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

<p>Abstract</p> <p>Background</p> <p>Functional endoscopic sinus surgery (FESS) is now a well-established strategy for the treatment of chronic rhinosinusitis which has not responded to medical treatment. There is a wide variation in the practice of FESS by various surgeons within the UK and in other countries.</p> <p>Objectives</p> <p>To identify anatomic factors that may predispose to persistent or recurrent disease in patients undergoing revision FESS.</p> <p>Methods</p> <p>Retrospective review of axial and coronal CT scans of patients undergoing revision FESS between January 2005 and November 2008 in a tertiary referral centre in South West of England.</p> <p>Results</p> <p>The CT scans of 63 patients undergoing revision FESS were reviewed. Among the patients studied, 15.9% had significant deviation of the nasal septum. Lateralised middle turbinates were present in 11.1% of the studied sides, and residual uncinate processes were identified in 57.1% of the studied sides. There were residual cells in the frontal recess in 96% of the studied sides. There were persistent other anterior and posterior ethmoidal cells in 92.1% and 96% of the studied sides respectively.</p> <p>Conclusions</p> <p>Analysis of CT scans of patients undergoing revision FESS shows persistent structures and non-dissected cells that may be responsible for persistence or recurrence of rhinosinusitis symptoms. Trials comparing the outcome of conservative FESS techniques with more radical sinus dissections are required.</p

Is frontal pain a useful marker of chronic frontal sinusitis?

Objective: This study evaluates the relationship of frontal pain as a symptom in chronic frontal sinusitis drawing comparisons with radiological and endoscopic findings, quality of life and disease severity. The aim: to determine its utility as a marker in chronic frontal sinusitis and in surgical decision-making. Methods: Prospective study of 51 consecutive patients undergoing endoscopic sinus surgery for chronic rhinosinusitis. Patients ranked their frontal pain score on a numerical rating scale from 0-10. Facial pain/pressure, SNOT-22, NOSE, Lund-Mackay, and Modified Lund-Kennedy scores were also collated. Statistical analysis: ANOVA and Pearsons correlation coefficient. Results: Frontal pain scores were low and demonstrated no correlation with the extent of frontal sinus disease radiologically or the severity of overall sinus disease endoscopically. Higher frontal pain scores significantly correlated with poorer quality-of-life. Conclusion: We do not support the use of frontal pain as a sensitive or specific marker of chronic frontal sinus disease