Sinonasal anatomical findings associated with revision functional endoscopic sinus surgery in chronic rhinosinusitis

Abstract

Background: Functional endoscopic sinus surgery (FESS) is an important adjunct used in the treatment of chronic rhinosinusitis. It has largely replaced the external approaches for treating chronic rhinosinusitis refractory to medical management. Various instruments were developed over the years that are used to remove anatomic obstruction and to restore function within the drainage pathways of the sinuses. Aim: To reflect on various anatomical findings after primary functional endoscopic sinus surgery and their relationship with sinus surgery revision. Methods: This is a prospective cohort study which was performed on 40 patients with CRS due to persistent, residual and/or retained anatomical variants proved by radiological and endoscopic evaluations. The Sino-Nasal Outcome Test version 22 (SNOT-22) was used as an outcome measure and was completed by patients before and after surgery (at 6 and 12 months). Patients selected from the outpatient clinic of the Otorhinolaryngology Department of Tanta University Hospital during the period between February 2021 to November 2023. Results: There were multiple anatomical findings encountered in CRS persistence and subsequent need for revision FESS, the most common was incomplete ethmoidectomy (both anterior and posterior) 62.5% (N =25) and the least common were misplaced antrostomy and full or partial resection of the middle turbinate 7.5% (N=3). Preoperative total SNOT-22 scoring ranged from 42 to 86 with mean 58.83 ± 12.08 while 6 months postoperative scoring ranged from 10 to 32 with mean 21.48 ± 5.12 and 12 months postoperative scoring ranged from 15 to 37 with mean 28.83 ± 5.52.There was significant improvement (P=0.001). Ages of patients range between 18 years to 62 years. Conclusions: A number of frequent anatomic findings encountered at revision surgery by analysis of CT scans and endoscopic examination of patients undergoing revision FESS for persistent or recurrent CRS and this frequently reveals persistent anatomical structures or incompletely resected cells associated with persistent symptoms and signs of CRS and the most common was incomplete ethmoidectomy. Also there was significant improvement regarding outcome measure SNOT 22, 6 and 12 months postoperative as compared with preoperative scoring.