Radiological findings in patients undergoing revision endoscopic sinus surgery: a retrospective case series study

Area of Science:

• Otolaryngology
• Surgical Anatomy
• Medical Imaging

Background:

• Functional endoscopic sinus surgery (FESS) is a standard treatment for chronic rhinosinusitis unresponsive to medication.
• Practices of FESS vary significantly among surgeons globally.
• Revision FESS is performed when initial surgery fails to resolve symptoms.

Purpose of the Study:

• To identify anatomical factors contributing to persistent or recurrent chronic rhinosinusitis after FESS.
• To analyze CT scan findings in patients requiring revision FESS.

Main Methods:

• Retrospective review of CT scans from patients undergoing revision FESS.
• Data collected from January 2005 to November 2008 at a UK tertiary referral center.
• Analysis focused on identifying residual anatomical structures and cells.

Main Results:

• CT scans of 63 patients were reviewed.
• High prevalence of residual cells noted: frontal recess (96%), anterior ethmoid (92.1%), posterior ethmoid (96%).
• Other findings included septal deviation (15.9%), lateralized middle turbinates (11.1%), and residual uncinate processes (57.1%).

Conclusions:

• Persistent anatomical structures and unaddressed cells identified on CT scans are likely causes of rhinosinusitis recurrence post-FESS.
• Further clinical trials are recommended to compare conservative versus radical FESS approaches.