Our Summary

This research paper is about a study that looked at how remaining anatomical structures in the nose and sinuses can affect the outcomes of surgery in patients with chronic rhinosinusitis (CRS), a long-term inflammation of the sinuses. The researchers reviewed multiple studies and found a significant variation in the presence of these structures after endoscopic sinus surgery (ESS), a minimally invasive surgery used to treat CRS.

The studies included in the review had different focuses, including full-house functional ESS, frontal sinus surgery, and conventional ESS. The researchers noted a wide range in the percentage of cases in which certain structures remained post-surgery, such as the uncinate process (29.6-64%), agger nasi cell (4.5-83.33%) and frontoethmoidal cells (40.7-96.8%).

The study concluded that incomplete removal of these structures during revision surgeries for CRS remains an ongoing problem. This variability in surgical outcomes highlights the complexity of these surgeries and suggests a need for further refinement in surgical techniques.

FAQs

  1. What is the significance of the remaining anatomical structures in the nose and sinuses after endoscopic sinus surgery (ESS)?
  2. What is the range of variation in the presence of certain structures post-surgery as per the studies reviewed?
  3. Why is the incomplete removal of certain structures during sinus surgery an ongoing problem, and how does it affect the outcomes of the surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about sinus surgery is to follow all post-operative care instructions carefully to ensure proper healing and minimize the risk of complications. This may include avoiding strenuous activities, keeping the nasal passages moist with saline spray, and attending all follow-up appointments with their healthcare provider. It’s also important for patients to communicate any concerns or changes in symptoms to their doctor promptly.

Suitable For

Patients with chronic rhinosinusitis who have not responded well to other treatments, such as antibiotics or nasal corticosteroids, are typically recommended for sinus surgery. Other factors that may indicate a need for sinus surgery include severe symptoms that significantly impact quality of life, structural issues in the nose or sinuses, or the presence of nasal polyps. Additionally, patients with recurrent acute sinusitis or complications of sinusitis, such as sinus infections that spread to the eyes or brain, may also be candidates for sinus surgery.

Overall, the decision to recommend sinus surgery is based on the individual patient’s symptoms, medical history, and response to other treatments. It is important for patients to discuss their options with their healthcare provider to determine if sinus surgery is the best course of action for their specific situation.

Timeline

Before sinus surgery:

  1. Patient presents with symptoms of chronic rhinosinusitis (CRS), such as nasal congestion, facial pain, and sinus pressure.
  2. Patient undergoes diagnostic tests, such as nasal endoscopy and imaging studies, to confirm the diagnosis and assess the severity of the condition.
  3. Patient may undergo medical treatments, such as antibiotics, nasal steroid sprays, and sinus irrigation, to manage symptoms before considering surgery.

After sinus surgery:

  1. Patient undergoes endoscopic sinus surgery (ESS) to remove diseased tissue, open blocked sinuses, and improve drainage.
  2. In the immediate post-operative period, patient may experience nasal congestion, mild pain, and bloody discharge.
  3. Over the following weeks and months, patient’s symptoms gradually improve as the sinuses heal and inflammation resolves.
  4. Patient may require follow-up visits with their surgeon to monitor healing progress and address any complications.
  5. In some cases, patient may require revision surgery if symptoms persist or recur due to incomplete removal of anatomical structures during the initial surgery.

Overall, the timeline of a patient’s experience before and after sinus surgery involves a thorough evaluation, surgical intervention, and ongoing monitoring to ensure optimal outcomes and symptom relief.

What to Ask Your Doctor

  1. What specific anatomical structures will be targeted during my sinus surgery?

  2. How will the presence or absence of certain structures affect the success of the surgery?

  3. What is the likelihood of certain structures remaining after the surgery, based on my individual case?

  4. What are the potential complications or risks associated with incomplete removal of these structures?

  5. Will I need additional surgeries or treatments if certain structures are not fully removed during the initial surgery?

  6. How will you ensure that all relevant anatomical structures are properly addressed during the surgery?

  7. What can I expect in terms of recovery and long-term outcomes if certain structures are not completely removed during the surgery?

  8. Are there any alternative treatment options or techniques that may be more effective for my specific case if certain structures cannot be fully removed during surgery?

  9. How will you monitor and assess the success of the surgery in relation to the presence of these anatomical structures post-operatively?

  10. Are there any specific post-operative care instructions or precautions I should follow to minimize the risk of complications related to the presence of these structures after surgery?

Reference

Authors: Martin-Jimenez D, Moreno-Luna R, Gago-Torres C, Maza-Solano J, Sanchez-Gomez S. Journal: Eur Ann Otorhinolaryngol Head Neck Dis. 2025 Mar;142(2):84-92. doi: 10.1016/j.anorl.2024.09.009. Epub 2024 Oct 10. PMID: 39393936