Department of Otolaryngology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA.
Int Forum Allergy Rhinol. 2013 Feb;3(2):139-46. doi: 10.1002/alr.21079. Epub 2012 Nov 5.
Functional endoscopic sinus surgery (FESS) is widely used by otolaryngologists to treat chronic rhinosinusitis (CRS). The sinonasal anatomy and pathology found in patients with CRS varies widely, as does the FESS technique practiced by otolaryngologists. Variations in the completeness of cell group dissection, combined with the technical challenge of angled endoscopy, result in a wide variation of the post-FESS cavities harboring persistent disease. The purpose of this study was to identify previously incompletely dissected anatomic structures associated with mucosal thickening found in patients undergoing revision FESS for persistent or recurrent CRS.
Retrospective review of axial, coronal, and sagittal computed tomography (CT) scans of patients undergoing revision FESS by 3 fellowship-trained rhinologists at a tertiary referral center.
The CT scans of 55 patients undergoing revision FESS were reviewed. The most frequent radiographic findings were residual anterior and posterior ethmoid cells or septations, found in 65% of sides and 75% of patients. In addition, residual anterior ethmoid agger nasi cells, unopened sphenoid, and residual uncinates were found in 52%, 51%, and 46% of sides, respectively. A large percentage of the patients demonstrated residual ethmoid cells present on the lamina papyracea and skull base, with a lower number found posterior to the middle turbinate basal lamella. A greater number of residual right-sided vs left-sided ethmoid cells was noted, with the difference being significant (p < 0.05) at the skull base.
Analysis of CT scans of patients undergoing revision FESS for persistent or recurrent CRS frequently reveals persistent anatomical structures or incompletely resected cells associated with persistent mucosal thickening. Meticulous, complete cell group dissection combined with use of angled endoscopy along with identification of possible predisposing structures may aid in the reduction of need for revision surgery.
鼻内镜鼻窦手术（FESS）被耳鼻喉科医生广泛用于治疗慢性鼻-鼻窦炎（CRS）。患有 CRS 的患者的鼻-鼻窦解剖结构和病理学变化广泛，耳鼻喉科医生施行的 FESS 技术也存在差异。细胞群解剖的完整性存在差异，加上角度内镜的技术挑战，导致 FESS 后存在持续性疾病的鼻腔存在广泛的变化。本研究旨在确定在接受复发性 FESS 治疗持续性或复发性 CRS 的患者中，与黏膜增厚相关的先前未完全解剖的解剖结构。
对在三级转诊中心接受 FESS 翻修的 3 名鼻科 fellowship培训医师的轴向、冠状和矢状面计算机断层扫描（CT）进行回顾性分析。
共对 55 名接受 FESS 翻修的患者的 CT 扫描进行了评估。最常见的放射影像学表现是残留的前、后筛窦或分隔，分别在 65%的侧别和 75%的患者中发现。此外，残留的前筛窦嗅裂气房、未开放的蝶窦和残留的钩突分别在 52%、51%和 46%的侧别中发现。很大一部分患者在纸样板和颅底存在残留的筛窦细胞，而中鼻甲基底部后发现的筛窦细胞较少。右侧残留筛窦细胞的数量明显多于左侧，差异具有统计学意义（p < 0.05）。
对接受复发性 FESS 治疗持续性或复发性 CRS 的患者的 CT 扫描进行分析，常可发现与持续性黏膜增厚相关的持续性解剖结构或未完全切除的细胞。细致、完整的细胞群解剖，结合使用角度内镜以及识别可能的易感结构，可能有助于减少翻修手术的需求。
