽

10.5631/jibirin.109.675 ◽

2016 ◽

Vol 109 (10) ◽

pp. 675-684

Author(s):

Kota Wada

Keyword(s):

Endoscopic Sinus Surgery ◽

Sphenoid Sinus ◽

Sinus Surgery ◽

New Classification ◽

Onodi Cell

Download Full-text

A COMPARATIVE STUDY OF LUND-MACKAY SCORING AND POSE SCORING IN CHRONIC RHINO-SINUSITIS PATIENTS.

10.36106/ijsr/8305540 ◽

2021 ◽

pp. 1-2

Author(s):

Arun Nair ◽

Swaroop Dev

Keyword(s):

Standard Deviation ◽

Ct Scan ◽

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Scoring System ◽

Mean Value ◽

Sinus Surgery ◽

Medical College ◽

Operative Endoscopy ◽

Chronic Rhino Sinusitis

INTRODUCTION: To compare preoperative Computed Tomography scan ndings of Para nasal sinuses using Lund-Mackay scoring and intra operative Functional endoscopic sinus surgery ndings in patients with Chronic Rhino-sinusitis using the POSE scoring and to correlate maximum scores obtained in Perioperative sinus endoscopy (POSE) scoring system and Lund-Mackay scoring system. MATERIALS AND METHODS:AProspective study was done for 1 year on 48 patients attending outpatient department of ENT, Sri Siddhartha Medical College aged between 18-60 years, who were clinically diagnosed to have Chronic Rhino-sinusitis, underwent pre-operative CT scan of nose and paranasal sinuses and thereafter FESS were enrolled for the study after obtaining the due consent. RESULTS: From our study group of 48 patients who underwent endoscopic sinus surgery for CRS, the minimum value of Lund-MacKay Scoring was 3 whereas the maximum was 18 (maximum obtainable is 24) with a mean value of 12.02 and standard deviation of 3.987. The minimum POSE Score obtained was 7 and the maximum POSE Score obtained was 37 (maximum obtainable being 40), with a mean value of 16.31 and standard deviation of 5.095. CONCLUSION: Pre operative CT scan combined with per operative endoscopy ndings has made the approach to Chronic rhinosinusitis more specic, rational and accurate. The results of our study highlights that CT scan is an important investigation tool to detect Chronic rhinosinusitis . CT scan has very much emerged as the gold standard in preoperative diagnosis and allows for accurate patient selection for FESS. In our study, POSE Scoring has shown a good correlation with Lund MacKay scoring system

Download Full-text

Effectiveness of Functional Endoscopic Sinus Surgery in Surgical Management of Ethmoid Polyps

Annals of International medical and Dental Research ◽

10.53339/aimdr.2022.8.1.6 ◽

2022 ◽

Vol 8 (1) ◽

pp. 38-42

Author(s):

Kumari Radha M. N ◽

Anju Unnikrishnan ◽

Manju N

Keyword(s):

Ct Scan ◽

Surgical Management ◽

Paranasal Sinuses ◽

Endoscopic Sinus Surgery ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Middle Meatus ◽

Frontal Recess ◽

Extent Of Surgery ◽

Middle Meatus Antrostomy

Background: Aim: To assess efficacy of functional endoscopic sinus surgery in surgical management of ethmoid polyps.Methods:One hundred twelve adult patients age ranged 18- 38 years of either gender with ethmoid polyps underwent FESS under general anesthesia. The extent of surgery was decided based on the findings in pre-operative CT scan of paranasal sinuses. Anterior ethmoidectomy, posterior ethmoidectomy, middle meatus antrostomy and clearance of frontal recess were performed in all the patients. Five functional criteria were evaluated as nasalobstruction , anosmia, rhinorrhea, post nasal drip, head ache and facial pain.Results:Pre- operative nasal obstruction percentage was 3.42 and post- operative ercentage was 2.10, Anosmia percentage was 2.14 and 1.15, Rhinorrhea percentage was 3.56 and 2.08 and ocular problem in 1 and synechia in 4 cases.Conclusions:Functional endoscopic sinus surgery found to be effective in management of ethmoid polyps and hence can be the treatment of choice.

Download Full-text

Efficacy of Carragelose® Nasal Spray Impregnated Versus Mupirocin Ointment Impregnated Nasal Packs on Mucosal Healing after Endoscopic Sinus Surgery: A Double-Blind, Non-Randomized, Right-Left Side Comparison

Philippine Journal of Otolaryngology Head and Neck Surgery ◽

10.32412/pjohns.v35i2.1503 ◽

2020 ◽

Vol 35 (2) ◽

pp. 11

Author(s):

Joseph Bernard Lo ◽

Emmanuel Tadeus Cruz

Keyword(s):

Chronic Rhinosinusitis ◽

Nasal Spray ◽

Endoscopic Sinus Surgery ◽

Scoring System ◽

Nasal Polyposis ◽

Mucosal Healing ◽

Sinus Surgery ◽

Double Blind ◽

Mupirocin Ointment ◽

Sinus Endoscopy

ABSTRACTObjective: To determine the efficacy of carragelose® nasal spray versus mupirocin ointment impregnated nasal packs on postoperative mucosal healing among chronic rhinosinusitis with nasal polyposis (CRSwNP) patients after endoscopic sinus surgery (ESS). Methods:Design: Double-Blind, Non-Randomized, Right-Left Side ComparisonSetting: Tertiary Government Training HospitalParticipants: Fifteen (15) patients diagnosed with chronic rhinosinusitis with nasal polyposis (CRSwNP) who had ESS were included in the study. Nasal packs (Netcell®) impregnated with carragelose® nasal spray or mupirocin ointment were respectively applied in right and left nostrils. Postoperative mucosal healing was graded by a blinded consultant using the Lund-Kennedy Endoscopic Scoring System and Perioperative Sinus Endoscopy (POSE) scoring system. Results: Six patients (12 nasal sides) completed the study. Comparing nasal packs impregnated with carragelose® nasal spray mupirocin ointment, the carragelose® group had lower Lund- Kennedy median scores than the mupirocin group on the 7th post-operative day; and this was statistically significant (p = .027). There were no significant differences in Lund-Kennedy postoperative scores on days 4 (p = .217), 14 (p = .171) and 28 (p = .151). Conclusion: Carragelose® nasal spray impregnated nasal packs may be comparable with, and may be an alternative to mupirocin ointment impregnated nasal packs in terms of postoperative mucosal healing among ESS patients with CRSwNP.

Download Full-text