Our Summary

This research paper looks at why sinus surgery (specifically, functional endoscopic sinus surgery or FESS) sometimes fails and requires a repeat operation. FESS is a very common procedure for treating chronic sinus inflammation, but for 10-15% of patients, it doesn’t work the first time around. The researchers believe the main reasons for this are: the severity of the sinus disease, other existing health conditions, and variations in the patient’s anatomy that aren’t properly accounted for during the first surgery.

The researchers studied 24 patients needing a second FESS to try and find out what caused the first one to fail. They found that the most common issues were to do with certain parts of the sinus anatomy, namely the frontoethmoidal cell, and the anterior and posterior ethmoid cells. Over two-thirds of the patients also had bony inflammation and scar tissue in the sinus.

The researchers conclude that the reasons for FESS failure are complex and can range from severe inflammation to anatomical variations. They suggest that more research needs to be done, including studies with more patients, to better understand how these anatomical differences affect the recurrence of chronic sinus inflammation. This could help improve the success rate of FESS.

FAQs

  1. What are the main reasons for functional endoscopic sinus surgery (FESS) failure according to the research?
  2. What were the most common anatomical issues found in patients needing a second FESS?
  3. What further research is suggested by the researchers to improve the success rate of FESS?

Doctor’s Tip

A doctor might advise a patient undergoing sinus surgery to follow post-operative care instructions carefully, including taking prescribed medications, avoiding activities that may increase sinus pressure, and attending follow-up appointments to monitor healing and address any concerns. It is important for patients to communicate any ongoing symptoms or issues to their healthcare provider to ensure proper management of their condition and reduce the risk of needing a repeat surgery.

Suitable For

Typically, patients who are recommended for sinus surgery are those who have chronic sinus inflammation that does not respond to other treatments such as medications or nasal sprays. These patients may have symptoms such as facial pain, pressure, headaches, nasal congestion, and difficulty breathing. They may also have recurrent sinus infections, nasal polyps, or a deviated septum.

In some cases, patients with severe sinusitis or complications of sinusitis, such as the spread of infection to nearby structures or the development of abscesses, may also be recommended for sinus surgery. Additionally, patients with sinus tumors or cysts that are causing symptoms may also require surgery.

Overall, sinus surgery is typically recommended for patients who have tried other treatments without success and who are experiencing significant symptoms that impact their quality of life. It is important for patients to discuss their symptoms and treatment options with their healthcare provider to determine if sinus surgery is the right choice for them.

Timeline

Before sinus surgery:

  • Patient experiences chronic sinus inflammation and symptoms such as nasal congestion, facial pain, headaches, and difficulty breathing.
  • Patient may try various medications and treatments to alleviate symptoms, but they are not effective in providing long-term relief.
  • Patient consults with an ENT specialist who recommends sinus surgery (FESS) as a treatment option.
  • Patient undergoes pre-operative assessments, including imaging tests, to evaluate the severity of sinus disease and plan the surgical procedure.

After sinus surgery:

  • Patient undergoes FESS procedure to remove blockages, diseased tissue, and improve sinus drainage.
  • Patient experiences post-operative discomfort, such as nasal congestion, mild pain, and fatigue.
  • Patient follows post-operative care instructions, including taking medications, using saline rinses, and attending follow-up appointments.
  • Patient gradually experiences improvement in symptoms, with reduced nasal congestion, improved breathing, and decreased facial pain.
  • Patient may require a repeat FESS surgery if symptoms persist or recur due to factors such as severe inflammation, anatomical variations, bony inflammation, and scar tissue in the sinus.

What to Ask Your Doctor

Some questions a patient should ask their doctor about sinus surgery include:

  1. What specific type of sinus surgery will be performed and why is it recommended for my condition?
  2. What are the potential risks and complications associated with the surgery?
  3. What is the success rate of this type of sinus surgery, and what factors could affect the outcome?
  4. Will I need to undergo any pre-operative tests or evaluations before the surgery?
  5. How long is the recovery period expected to be, and what can I do to help facilitate a smooth recovery?
  6. Are there any alternative treatment options to consider before proceeding with surgery?
  7. What steps can I take to reduce the chances of needing a repeat surgery in the future?
  8. How will my sinus anatomy be evaluated and taken into consideration during the surgery?
  9. Will I need any post-operative care or follow-up appointments after the surgery?
  10. Can you explain the potential reasons for why sinus surgery may fail and require a repeat operation, and how can these be addressed in my case?

Reference

Authors: Baban MIA, Mirza B, Castelnuovo P. Journal: Surg Radiol Anat. 2020 Sep;42(9):1003-1012. doi: 10.1007/s00276-020-02427-5. Epub 2020 Feb 6. PMID: 32025784