Article
Radiological findings in patients undergoing Revision Functional Endoscopic Sinus Surgery: a retrospective study
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Published: | April 14, 2014 |
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Introduction: Revision Functional Endoscopic Sinus Surgery (FESS) is an increasingly common procedure, often due to inadequate treatment in the initial FESS surgery. By reviewing the common areas of treatment failure on the pre-operative scans of revision cases, we hope to identify common areas of disease recurrence that need particular attention during initial surgery.
Methods: A retrospective study of all cases of revision FESS (from 2004–2012) performed by a Senior Consultant Rhinologist in a tertiary hospital in Singapore were to be identified. Symptoms were correlated with pre-operative CT Paranasal Sinus scans to identify sites of disease recurrence as well as anatomical abnormalities. These include, and are not limited to, retained frontal recess cells, recurrent nasal polyps, residual anterior ethmoid cells, lateralised middle turbinates, residual Haller cells, residual uncinate process, significant septal deviation and residual posterior ethmoid cells.
Results: 69 patients underwent revision FESS for persistent or recurrent sinusitis. CT scans for only 49 patients were available via the hospital medical records system. Among the patients studied, 67.3% had residual frontal recess cells, 61.2% had residual anterior ethmoid cells, 69.4% had residual posterior ethmoid cells and 6.1% had residual Haller cells. 14.3% had recurrent nasal polyps. 30.6% had residual uncinate processes, 26.5% had lateralised turbinates and 42.9% had blocked sphenoid ostia.
Conclusion: Majority of persistent or recurrent sinusitis occurred as a result of anatomical structures that were left behind in the initial FESS surgery. This study helps to validate anecdotal evidence that more aggressive techniques of FESS could reduce the recurrence or persistent of sinusitis.
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