Computed tomographic staging and the fate of the dependent sinuses in revision endoscopic sinus surgery

Objectives: To determine the patterns of disease recurrence in chronic sinusitis and to examine the influence of surgical intervention on the presence or absence of disease among sinuses at the time of revision. Design: Retrospective review of case series in a 56-month period. Preoperative computed tomography (CT) scans at the initial surgery and at revision were staged using the Lund and Mackay system. Patterns of disease and CT stage were analyzed with respect to operative intervention, and statistical analysis was conducted to determine the influence of the initial surgical intervention on the patterns of disease at revision. Setting: An academic general otolaryngology practice. Results: A total of 42 paired cases of primary and revision endoscopic sinus surgery were identified with complete data. The average interval between procedures was 11.8 months, with a mean follow-up of 31.7 months. The average total Lund scores for the CT scan before the primary procedure and at revision were not significantly different at 10.5 and 9.7, respectively (P = .38). Analysis of 84 sides revealed that performance of a sinusotomy on an initially undiseased sinus resulted in a higher percentage of disease in that sinus at revision, although this was not significant (P = .15). A sinusotomy performed on an initially diseased sinus was associated with a higher likelihood of disease in that sinus at revision (P = .02). Similar data were found for the subset analysis of the sphenoid and frontal sinuses. Conclusions: The Lund and Mackay system can be applied in the setting of revision endoscopic sinus surgery. Sinusotomies should be performed only in sinuses with radiographic disease, and not prophylactically to prevent disease. The standard functional approach may allow disease initially present in the sphenoid or frontal sinuses to normalize without formal sphenoidotomy or frontal sinusotomy.