title: Causes of failure in endoscopic frontal sinus surgery in chronic rhinosinusitis patients.
abstract: BACKGROUND
  The frontal sinus is the most challenging area to address in endoscopic sinus surgery (ESS). Incomplete surgery or iatrogenic injury in the narrow space of the frontal recess with synechia formation can lead to recurrence or persistence of disease. The goal of this study was to identify causes of failure of endoscopic frontal sinus surgery and to determine complication rates.
  
  
  METHODS
  A cross-sectional retrospective study was conducted. Charts and preoperative sinus computed tomography (CT) scans of patients who underwent revision frontal ESS for chronic frontal rhinosinusitis, between 2006 and 2012 were reviewed.
  
  
  RESULTS
  Of 829 patients who underwent ESS during the study period, 740 had the frontal recess dissected and frontal sinus opened. Of these, 66 patients had revision surgery of the frontal sinus, with a total of 109 frontal sinuses. The mean ± standard deviation (SD) age was 52 ± 12.9 years. Forty patients were male (59.1%). The most common findings were the following: edematous or hypertrophic mucosa (92.7%); retained agger nasi cell (73.4%); neo-osteogenesis within the frontal recess (45.9%); lateral scarring of the middle turbinate (47.7%); residual anterior ethmoid air cell (32.1.%); and residual frontal cells (24.8%).
  
  
  CONCLUSIONS
  With the exception of mucosal disease and neo-osteogenesis, all identified causes of failure of frontal sinus surgery are a result of surgical technique. Careful preoperative planning and meticulous and complete surgical execution are therefore critical for a successful surgical outcome in primary frontal sinus surgery.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Hospital del Salvador, Universidad de Chile, Santiago, Chile.
authors.forename: Constanza J
authors.initials: CJ
authors.lastname: Valdes
authors.forename: Mariana
authors.initials: M
authors.lastname: Bogado
authors.forename: Mark
authors.initials: M
authors.lastname: Samaha
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D002921:Cicatrix / Q000209:etiology*; D003430:Cross-Sectional Studies; D004724:Endoscopy / Q000009:adverse effects*; D005260:Female; D005626:Frontal Sinus / Q000601:surgery*; D006801:Humans; D006984:Hypertrophy; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000473:pathology / Q000601:surgery*; D010012:Osteogenesis; D011183:Postoperative Complications; D012189:Retrospective Studies; D012220:Rhinitis / Q000601:surgery*; D012852:Sinusitis / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure
keywords: chronic rhinosinusitis; endoscopic sinus surgery; frontal sinus surgery; recalcitrant frontal sinusitis; revision surgery