Revision endoscopic sinus surgery in children: surgical causes of failure

Revision endoscopic sinus surgery (ESS) in children is uncommon. Causes of failure, however, are not very well delineated. The purpose of this study was to evaluate surgical causes of failure in children after ESS.

A retrospective review of children who had ESS at a tertiary children's referral center between 1993 and 2005 for chronic rhinosinusitis.

ESS was performed on 243 children. Children with cystic fibrosis, immune deficiency/suppression, and ciliary abnormalities were excluded because the reasons of failure in those children are well known. Data were available on 176 children with at least one year of follow-up.

Twenty-three (13%) children required revision. The most common finding was adhesions in 57%, followed by maxillary sinus ostium stenosis or missed maxillary sinus ostium in 52% of the cases. In 39% of the cases, there was recurrent disease in the sinuses that were operated on initially. Interestingly, however, we found that in 26% surgery was needed because of disease that was present in nonoperated sinuses during the primary ESS. A deviated septum and a mucocele were the cause of failure in 17% and 13% of the patients, respectively. Presence of asthma and younger age contributed to the failure in some of these children.

Adhesions and a scarred, narrow maxillary sinus ostium were the most common cause of failure in children after ESS. Steps taken during surgery may be required to help reduce the need for revision in particular for younger asthmatic children. Laryngoscope, 2009.