A Review of the Different Intraoperative Findings of Revision Endoscopic Frontal Surgery
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ORIGINAL ARTICLE
A Review of the Different Intraoperative Findings of Revision Endoscopic Frontal Surgery Fatmah A. Al-Abdulwahid1 • Ali Almomen2 • Abdullah Alshakhs3 • Ibrahim Al Yaeesh3 • Ahmed AlOmairin3 • Abdulwahab Al Yahya3 Hesham Al Suqair3 • Fatima Al Omayrin4 • Norah Al Ghwainem3 • Razan AlHussain3
•
Received: 26 June 2020 / Accepted: 3 October 2020 Ó Association of Otolaryngologists of India 2020
Abstract A revision endoscopic sinus surgery (rESS) is considered when the primary surgery fails to improve the symptoms or causes problems. The rESS is still a difficult surgical procedure, despite the use of imaging-guided surgical navigation systems, because the anatomical landmarks are removed or scarred. To determine the causes and indications of rESS observed radiologically or endoscopically in patients with frontal rhinosinusitis. This retrospective clinical study was conducted between 2010 and 2019 in the Ear, Nose, and Throat Department of King Fahad Specialist Hospital, Saudi Arabia. Sixty cases were indicated for revision endoscopic surgery, and all had distorted or lost anatomical landmarks. Most landmark losses were caused by undissected uncinate processes and residual agger nasi with/without ethmoid disease. The rESS surgical procedure remains difficult, despite the use of imaging-guided surgical navigation systems, because most of the anatomical landmarks are removed or scarred. An undissected uncinate process, residual agger nasi with/ without ethmoid disease, extensive mucosal disease with polyps obstructing the frontal recess, and lateralized middle turbinates are the most common conditions requiring rESS.
& Ali Almomen [email protected] 1
Department of Otorhinolaryngology, King Abdulaziz Hospital, AlAhsa, Saudi Arabia
2
Department of Rhinology & Skull Base Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
3
College of Medicine, King Faisal University, AlAhsa, Saudi Arabia
4
Department of Biomedical Engineering, King Faisal University, AlAhsa, Saudi Arabia
Keywords Revision endoscopic frontal sinus surgery Chronic rhinosinusitis Multi drug therapy Residual agger nasi cells Uncinate process Middle turbinate lateralization Suprabullar cells
Introduction Chronic rhinosinusitis (CRS) is an inflammatory condition of the nasal cavity, sinus mucosa, and one or more of the paranasal sinuses; it most often causes chronic symptoms that significantly decrease the quality of life of about 12% of the global population [1–3]. The symptoms of CRS include the presence of at least two of four cardinal symptoms: nasal blockage, nasal discharge (anterior /posterior nasal drip), facial pain or pressure, and olfactory disorder for more than 12 weeks [4]. Revision endoscopic sinus surgery (rESS) is considered when the primary surgery fails to improve the symptoms or causes problems. These cases requiring revision may present with headache and forehead pressure after frontal sinusotomy, or they could remain asymptomatic for years. A 12-year follow-up study reported that 21% o
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