Revision endoscopic sinus surgery--long-term follow up and operative findings

Among 170 cases (301 sides) with chronic sinusitis who underwent endoscopic sinus surgery, 15 cases (25 sides) were reoperated on because of unsatisfactory results. We examined 12 such cases, periodically, with an endoscope following the first operation. Postoperative endoscopic management, including removal of polyps in the middle nasal meatus and irrigation of the maxillary sinus with sterilized saline water through the enlarged opening, had been done if necessary. However, stenosis of the middle nasal meatus had gradually progressed and mucous or purulent discharge had increased despite postoperative endoscopic treatment. The middle nasal meatus in 17 of the 25 sides had been closed by polyps or/and adhesion at the time of reoperation. The adhesion occurred between the lateral wall of the anterior ethmoid cavity and the middle turbinate. As a result, the opening of the frontal sinus became narrow or even closed, and pus retention was noted in 14 frontal sinuses during revision surgery. In contrast, only seven maxillary sinuses had pus retention. We concluded that adhesion in the middle nasal meatus holds the key to control of inflammatory changes in the paranasal sinuses.