Radiological findings in patients undergoing revision endoscopic sinus surgery: a retrospective case series study

To identify anatomic factors that may predispose to persistent or recurrent disease in patients undergoing revision FESS.Retrospective review of axial and coronal CT scans of patients undergoing revision FESS between January 2005 and November 2008 in a tertiary referral centre in South West of England.The CT scans of 63 patients undergoing revision FESS were reviewed. Among the patients studied, 15.9% had significant deviation of the nasal septum. Lateralised middle turbinates were present in 11.1% of the studied sides, and residual uncinate processes were identified in 57.1% of the studied sides. There were residual cells in the frontal recess in 96% of the studied sides. There were persistent other anterior and posterior ethmoidal cells in 92.1% and 96% of the studied sides respectively.Analysis of CT scans of patients undergoing revision FESS shows persistent structures and non-dissected cells that may be responsible for persistence or recurrence of rhinosinusitis symptoms. Trials comparing the outcome of conservative FESS techniques with more radical sinus dissections are required.Functional endoscopic sinus surgery (FESS) has become a well established strategy for the treatment of rhinosinusitis not responding to medical treatment [1]. Published success rates for FESS vary from 76% to 98% [2]. However, there remains a group of patients in whom FESS does not provide symptomatic relief [3]. Some of these patients may require revision FESS. In a national audit of the sinonasal surgery in the UK, it was shown that 11.4% of patients had revision surgery within 3 years of the primary procedure [4].Revision endoscopic sinus surgery represents a challenge to all who practise sinus surgery. Among the most important considerations in revision sinus surgery is the identification of the anatomy that is contributing to the patient's symptoms and the disease process [5].A patient with persistent chronic sinusitis or recurrent infections after primary sinus surgery needs aggr