Ramadan Hassan H
Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA.
Laryngoscope. 2009 Jun;119(6):1214-7. doi: 10.1002/lary.20230.
OBJECTIVES/HYPOTHESIS: Revision endoscopic sinus surgery (ESS) in children is uncommon. Causes of failure, however, are not very well delineated. The purpose of this study was to evaluate surgical causes of failure in children after ESS.
A retrospective review of children who had ESS at a tertiary children's referral center between 1993 and 2005 for chronic rhinosinusitis.
ESS was performed on 243 children. Children with cystic fibrosis, immune deficiency/suppression, and ciliary abnormalities were excluded because the reasons of failure in those children are well known. Data were available on 176 children with at least one year of follow-up.
Twenty-three (13%) children required revision. The most common finding was adhesions in 57%, followed by maxillary sinus ostium stenosis or missed maxillary sinus ostium in 52% of the cases. In 39% of the cases, there was recurrent disease in the sinuses that were operated on initially. Interestingly, however, we found that in 26% surgery was needed because of disease that was present in nonoperated sinuses during the primary ESS. A deviated septum and a mucocele were the cause of failure in 17% and 13% of the patients, respectively. Presence of asthma and younger age contributed to the failure in some of these children.
Adhesions and a scarred, narrow maxillary sinus ostium were the most common cause of failure in children after ESS. Steps taken during surgery may be required to help reduce the need for revision in particular for younger asthmatic children. Laryngoscope, 2009.
目的/假设：儿童内镜鼻窦手术（ESS）翻修术并不常见。然而，手术失败的原因尚未完全明确。本研究旨在评估儿童ESS术后手术失败的原因。
对1993年至2005年间在一家三级儿童转诊中心因慢性鼻窦炎接受ESS的儿童进行回顾性研究。
对243名儿童实施了ESS。排除患有囊性纤维化、免疫缺陷/抑制和纤毛异常的儿童，因为这些儿童手术失败的原因已为人熟知。有176名儿童随访至少一年，获取了相关数据。
23名（13%）儿童需要进行翻修手术。最常见的发现是粘连，占57%，其次是上颌窦口狭窄或上颌窦口未开放，占52%。在39%的病例中，最初接受手术的鼻窦出现了疾病复发。然而，有趣的是，我们发现26%的病例需要再次手术是因为在初次ESS时未手术的鼻窦存在病变。鼻中隔偏曲和黏液囊肿分别是17%和13%患者手术失败的原因。哮喘的存在和年龄较小在部分患儿手术失败中起到了一定作用。
粘连以及上颌窦口瘢痕化、狭窄是儿童ESS术后最常见的失败原因。可能需要在手术过程中采取措施，以减少尤其是年幼哮喘患儿的翻修需求。《喉镜》，2009年
