eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Nasal & Sinus Diseases

Sinusitis, Maxillary, Chronic, Surgical Treatment: Follow-up

Author: Ankit Patel, MD, Staff Physician, Department of Otolaryngology-Head and Neck Surgery, St Joseph Medical Center, Silver Cross Hospital
Coauthor(s): Winston C Vaughan, MD, Founder and Director, California Sinus Institute and Foundation; Director, CSI Advanced Sinus Surgery and Rhinology
Contributor Information and Disclosures

Updated: Mar 6, 2008

Outcome and Prognosis

Outcomes with properly selected patients for FESS have been outstanding. In 1989, Kamel reported a 96.8% patency rate for 94 endoscopic maxillary antrostomies (follow-up: 4-12 mo).3 Of his 66 patients, 95.5% had subjective improvement in their symptoms. In 1993, Salam and Cable reported long-term 89% patency rate of 90 maxillary antrostomies with statistically significant improvements in headache, nasal obstruction, and pain with a 26-month mean follow-up.4 Revision surgery is required in about 10% of cases.

Future and Controversies

Much remains to be discovered about the pathophysiology of chronic rhinosinusitis. Interesting work in the field is implicating an immunologic component in a large subset of patients with chronic rhinosinusitis. A heterogeneous group of patients seems to be lumped under the umbrella diagnosis of chronic rhinosinusitis without differentiation. Further work is needed to better characterize the different subsets of these patients to enhance understanding of the causes of rhinosinusitis and better optimize outcomes for people with this disease.

Another area of controversy is whether FESS is useful for patients with history and physical examination findings that are consistent with recurrent or chronic sinusitis but who have relatively normal findings on CT scanning. Little information exists in the literature regarding the optimal management of these patients with no abnormality detected on CT scanning, but one study with a very limited number of subjects demonstrated preliminary improvement in a very select group of patients without significant disease based on CT scan findings. Presently, this subset of patients is thought to be a very small minority of patients with chronic rhinosinusitis, and every effort should be made to confirm the diagnosis of chronic sinusitis and to prescribe a comprehensive course of medical treatment, including allergy treatment and saline, before resorting to surgical treatment.

Balloon catheter technology has been used to dilate the maxillary sinus natural ostia without bone or soft tissue removal.  Early reports show persistent patient symptom improvement and sinus ostia patency.  Further study and long-term outcomes with this technology will determine its role in endoscopic sinus surgery.5

The benefits of surgery should always outweigh the risks, a ratio that is only elucidated via a thorough workup and evaluation that includes careful consideration for conservative therapy.

 


More on Sinusitis, Maxillary, Chronic, Surgical Treatment

Overview: Sinusitis, Maxillary, Chronic, Surgical Treatment
Workup: Sinusitis, Maxillary, Chronic, Surgical Treatment
Treatment: Sinusitis, Maxillary, Chronic, Surgical Treatment
Follow-up: Sinusitis, Maxillary, Chronic, Surgical Treatment
Multimedia: Sinusitis, Maxillary, Chronic, Surgical Treatment
References
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References

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Further Reading

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Keywords

maxillary sinus, chronic rhinosinusitis, chronic sinusitis, chronic maxillary sinusitis, functional endoscopic sinus surgery, FESS, intranasal middle meatus antrostomy, Caldwell-Luc operation, sinusitis

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Contributor Information and Disclosures

Author

Ankit Patel, MD, Staff Physician, Department of Otolaryngology-Head and Neck Surgery, St Joseph Medical Center, Silver Cross Hospital
Ankit Patel, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery and American Rhinologic Society
Disclosure: a Salary Employment

Coauthor(s)

Winston C Vaughan, MD, Founder and Director, California Sinus Institute and Foundation; Director, CSI Advanced Sinus Surgery and Rhinology
Disclosure: Nothing to disclose.

Medical Editor

Hassan H Ramadan, MD, MSc, Professor and Vice-Chair, Department of Otolaryngology-Head and Neck Surgery, Professor, Department of Pediatrics, West Virginia University
Hassan H Ramadan, MD, MSc is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and American Rhinologic Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Stephen G Batuello, MD, Consulting Staff, Colorado ENT Specialists
Stephen G Batuello, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Physician Executives, American Medical Association, and Colorado Medical Society
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Advanced Headache Intervention Consulting fee Consulting; Covidien Corp Consulting fee Consulting

 
 
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