Top 10 reasons for endoscopic maxillary sinus surgery failure.
OBJECTIVE
Endoscopic sinus surgery has enjoyed impressive success curing chronic disease in sinuses and has virtually replaced the Caldwell-Luc procedure for correction of problems with the maxillary sinus. Unfortunately, a significant number of patients have persistent maxillary symptoms after one or more endoscopic sinus operations. Existing reviews of this issue have identified only a few general causes for surgical failure.


METHODS
The records of 85 patients presenting to the author over a 5-year period with persistent maxillary sinus symptoms were reviewed.


RESULTS
In reviewing the causes of persistent disease requiring revision surgery, the author identified 10 categories of reasons for failure to improve. Many patients have multiple causes that could be individually or sequentially identified. Some problems associated with surgical failure were likely present at the time of initial presentation, whereas others were undoubtedly caused by the first surgical procedure. Ten reasons for maxillary sinus surgical failure identified were clustered into the following categories: 1) obstructed natural ostia, 2) disease in the anterior ethmoid or frontal sinus, 3) resistant organisms, 4) intrasinus foreign body, 5) incurable mucosal disease, 6) noncompliant patient, 7) wrong primary diagnosis, 8) maxillary osteitis, 9) mucus maltransport, and 10) fundamental immunodeficiency.


CONCLUSIONS
A careful assessment of each patient with persistent maxillary sinus disease is central to understanding each specific patient and should include a careful history, a detailed endoscopic examination, repeat computed tomography imaging, culture of secretions, and possible revision surgery.
Richtsmeier
W J
WJ
Department of Otolaryngology-Head and Neck Surgery, Bassett Healthcare, Cooperstown, New York 13326, USA. william.richtsmeier@bassett.org
D004724:Endoscopy; D005547:Foreign Bodies; D006801:Humans; D008443:Maxillary Sinus / Q000601:surgery*; D008444:Maxillary Sinus Neoplasms / Q000601:surgery; D015523:Maxillary Sinusitis / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure