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Surgical Management of Rhinosinusitis in Children and Adolescents

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Diseases of the Sinuses

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Abstract

Pediatric rhinosinusitis is very common. Chronic rhinosinusitis (CRS) in children, as in adults, is defined as 12 weeks or more of signs and symptoms of inflammation of the sinuses. First-line therapy for pediatric CRS should be medical, including management of any underlying conditions causing mucosal congestion leading to sinus ostium obstruction.

Should medical therapy fail to effectively improve a child’s symptoms, surgical intervention should be offered. We recommend a stepwise approach in most children, with adenoidectomy used for medical failures and functional endoscopic sinus surgery (FESS) used for adenoidectomy failures. Adenoidectomy is likely effective in medical failures because it removes from the nasopharynx a reservoir of pathogenic bacteria that could otherwise infect the sinuses. FESS is likely effective in children who have failed other therapies because it improves drainage pathways. A preoperative CT scan should be obtained and used to help guide the extent of FESS, although the procedure should, at a minimum, address the osteomeatal complex.

Certain diseases, including orbital infections secondary to sinusitis, cystic fibrosis, and antrochoanal polyps, merit particular attention when considering sinus surgery in children. Orbital abscesses that require surgical drainage tend to be larger. Successful drainage of orbital abscesses can usually be accomplished endoscopically via a limited opening of the lamina papyracea. Although a majority of patients with cystic fibrosis will have nasal polyposis, only a minority will be symptomatic. In these patients, surgery to treat sinonasal disease should, at a minimum, consist of endoscopic ethmoidectomy and wide maxillary antrostomy with removal of polyps. Antrochoanal polyps can generally be removed via a wide maxillary antrostomy using angled telescopes and instruments.

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Authors and Affiliations

  1. Department of Otolaryngology Head and Neck Surgery and the Department of Pediatrics, Boston University/Boston Medical Center, Moakley Building, 830 Harrison Ave, Boston, MA, 02118, USA

    Jessica R. Levi MD

  2. Department of Surgery, Nemours duPont Hospital for Children, Wilmington, DE, 19803, USA

    Richard Schmidt MD

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Correspondence to Richard Schmidt MD .

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Editors and Affiliations

  1. Division of Allergy and Immunology, Department of Pediatrics, Thomas Jefferson University, Wilmington, Delaware, USA

    Christopher C. Chang

  2. Division of Rheumatology, Allergy and Clinical Immunology, University of California School of Medicine, Davis, California, USA

    Gary A. Incaudo

  3. The Jack and Donald Chia Distinguished Professor of Medicine, Division of Rheumatology, Allergy and Clinical Immunology, University of California School of Medicine, Davis, California, USA

    M. Eric Gershwin

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Levi, J.R., Schmidt, R. (2014). Surgical Management of Rhinosinusitis in Children and Adolescents. In: Chang, C., Incaudo, G., Gershwin, M. (eds) Diseases of the Sinuses. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0265-1_22

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