Analysis of radiological results of residual frontal recess cells and the efficacy of revision surgery in patients with recurrent frontal sinusitis after sinusotomy

doi:10.3969/j.issn.1006-7795.2022.06.015

Abstract

Abstract: Objective To investigate the situation of residual frontal recess cells and efficacy of revision surgery by analyzing the computed tomographic (CT) results of the patients with recurrent frontal sinusitis after endoscopic sinus surgery. Methods A retrospective analysis of 64 chronic rhinosinusitis patients with recurrent frontal sinusitis after surgery who were prepared for surgery in Department of Otorhinolaryngology Head and Neck Surgery of Peking University People's Hospital from January 2017 to December 2019 was performed. The results of Visual Analog Scales (VAS) of nasal symptoms of the patients before and after surgery were collected. The patients' CT were analyzed according to The International Frontal Sinus Anatomy Classification (IFAC) to record the prevalence of every type of the residual frontal recess cells. The Lund-Mackay (LM) scores of all frontal sinuses were also recorded. The relationship of the patient's general information and the situation of residual frontal recess cells between the frontal sinus LM sores was analyzed statistically by using SPSS 27.0. The VAS scores of patients before and after surgery were analyzed. Results In this study 121 sides frontal sinuses were evolved. All kinds of frontal recess cells were found in the patients: agger nasi cell in 108 sides (89.3%), supra agger cell in 11 sides (9.1%), supra agger cell in 19 sides (15.7%), supra bulla cell in 20 sides (16.5%), supra bulla frontal cell in 13 sides (10.7%), supraorbital ethmoid cell in 40 sides (33.1%), frontal septal cell in 49 sides (40.5%), type 1 frontal septal cell in 15 sides (12.4%), and type 2 frontal septal cell in 34 sided (28.1%). Besides, the frontal septal cells and the supraorbital ethmoid cells were more prone to remaining. There were 54 patients followed up 1 year after surgery. The average VAS scores of the patients before and 1 year after surgery were 6.6±1.4 and 2.8±1.4, respectively. A total of 7 patients underwent Draf Ⅲ surgery. The mean VAS scores of total symptoms before and 1 year after surgery were 7.6±1.1 and 3.9±0.9, respectively. In statistical analysis, t the number of previous surgery (P=0.016, OR=2.639) was correlated with the increase of the frontal sinus LM sores. There were statistical differences between the VAS scores of the patients before and after surgery (t=19.656, P<0.01). Conclusions The proportion of some residual frontal recess cells were high in chronic rhinosinusitis patients after surgery. It may increase the risk of recurrence of frontal sinusitis. For the patients with recurrent frontal sinusitis, appropriate surgical skills should be measured. During the surgery, the frontal recess cells should be completely removed and ensure the drainage pathway smoothly to prevent recurrence.

Key words: chronic rhinosinusitis, frontal recess cell, endoscopic sinus surgery

CLC Number:

Shi Muhan, Wang Chong, Wang Min, Yuan Fei, Xing Zhimin, Yuan Xiaopei, Wu Yuxiao. Analysis of radiological results of residual frontal recess cells and the efficacy of revision surgery in patients with recurrent frontal sinusitis after sinusotomy[J]. Journal of Capital Medical University, 2022, 43(6): 911-918.

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URL: https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/10.3969/j.issn.1006-7795.2022.06.015

https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/Y2022/V43/I6/911

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