The Clinical Applications of Image Guidance in Revision Endoscopic Frontal Sinus Surgery

Abstract

Background: Frontal sinus disease is obstinate. With its multifaceted anatomy and neighboring vital structures, frontal sinus disease creates a dreaded encounter to every otolaryngologist. Further complicated are revision endoscopic frontal sinus surgeries beside unrecognizable anatomy, revision endoscopic frontal sinus surgeries present technical challenges. The objective is to highlight the causes of revision endoscopic frontal sinus surgery and illustrate the clinical applications of the image guidance in managing them. Methods: Retrospective review of 60 patients underwent revision endoscopic sinus surgery with image guidance from 2015 to 2019 Results: the causes of revision out of 60 patients 33% were due to retained uncinate process, residual agger nasi with/without ethmoid disease. Followed by 25% due to extensive mucosal disease with polyps then 24%, 11% and 5% presenting lateralized middle turbinate, unopened suprabullar cell and neo-osteogenesis, respectively. All patients were followed up for 3 years with 91.67% successful patency rate of frontal outflow after revision. Conclusion: the image guidance in revision endoscopic frontal sinus surgery provides accurate identification of remnant bones or cells that may obscure the outflow. Its further aids in evading recurrence or persistent disease with adequate frontal sinusotomy while protecting vital structures.