Failures in endoscopic surgery of the maxillary sinus
Received 16 May 2009; received in revised form 25 October 2009; accepted 27 October 2009.
Abstract
Objective
To assess the prognostic factors of recurrence after endoscopic sinus surgery for maxillary chronic rhinosinusitis without nasal polyps.
Study Design
Prospective.
Setting
Tertiary referral center.
Methods
A total of 411 patients were operated on for maxillary chronic rhinosinusitis without nasal polyps (307 rhinogenic rhinosinusitis, 74 odontogenic rhinosinusitis, and 30 oroantral fistula cases) in a single institution between 2002 and 2007. Ten parameters were analyzed to study their relationship with recurrence: etiology of rhinosinusitis, partial resection of middle turbinate, smoking history, allergy, asthma, gastroesophageal reflux, preoperative endoscopic score, CT stage, maxillary sinus mucosa score, and bleeding score. Preoperative characteristics and recurrence rates were compared with the analysis of variance test. Failure was analyzed as a time-dependent variable by the Kaplan-Meier method. Variables identified on univariate analysis were entered into a multivariate Cox proportional hazards model.
Results
Recurrent rhinosinusitis developed in 28 (6.8%) cases. In the univariate analysis, preoperative endoscopic score, CT stage, and bleeding score were associated with recidivism. However, the multivariate analysis suggested that only bleeding is an independent predictive factor of recurrence (P = 0.034, 95% confidence interval for odds ratio 0.92-7.21).
Conclusion
Intraoperative bleeding may be a risk factor for failure in endoscopic surgery of maxillary rhinosinusitis, but there is substantial uncertainty and future research is needed.
aDepartment of Otolaryngology, University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
bDepartment of Maxillofacial Surgery, University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
Corresponding author: Silviu Albu, MD, Professor, Department of Otolaryngology, University of Medicine and Pharmacy Cluj-Napoca, Str Republicii nr 18, 3400 Cluj-Napoca, Romania
No sponsorships or competing interests have been disclosed for this article.
ABSTRACT