title: Office surgery for paranasal sinus recirculation.
abstract: BACKGROUND
  Circular flow of mucus between adjacent openings of a single paranasal sinus is known as recirculation, and can cause persistent sinonasal symptoms. Removing the bridging tissues allows the surgical ostium to connect to the natural ostium. This procedure prevents the circular flow between the 2 ostia, and allows the mucociliary system to provide for physiologic drainage of the sinuses. Traditionally this has taken place in the operating room; however, performing this procedure in the office is possible, even when there is significant intervening bone. Here we report a series patients with recirculation successfully treated in the office.
  
  
  METHODS
  A prospective study of 10 patients endoscopically diagnosed with recirculation, 9 involving the maxillary sinus and 1 involving the sphenoid. Symptoms included facial pressure, mucus stasis, congestion, and recurrent sinusitis. All patients had previous sinus surgery. All patients were treated in the office under topical ± local anesthesia. The bridging tissues between ostia were removed, 6 of which consisted of mucosal bands within the middle meatus, 1 with mucosa and intervening bone within the middle meatus, 2 with mucosa and inferior turbinate bone between ostia in the inferior and middle meatus, and 1 involving bone of the face of the sphenoid sinus.
  
  
  RESULTS
  All 10 patients had significant improvement or resolution of the symptoms associated with recirculation, with no further endoscopic evidence of mucus recirculation.
  
  
  CONCLUSIONS
  This case series demonstrates that mucus recirculation can be successfully treated in the office setting, even across bony structures. This leads to significant savings to the healthcare system and less missed work/school compared to an operating room procedure.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Emory Sinus, Nasal, and Allergy Center, Emory University Hospital Midtown, Atlanta, GA.
authors.forename: John M
authors.initials: JM
authors.lastname: DelGaudio
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Ochsner
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008443:Maxillary Sinus / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D009079:Mucociliary Clearance / Q000502:physiology; D009093:Mucus / Q000502:physiology*; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D012852:Sinusitis / Q000503:physiopathology / Q000601:surgery*; D013101:Sphenoid Sinus / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult
keywords: Sinus recirculation; chronic sinusitis; mucus recirculation; office sinus surgery; recirculation; sinus surgery