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

Abstract

Functional endoscopic sinus surgery (FESS) is a crucial additional procedure employed in the management of chronic rhinosinusitis (CRS). It has mostly overtaken the external methods for managing CRS that do not respond to medicinal treatment. Over the years, several instruments have been created to eliminate anatomical obstructions and restore proper function in the sinus drainage pathways. The purpose of this work was to reflect on various anatomical findings after primary functional endoscopic sinus surgery and their relationship with sinus surgery revision. This is a prospective cohort study conducted on 40 participants with CRS. The Sino-Nasal Outcome Test version 22 (SNOT-22) was utilized as a measure of results and was filled out by participants both prior to and following their operation (at the 6-month and 12-month intervals). 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 was misplaced antrostomy and partial or full 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-month postoperative scoring ranged from 10 to 32 with mean 21.48 ± 5.12, and 12-month postoperative scoring ranged from 15 to 37 with mean 28.83 ± 5.52. There was significant improvement (P = 0.001). The ages of patients range between 18 and 62 years. Several common anatomical findings are often found during revision surgeries by analysis of CT scans and endoscopic examination of participants who underwent revision FESS for recurrent or persistent CRS, and this often shows persisting anatomical features or incompletely excised cells that correspond to persistent symptoms and signs of CRS, and the most common was incomplete ethmoidectomy. Also, there was significant improvement regarding outcome measure SNOT-22, 6-month and 12-month period postoperative as contrasted with preoperative scoring.