Anatomic Findings in Revision Endoscopic Sinus Surgery: Case Series and Review of Contributory Factors

Background It is recognized that patients who undergo endoscopic sinus surgery (ESS) do not always achieve control of their disease. The causes are multifactorial; variations in surgical practice have been identified as possible factors in refractory disease. Objective To reflect on the frequent ana...
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Autor*in:	Jessica Bewick F.R.C.S. [verfasserIn] Francesco M. Egro M.R.C.S. [verfasserIn] Liam Masterson M.R.C.S. [verfasserIn] Amin R. Javer M.D., F.R.C.S.C. [verfasserIn] Carl M. Philpott F.R.C.S. [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2016

Übergeordnetes Werk:	In: Allergy & Rhinology - SAGE Publishing, 2018, 7(2016)
Übergeordnetes Werk:	volume:7 ; year:2016

Links:	Link aufrufen Link aufrufen Link aufrufen Journal toc

DOI / URN:	10.2500/ar.2016.7.0173

Katalog-ID:	DOAJ060374330

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520			\|a Background It is recognized that patients who undergo endoscopic sinus surgery (ESS) do not always achieve control of their disease. The causes are multifactorial; variations in surgical practice have been identified as possible factors in refractory disease. Objective To reflect on the frequent anatomic findings of patients with chronic rhinosinusitis (CRS) who require revision ESS. Methods A retrospective review of patients who required revision ESS at a tertiary institution over a 3-year period. Patients for whom maximal medical therapy failed for CRS underwent computed tomography of the paranasal sinuses and image-guided surgery. Surgical records of anatomic findings were reviewed and analyzed. Results Over 3 years, a total of 75 patients underwent revision procedures, 28% of all ESS performed in the unit. The most frequent finding was a residual uncinate process in 64% of the patients (n = 48); other findings included a maxillary antrostomy not based on the natural ostium of the maxillary sinus in 47% (n = 35), an oversized antrostomy in 29% (n = 22), resected middle turbinates in 35% (n = 26), middle meatal stenosis in 15% (n = 11), synechiae in 29% (n = 22), and osteitic bone that required drilling in 13% (n = 10). Conclusion Surgical technique can give rise to anatomic variations that may prevent adequate mucociliary clearance and medication delivery, which leads to failure in ESS in patients with CRS. This study demonstrated the surgical findings encountered in revision ESS that should be highlighted in the training of Ear, Nose and Throat surgeons to help prevent primary failure and reduce health care costs.
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allfields	10.2500/ar.2016.7.0173 doi (DE-627)DOAJ060374330 (DE-599)DOAJfe60273278174b8dbb2c97bc170f60db DE-627 ger DE-627 rakwb eng RF1-547 RC581-607 Jessica Bewick F.R.C.S. verfasserin aut Anatomic Findings in Revision Endoscopic Sinus Surgery: Case Series and Review of Contributory Factors 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background It is recognized that patients who undergo endoscopic sinus surgery (ESS) do not always achieve control of their disease. The causes are multifactorial; variations in surgical practice have been identified as possible factors in refractory disease. Objective To reflect on the frequent anatomic findings of patients with chronic rhinosinusitis (CRS) who require revision ESS. Methods A retrospective review of patients who required revision ESS at a tertiary institution over a 3-year period. Patients for whom maximal medical therapy failed for CRS underwent computed tomography of the paranasal sinuses and image-guided surgery. Surgical records of anatomic findings were reviewed and analyzed. Results Over 3 years, a total of 75 patients underwent revision procedures, 28% of all ESS performed in the unit. The most frequent finding was a residual uncinate process in 64% of the patients (n = 48); other findings included a maxillary antrostomy not based on the natural ostium of the maxillary sinus in 47% (n = 35), an oversized antrostomy in 29% (n = 22), resected middle turbinates in 35% (n = 26), middle meatal stenosis in 15% (n = 11), synechiae in 29% (n = 22), and osteitic bone that required drilling in 13% (n = 10). Conclusion Surgical technique can give rise to anatomic variations that may prevent adequate mucociliary clearance and medication delivery, which leads to failure in ESS in patients with CRS. This study demonstrated the surgical findings encountered in revision ESS that should be highlighted in the training of Ear, Nose and Throat surgeons to help prevent primary failure and reduce health care costs. Otorhinolaryngology Immunologic diseases. Allergy Francesco M. Egro M.R.C.S. verfasserin aut Liam Masterson M.R.C.S. verfasserin aut Amin R. Javer M.D., F.R.C.S.C. verfasserin aut Carl M. Philpott F.R.C.S. verfasserin aut In Allergy & Rhinology SAGE Publishing, 2018 7(2016) (DE-627)72193353X (DE-600)2675684-5 21526567 nnns volume:7 year:2016 https://doi.org/10.2500/ar.2016.7.0173 kostenfrei https://doaj.org/article/fe60273278174b8dbb2c97bc170f60db kostenfrei https://doi.org/10.2500/ar.2016.7.0173 kostenfrei https://doaj.org/toc/2152-6567 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_374 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_2034 GBV_ILN_2068 GBV_ILN_2098 GBV_ILN_2707 GBV_ILN_2890 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 7 2016
spelling	10.2500/ar.2016.7.0173 doi (DE-627)DOAJ060374330 (DE-599)DOAJfe60273278174b8dbb2c97bc170f60db DE-627 ger DE-627 rakwb eng RF1-547 RC581-607 Jessica Bewick F.R.C.S. verfasserin aut Anatomic Findings in Revision Endoscopic Sinus Surgery: Case Series and Review of Contributory Factors 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background It is recognized that patients who undergo endoscopic sinus surgery (ESS) do not always achieve control of their disease. The causes are multifactorial; variations in surgical practice have been identified as possible factors in refractory disease. Objective To reflect on the frequent anatomic findings of patients with chronic rhinosinusitis (CRS) who require revision ESS. Methods A retrospective review of patients who required revision ESS at a tertiary institution over a 3-year period. Patients for whom maximal medical therapy failed for CRS underwent computed tomography of the paranasal sinuses and image-guided surgery. Surgical records of anatomic findings were reviewed and analyzed. Results Over 3 years, a total of 75 patients underwent revision procedures, 28% of all ESS performed in the unit. The most frequent finding was a residual uncinate process in 64% of the patients (n = 48); other findings included a maxillary antrostomy not based on the natural ostium of the maxillary sinus in 47% (n = 35), an oversized antrostomy in 29% (n = 22), resected middle turbinates in 35% (n = 26), middle meatal stenosis in 15% (n = 11), synechiae in 29% (n = 22), and osteitic bone that required drilling in 13% (n = 10). Conclusion Surgical technique can give rise to anatomic variations that may prevent adequate mucociliary clearance and medication delivery, which leads to failure in ESS in patients with CRS. This study demonstrated the surgical findings encountered in revision ESS that should be highlighted in the training of Ear, Nose and Throat surgeons to help prevent primary failure and reduce health care costs. Otorhinolaryngology Immunologic diseases. Allergy Francesco M. Egro M.R.C.S. verfasserin aut Liam Masterson M.R.C.S. verfasserin aut Amin R. Javer M.D., F.R.C.S.C. verfasserin aut Carl M. Philpott F.R.C.S. verfasserin aut In Allergy & Rhinology SAGE Publishing, 2018 7(2016) (DE-627)72193353X (DE-600)2675684-5 21526567 nnns volume:7 year:2016 https://doi.org/10.2500/ar.2016.7.0173 kostenfrei https://doaj.org/article/fe60273278174b8dbb2c97bc170f60db kostenfrei https://doi.org/10.2500/ar.2016.7.0173 kostenfrei https://doaj.org/toc/2152-6567 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_374 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_2034 GBV_ILN_2068 GBV_ILN_2098 GBV_ILN_2707 GBV_ILN_2890 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 7 2016
allfields_unstemmed	10.2500/ar.2016.7.0173 doi (DE-627)DOAJ060374330 (DE-599)DOAJfe60273278174b8dbb2c97bc170f60db DE-627 ger DE-627 rakwb eng RF1-547 RC581-607 Jessica Bewick F.R.C.S. verfasserin aut Anatomic Findings in Revision Endoscopic Sinus Surgery: Case Series and Review of Contributory Factors 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background It is recognized that patients who undergo endoscopic sinus surgery (ESS) do not always achieve control of their disease. The causes are multifactorial; variations in surgical practice have been identified as possible factors in refractory disease. Objective To reflect on the frequent anatomic findings of patients with chronic rhinosinusitis (CRS) who require revision ESS. Methods A retrospective review of patients who required revision ESS at a tertiary institution over a 3-year period. Patients for whom maximal medical therapy failed for CRS underwent computed tomography of the paranasal sinuses and image-guided surgery. Surgical records of anatomic findings were reviewed and analyzed. Results Over 3 years, a total of 75 patients underwent revision procedures, 28% of all ESS performed in the unit. The most frequent finding was a residual uncinate process in 64% of the patients (n = 48); other findings included a maxillary antrostomy not based on the natural ostium of the maxillary sinus in 47% (n = 35), an oversized antrostomy in 29% (n = 22), resected middle turbinates in 35% (n = 26), middle meatal stenosis in 15% (n = 11), synechiae in 29% (n = 22), and osteitic bone that required drilling in 13% (n = 10). Conclusion Surgical technique can give rise to anatomic variations that may prevent adequate mucociliary clearance and medication delivery, which leads to failure in ESS in patients with CRS. This study demonstrated the surgical findings encountered in revision ESS that should be highlighted in the training of Ear, Nose and Throat surgeons to help prevent primary failure and reduce health care costs. Otorhinolaryngology Immunologic diseases. Allergy Francesco M. Egro M.R.C.S. verfasserin aut Liam Masterson M.R.C.S. verfasserin aut Amin R. Javer M.D., F.R.C.S.C. verfasserin aut Carl M. Philpott F.R.C.S. verfasserin aut In Allergy & Rhinology SAGE Publishing, 2018 7(2016) (DE-627)72193353X (DE-600)2675684-5 21526567 nnns volume:7 year:2016 https://doi.org/10.2500/ar.2016.7.0173 kostenfrei https://doaj.org/article/fe60273278174b8dbb2c97bc170f60db kostenfrei https://doi.org/10.2500/ar.2016.7.0173 kostenfrei https://doaj.org/toc/2152-6567 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_374 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_2034 GBV_ILN_2068 GBV_ILN_2098 GBV_ILN_2707 GBV_ILN_2890 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 7 2016
allfieldsGer	10.2500/ar.2016.7.0173 doi (DE-627)DOAJ060374330 (DE-599)DOAJfe60273278174b8dbb2c97bc170f60db DE-627 ger DE-627 rakwb eng RF1-547 RC581-607 Jessica Bewick F.R.C.S. verfasserin aut Anatomic Findings in Revision Endoscopic Sinus Surgery: Case Series and Review of Contributory Factors 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background It is recognized that patients who undergo endoscopic sinus surgery (ESS) do not always achieve control of their disease. The causes are multifactorial; variations in surgical practice have been identified as possible factors in refractory disease. Objective To reflect on the frequent anatomic findings of patients with chronic rhinosinusitis (CRS) who require revision ESS. Methods A retrospective review of patients who required revision ESS at a tertiary institution over a 3-year period. Patients for whom maximal medical therapy failed for CRS underwent computed tomography of the paranasal sinuses and image-guided surgery. Surgical records of anatomic findings were reviewed and analyzed. Results Over 3 years, a total of 75 patients underwent revision procedures, 28% of all ESS performed in the unit. The most frequent finding was a residual uncinate process in 64% of the patients (n = 48); other findings included a maxillary antrostomy not based on the natural ostium of the maxillary sinus in 47% (n = 35), an oversized antrostomy in 29% (n = 22), resected middle turbinates in 35% (n = 26), middle meatal stenosis in 15% (n = 11), synechiae in 29% (n = 22), and osteitic bone that required drilling in 13% (n = 10). Conclusion Surgical technique can give rise to anatomic variations that may prevent adequate mucociliary clearance and medication delivery, which leads to failure in ESS in patients with CRS. This study demonstrated the surgical findings encountered in revision ESS that should be highlighted in the training of Ear, Nose and Throat surgeons to help prevent primary failure and reduce health care costs. Otorhinolaryngology Immunologic diseases. Allergy Francesco M. Egro M.R.C.S. verfasserin aut Liam Masterson M.R.C.S. verfasserin aut Amin R. Javer M.D., F.R.C.S.C. verfasserin aut Carl M. Philpott F.R.C.S. verfasserin aut In Allergy & Rhinology SAGE Publishing, 2018 7(2016) (DE-627)72193353X (DE-600)2675684-5 21526567 nnns volume:7 year:2016 https://doi.org/10.2500/ar.2016.7.0173 kostenfrei https://doaj.org/article/fe60273278174b8dbb2c97bc170f60db kostenfrei https://doi.org/10.2500/ar.2016.7.0173 kostenfrei https://doaj.org/toc/2152-6567 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_374 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_2034 GBV_ILN_2068 GBV_ILN_2098 GBV_ILN_2707 GBV_ILN_2890 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 7 2016
allfieldsSound	10.2500/ar.2016.7.0173 doi (DE-627)DOAJ060374330 (DE-599)DOAJfe60273278174b8dbb2c97bc170f60db DE-627 ger DE-627 rakwb eng RF1-547 RC581-607 Jessica Bewick F.R.C.S. verfasserin aut Anatomic Findings in Revision Endoscopic Sinus Surgery: Case Series and Review of Contributory Factors 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background It is recognized that patients who undergo endoscopic sinus surgery (ESS) do not always achieve control of their disease. The causes are multifactorial; variations in surgical practice have been identified as possible factors in refractory disease. Objective To reflect on the frequent anatomic findings of patients with chronic rhinosinusitis (CRS) who require revision ESS. Methods A retrospective review of patients who required revision ESS at a tertiary institution over a 3-year period. Patients for whom maximal medical therapy failed for CRS underwent computed tomography of the paranasal sinuses and image-guided surgery. Surgical records of anatomic findings were reviewed and analyzed. Results Over 3 years, a total of 75 patients underwent revision procedures, 28% of all ESS performed in the unit. The most frequent finding was a residual uncinate process in 64% of the patients (n = 48); other findings included a maxillary antrostomy not based on the natural ostium of the maxillary sinus in 47% (n = 35), an oversized antrostomy in 29% (n = 22), resected middle turbinates in 35% (n = 26), middle meatal stenosis in 15% (n = 11), synechiae in 29% (n = 22), and osteitic bone that required drilling in 13% (n = 10). Conclusion Surgical technique can give rise to anatomic variations that may prevent adequate mucociliary clearance and medication delivery, which leads to failure in ESS in patients with CRS. This study demonstrated the surgical findings encountered in revision ESS that should be highlighted in the training of Ear, Nose and Throat surgeons to help prevent primary failure and reduce health care costs. Otorhinolaryngology Immunologic diseases. Allergy Francesco M. Egro M.R.C.S. verfasserin aut Liam Masterson M.R.C.S. verfasserin aut Amin R. Javer M.D., F.R.C.S.C. verfasserin aut Carl M. Philpott F.R.C.S. verfasserin aut In Allergy & Rhinology SAGE Publishing, 2018 7(2016) (DE-627)72193353X (DE-600)2675684-5 21526567 nnns volume:7 year:2016 https://doi.org/10.2500/ar.2016.7.0173 kostenfrei https://doaj.org/article/fe60273278174b8dbb2c97bc170f60db kostenfrei https://doi.org/10.2500/ar.2016.7.0173 kostenfrei https://doaj.org/toc/2152-6567 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_374 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_2034 GBV_ILN_2068 GBV_ILN_2098 GBV_ILN_2707 GBV_ILN_2890 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 7 2016
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The causes are multifactorial; variations in surgical practice have been identified as possible factors in refractory disease. Objective To reflect on the frequent anatomic findings of patients with chronic rhinosinusitis (CRS) who require revision ESS. Methods A retrospective review of patients who required revision ESS at a tertiary institution over a 3-year period. Patients for whom maximal medical therapy failed for CRS underwent computed tomography of the paranasal sinuses and image-guided surgery. Surgical records of anatomic findings were reviewed and analyzed. Results Over 3 years, a total of 75 patients underwent revision procedures, 28% of all ESS performed in the unit. The most frequent finding was a residual uncinate process in 64% of the patients (n = 48); other findings included a maxillary antrostomy not based on the natural ostium of the maxillary sinus in 47% (n = 35), an oversized antrostomy in 29% (n = 22), resected middle turbinates in 35% (n = 26), middle meatal stenosis in 15% (n = 11), synechiae in 29% (n = 22), and osteitic bone that required drilling in 13% (n = 10). Conclusion Surgical technique can give rise to anatomic variations that may prevent adequate mucociliary clearance and medication delivery, which leads to failure in ESS in patients with CRS. 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author	Jessica Bewick F.R.C.S.
spellingShingle	Jessica Bewick F.R.C.S. misc RF1-547 misc RC581-607 misc Otorhinolaryngology misc Immunologic diseases. Allergy Anatomic Findings in Revision Endoscopic Sinus Surgery: Case Series and Review of Contributory Factors
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author_browse	Jessica Bewick F.R.C.S. Francesco M. Egro M.R.C.S. Liam Masterson M.R.C.S. Amin R. Javer M.D., F.R.C.S.C. Carl M. Philpott F.R.C.S.
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title_sort	anatomic findings in revision endoscopic sinus surgery: case series and review of contributory factors
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title_auth	Anatomic Findings in Revision Endoscopic Sinus Surgery: Case Series and Review of Contributory Factors
abstract	Background It is recognized that patients who undergo endoscopic sinus surgery (ESS) do not always achieve control of their disease. The causes are multifactorial; variations in surgical practice have been identified as possible factors in refractory disease. Objective To reflect on the frequent anatomic findings of patients with chronic rhinosinusitis (CRS) who require revision ESS. Methods A retrospective review of patients who required revision ESS at a tertiary institution over a 3-year period. Patients for whom maximal medical therapy failed for CRS underwent computed tomography of the paranasal sinuses and image-guided surgery. Surgical records of anatomic findings were reviewed and analyzed. Results Over 3 years, a total of 75 patients underwent revision procedures, 28% of all ESS performed in the unit. The most frequent finding was a residual uncinate process in 64% of the patients (n = 48); other findings included a maxillary antrostomy not based on the natural ostium of the maxillary sinus in 47% (n = 35), an oversized antrostomy in 29% (n = 22), resected middle turbinates in 35% (n = 26), middle meatal stenosis in 15% (n = 11), synechiae in 29% (n = 22), and osteitic bone that required drilling in 13% (n = 10). Conclusion Surgical technique can give rise to anatomic variations that may prevent adequate mucociliary clearance and medication delivery, which leads to failure in ESS in patients with CRS. This study demonstrated the surgical findings encountered in revision ESS that should be highlighted in the training of Ear, Nose and Throat surgeons to help prevent primary failure and reduce health care costs.
abstractGer	Background It is recognized that patients who undergo endoscopic sinus surgery (ESS) do not always achieve control of their disease. The causes are multifactorial; variations in surgical practice have been identified as possible factors in refractory disease. Objective To reflect on the frequent anatomic findings of patients with chronic rhinosinusitis (CRS) who require revision ESS. Methods A retrospective review of patients who required revision ESS at a tertiary institution over a 3-year period. Patients for whom maximal medical therapy failed for CRS underwent computed tomography of the paranasal sinuses and image-guided surgery. Surgical records of anatomic findings were reviewed and analyzed. Results Over 3 years, a total of 75 patients underwent revision procedures, 28% of all ESS performed in the unit. The most frequent finding was a residual uncinate process in 64% of the patients (n = 48); other findings included a maxillary antrostomy not based on the natural ostium of the maxillary sinus in 47% (n = 35), an oversized antrostomy in 29% (n = 22), resected middle turbinates in 35% (n = 26), middle meatal stenosis in 15% (n = 11), synechiae in 29% (n = 22), and osteitic bone that required drilling in 13% (n = 10). Conclusion Surgical technique can give rise to anatomic variations that may prevent adequate mucociliary clearance and medication delivery, which leads to failure in ESS in patients with CRS. This study demonstrated the surgical findings encountered in revision ESS that should be highlighted in the training of Ear, Nose and Throat surgeons to help prevent primary failure and reduce health care costs.
abstract_unstemmed	Background It is recognized that patients who undergo endoscopic sinus surgery (ESS) do not always achieve control of their disease. The causes are multifactorial; variations in surgical practice have been identified as possible factors in refractory disease. Objective To reflect on the frequent anatomic findings of patients with chronic rhinosinusitis (CRS) who require revision ESS. Methods A retrospective review of patients who required revision ESS at a tertiary institution over a 3-year period. Patients for whom maximal medical therapy failed for CRS underwent computed tomography of the paranasal sinuses and image-guided surgery. Surgical records of anatomic findings were reviewed and analyzed. Results Over 3 years, a total of 75 patients underwent revision procedures, 28% of all ESS performed in the unit. The most frequent finding was a residual uncinate process in 64% of the patients (n = 48); other findings included a maxillary antrostomy not based on the natural ostium of the maxillary sinus in 47% (n = 35), an oversized antrostomy in 29% (n = 22), resected middle turbinates in 35% (n = 26), middle meatal stenosis in 15% (n = 11), synechiae in 29% (n = 22), and osteitic bone that required drilling in 13% (n = 10). Conclusion Surgical technique can give rise to anatomic variations that may prevent adequate mucociliary clearance and medication delivery, which leads to failure in ESS in patients with CRS. This study demonstrated the surgical findings encountered in revision ESS that should be highlighted in the training of Ear, Nose and Throat surgeons to help prevent primary failure and reduce health care costs.
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title_short	Anatomic Findings in Revision Endoscopic Sinus Surgery: Case Series and Review of Contributory Factors
url	https://doi.org/10.2500/ar.2016.7.0173 https://doaj.org/article/fe60273278174b8dbb2c97bc170f60db https://doaj.org/toc/2152-6567
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The causes are multifactorial; variations in surgical practice have been identified as possible factors in refractory disease. Objective To reflect on the frequent anatomic findings of patients with chronic rhinosinusitis (CRS) who require revision ESS. Methods A retrospective review of patients who required revision ESS at a tertiary institution over a 3-year period. Patients for whom maximal medical therapy failed for CRS underwent computed tomography of the paranasal sinuses and image-guided surgery. Surgical records of anatomic findings were reviewed and analyzed. Results Over 3 years, a total of 75 patients underwent revision procedures, 28% of all ESS performed in the unit. The most frequent finding was a residual uncinate process in 64% of the patients (n = 48); other findings included a maxillary antrostomy not based on the natural ostium of the maxillary sinus in 47% (n = 35), an oversized antrostomy in 29% (n = 22), resected middle turbinates in 35% (n = 26), middle meatal stenosis in 15% (n = 11), synechiae in 29% (n = 22), and osteitic bone that required drilling in 13% (n = 10). Conclusion Surgical technique can give rise to anatomic variations that may prevent adequate mucociliary clearance and medication delivery, which leads to failure in ESS in patients with CRS. 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Anatomic Findings in Revision Endoscopic Sinus Surgery: Case Series and Review of Contributory Factors

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