Skip to main content
SpringerLink
Log in

Impact of residual frontal recess cells on frontal sinusitis after endoscopic sinus surgery

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Endoscopic sinus surgery (ESS) is a well-established treatment for chronic rhinosinusitis (CRS). However, ESS for frontal sinusitis remains complicated and challenging. The aim of this study was to identify the relationship between residual frontal recess cells and primary ESS failure in the frontal sinus.

Methods

We prospectively collected information on 214 sides of 129 patients with CRS who underwent standard ESS from June 2010 to May 2011. To identify risk factors, we retrospectively analyzed clinical data and computed tomography (CT) images before and 3 months after surgery.

Results

The posterior side of the frontal recess cells remained relatively common: suprabullar cells (SBCs) were found in 12.2% (16 sides), suprabullar frontal cells (SBFCs) in 20.3% (12 sides), and supraorbital ethmoid cells in 23.7% (14 sides). In contrast, the anterior side of the frontal recess cells, agger nasi cells, supra agger cells, and supra agger frontal cells remained at < 10.0%. Frontal septal cells persisted in 25.0% (5 sides). The presence of residual frontal recess cells was an independent risk factor for postoperative frontal sinus opacification as were well-recognized risk factors such as nasal polyps, the peripheral eosinophil count, and the CT score. Among residual frontal recess cells, SBCs and SBFCs were independent risk factors for opacification.

Conclusions

Residual frontal recess cells, especially SBCs and SBFCs, were independent risk factors for postoperative opacification of the frontal sinus. Complete surgical excision of frontal recess cells may improve surgical outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Van Alyea OE (1939) Ethmoid labyrinth: anatomic study, with consideration of the clinical significance of its structural characteristics. Arch Otolaryngol 29:881–902

    Article  Google Scholar 

  2. Lund VJ, Stammberger H, Fokkens WJ et al (2014) European position paper on the anatomical terminology of the internal nose and paranasal sinuses. Rhinol Suppl 24:1–34

    PubMed  Google Scholar 

  3. Wormald PJ, Hoseman W, Callejas C et al (2016) The International Frontal Sinus Anatomy Classification (IFAC) and Classification of the Extent of Endoscopic Frontal Sinus Surgery (EFSS). Int Forum Allergy Rhinol 6:677–696. https://doi.org/10.1002/alr.21738

    Article  PubMed  Google Scholar 

  4. Orlandi RR, Kennedy DW (2001) Revision endoscopic frontal sinus surgery. Otolaryngol Clin N Am 34:77–90. https://doi.org/10.1016/S0030-6665(05)70296-6

    Article  CAS  Google Scholar 

  5. Bassiouni A, Naidoo Y, Wormald PJ (2012) When FESS fails: The inflammatory load hypothesis in refractory chronic rhinosinusitis. Laryngoscope 122:460–466. https://doi.org/10.1002/lary.22461

    Article  PubMed  Google Scholar 

  6. Valdes CJ, Bogado M, Samaha M (2014) Causes of failure in endoscopic frontal sinus surgery in chronic rhinosinusitis patients. Int Forum Allergy Rhinol 4:502–506. https://doi.org/10.1002/alr.21307

    Article  PubMed  Google Scholar 

  7. Ramadan HH (1999) Surgical causes of failure in endoscopic sinus surgery. Laryngoscope 109:27–29. https://doi.org/10.1097/00005537-199901000-00006

    Article  PubMed  CAS  Google Scholar 

  8. Bradley DT, Kountakis SE (2004) The role of agger nasi air cells in patients requiring revision endoscopic frontal sinus surgery. Otolaryngol Head Neck Surg 131:525–527. https://doi.org/10.1016/j.otohns.2004.03.038

    Article  PubMed  Google Scholar 

  9. Musy PY, Kountakis SE (2004) Anatomic findings in patients undergoing revision endoscopic sinus surgery. Am J Otolaryngol 25:418–422. https://doi.org/10.1016/j.amjoto.2004.06.002

    Article  PubMed  Google Scholar 

  10. Otto KJ, DelGaudio JM (2010) Operative findings in the frontal recess at time of revision surgery. Am J Otolaryngol 31:175–180. https://doi.org/10.1016/j.amjoto.2008.12.006

    Article  PubMed  Google Scholar 

  11. Okushi T, Mori E, Nakayama T et al (2012) Impact of residual ethmoid cells on postoperative course after endoscopic sinus surgery for chronic rhinosinusitis. Auris Nasus Larynx 39:484–489. https://doi.org/10.1016/j.anl.2011.09.001

    Article  PubMed  Google Scholar 

  12. Asaka D, Nakayama T, Hama T et al (2011) Risk factors for complications of endoscopic sinus surgery for chronic rhinosinusitis. Am J Rhinol Allergy 26:61–64. https://doi.org/10.2500/ajra.2012.26.3711

    Article  Google Scholar 

  13. Fokkens WJ, Lund VJ, Mullol J et al (2012) European position paper on rhinosinusitis and nasal polyps 2012. Rhinol Suppl 23:3 (preceding table of contents 1–298)

    PubMed  Google Scholar 

  14. Orlandi RR, Kingdom TT, Hwang PH et al (2016) International consensus statement on allergy and rhinology: rhinosinusitis. Int Forum Allergy Rhinol 6(Suppl 1):S22–S209. https://doi.org/10.1002/alr.21695

    Article  PubMed  Google Scholar 

  15. Moriyama H (2001) Endoscopic modification of the Takahashi technique. In: Kennedy DW (ed) Diseases of the sinuses: diagnosis and management. B.C. Decker Inc, London, pp 235–244

    Google Scholar 

  16. Moriyama H (1991) The technique of endoscopic surgery and diagnosis of frontal recess and sinus disease under local anesthesia. J Otolaryngol 20:382–384

    PubMed  CAS  Google Scholar 

  17. Okushi T, Yoshikawa M, Otori N et al (2012) Evaluation of symptoms and QOL with calcium alginate versus chitin-coated gauze for middle meatus packing after endoscopic sinus surgery. Auris Nasus Larynx 39:31–37. https://doi.org/10.1016/j.anl.2011.02.008

    Article  PubMed  Google Scholar 

  18. Moriyama H, Yanagi K, Ohtori N, Fukami M (1995) Evaluation of endoscopic sinus surgery for chronic sinusitis: post-operative erythromycin therapy. Rhinology 33:166–170

    PubMed  CAS  Google Scholar 

  19. Kennedy DW, Kuhn FA, Hamilos DL et al (2005) Treatment of chronic rhinosinusitis with high-dose oral terbinafine: a double blind, placebo-controlled study. Laryngoscope 115:1793–1799. https://doi.org/10.1097/01.mlg.0000175683.81260.26

    Article  PubMed  CAS  Google Scholar 

  20. Okushi T, Nakayama T, Morimoto S et al (2013) A modified Lund-Mackay system for radiological evaluation of chronic rhinosinusitis. Auris Nasus Larynx 40:548–553. https://doi.org/10.1016/j.anl.2013.04.010

    Article  PubMed  Google Scholar 

  21. Goldstein GH, Kennedy DW (2013) Long-term successes of various sinus surgeries: a comprehensive analysis. Curr Allergy Asthma Rep 13:244–249. https://doi.org/10.1007/s11882-012-0336-6

    Article  PubMed  Google Scholar 

  22. Matsuwaki Y, Ookushi T, Asaka D et al (2008) Chronic rhinosinusitis: risk factors for the recurrence of chronic rhinosinusitis based on 5-year follow-up after endoscopic sinus surgery. Int Arch Allergy Immunol 146(Suppl 1):77–81. https://doi.org/10.1159/000126066

    Article  PubMed  Google Scholar 

  23. Nakayama T, Yoshikawa M, Asaka D et al (2011) Mucosal eosinophilia and recurrence of nasal polyps—new classification of chronic rhinosinusitis. Rhinology 49:3–396. https://doi.org/10.4193/Rhino10.261

    Article  Google Scholar 

  24. Tokunaga T, Sakashita M, Haruna T et al (2015) Novel scoring system and algorithm for classifying chronic rhinosinusitis: the JESREC Study. Allergy 70:995–1003. https://doi.org/10.1111/all.12644

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  25. Batra PS, Tong L, Citardi MJ (2013) Analysis of comorbidities and objective parameters in refractory chronic rhinosinusitis. Laryngoscope 123 Suppl 7:S1–S11. https://doi.org/10.1002/lary.24418

    Article  Google Scholar 

  26. Gregurić T, Trkulja V, Baudoin T et al (2017) Association between computed tomography findings and clinical symptoms in chronic rhinosinusitis with and without nasal polyps. Eur Arch Otorhinolaryngol 274:2165–2173. https://doi.org/10.1007/s00405-016-4446-y

    Article  PubMed  Google Scholar 

  27. Friedman M, Bliznikas D, Vidyasagar R et al (2006) Long-term results after endoscopic sinus surgery involving frontal recess dissection. Laryngoscope 116:573–579. https://doi.org/10.1097/01.MLG.0000202086.18206.C8

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Angela Morben, DVM, ELS, from Edanz Group (http://www.edanzediting.com/ac), for editing a draft of this manuscript.

Author information

Author notes

  1. Tsuguhisa Nakayama and Daiya Asaka contributed equally to this work.

Authors and Affiliations

  1. Department of Otorhinolaryngology, Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 108-8461, Japan

    Tsuguhisa Nakayama, Daiya Asaka, Akihito Kuboki, Tetsushi Okushi & Hiromi Kojima

Authors
  1. Tsuguhisa Nakayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daiya Asaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Akihito Kuboki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tetsushi Okushi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hiromi Kojima
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tsuguhisa Nakayama.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest relevant to this report.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nakayama, T., Asaka, D., Kuboki, A. et al. Impact of residual frontal recess cells on frontal sinusitis after endoscopic sinus surgery. Eur Arch Otorhinolaryngol 275, 1795–1801 (2018). https://doi.org/10.1007/s00405-018-5003-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-018-5003-7

Keywords

Search

Navigation