Endoscopic sinus surgery in previously irradiated patients.
OBJECTIVE
Our purpose was to evaluate the safety and efficacy of endoscopic sinus surgery in irradiated patients with absolute indications for sinus surgery.


METHODS
During 5 years at a tertiary referral center, more than 200 patients received irradiation to a field that included the paranasal sinuses. Complaints related to the sinuses are common in such patients and often include crusting and increased mucus drainage. Six patients presented with significant sinus infections in the absence of tumor recurrence and failed medical management. Additional problems included epiphora and nasal obstruction caused by cicatricial choanal stricture. Surgical interventions included ethmoidectomy, multiple osteotomies, debridement of scarred or devitalized tissue, and dacryocystorhinostomy. Outcome measures included intraoperative findings and complications, length of hospital stays, endoscopic assessments of the healing over 6 months post-operatively, and improvement or persistence of symptoms over 2 to 3 years of follow-up.


RESULTS
Surgery can be technically difficult because of derangements of normal anatomy and dehiscence of important structures. Although bleeding problems, prolonged admission, and delayed healing were noted in certain cases, they did not result in long-term morbidity.


CONCLUSIONS
Endoscopic sinus surgery has become an invaluable tool in the treatment of refractory sinusitis. Our literature review has revealed no information, however, regarding endoscopic sinus surgery in previously irradiated patients. Theoretically, such patients are at risk for healing problems and anatomic derangements, which could lead to complications. There is, nevertheless, a theoretical benefit to avoiding external approaches in patients who might heal poorly.
Department of Otolaryngology, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, 1475 NW 12th Avenue, Suite 40037, Miami, FL 33136, USA.
F J
FJ
Civantos
A
A
Yoskovitch
R R
RR
Casiano
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010039:Otorhinolaryngologic Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D010256:Paranasal Sinuses / Q000473:pathology / Q000528:radiation effects* / Q000601:surgery*; D012852:Sinusitis / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents