Paediatric endoscopic sinus surgery (PESS): review of the indications

Area of Science:

• Otolaryngology
• Pediatric Surgery
• Endoscopic Surgery

Background:

• Functional endoscopic sinus surgery (FESS) techniques and indications vary significantly between pediatric and adult patients.
• Understanding pediatric-specific anatomical landmarks is crucial for successful FESS outcomes.
• Controversies exist regarding FESS overuse for chronic sinusitis and potential effects on sinus development.

Purpose of the Study:

• To delineate the anatomical landmarks, diagnostic approaches, and surgical peculiarities of FESS in children.
• To review and establish indications for FESS in the pediatric population.
• To evaluate the efficacy of endoscopic dacryocystorhinostomy (DCR) and juvenile angiofibroma removal in children.

Main Methods:

• Retrospective analysis of endoscopic dacryocystorhinostomy (DCR) in 31 children and endoscopic removal of 11 juvenile angiofibromas.
• DCR patency assessed via fluorescein dye, endoscopy, and clinical parameters (tearing, dacryocystitis).
• Juvenile angiofibroma patients monitored with nasal endoscopy and MRI for 2 years post-surgery.

Main Results:

• Successful outcomes for DCR were achieved in 90.3% of primary surgeries.
• The endoscopic approach for juvenile angiofibromas demonstrated a 90.9% cure rate after a minimum 24-month follow-up.
• The study highlights specific pediatric considerations for FESS procedures.

Conclusions:

• Endoscopic techniques offer effective solutions for DCR and juvenile angiofibromas in children.
• Careful consideration of pediatric anatomy and indications is essential for optimizing FESS outcomes.
• Further research may address FESS overuse and its impact on pediatric sinus development.