Failures in endoscopic surgery of the maxillary sinus.
OBJECTIVE
To assess the prognostic factors of recurrence after endoscopic sinus surgery for maxillary chronic rhinosinusitis without nasal polyps.


METHODS
Prospective.


METHODS
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).


CONCLUSIONS
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.
Albu
Silviu
S
Department of Otolaryngology, University of Medicine and Pharmacy Cluj-Napoca, Str Republicii nr 18, 3400 Cluj-Napoca, Romania. profdralbu@gmail.com
Baciut
Mihaela
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016001:Confidence Intervals; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006784:Hospitals, Teaching; D006801:Humans; D053208:Kaplan-Meier Estimate; D007828:Laryngoscopy / Q000379:methods; D008297:Male; D008443:Maxillary Sinus / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D016017:Odds Ratio; D019647:Oral Surgical Procedures / Q000379:methods; D009957:Oroantral Fistula / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012220:Rhinitis / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D012307:Risk Factors; D055502:Secondary Prevention; D012720:Severity of Illness Index; D012852:Sinusitis / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D017211:Treatment Failure