FESS الگوهاي اصلي بيماري التهابي سينونازال در 77 مورد جراحي فونكسيونل اندوسكوپيك سينوس

The Major Patterns of Inflammatory Sino nasal Disease in 77 Cases of Functional Endoscopic Sinus Surgery (FESS)

In the two past decade Functional Endoscopic Sinus Surgery (FESS) has appeared as a relatively benign surgical technique for treatment of chronic recurrent sinusitis. Coronal sinus CT Scan is the best method for preoperative evaluation. Identifying the major patterns of inflammatory Sino nasal disease in CT scan is very helpful for planning the technique. These five major patterns are 1) infundibular, II) ostomeatal unit or OMU, III) sphenoethmoidal recess or SER, IV) Sino nasal polyposis or SNP and V) sporadic or unclassifiable. By identifying these patterns more tailored endoscopic sinus surgery is possible. In 77 Consecutive Patients (age: 12Y to 68 Y, mean 32Y) undergoing FESS for treatment of chronic inflammatory Sino nasal disease, coronal sinus CT scans reviewed for the major inflammatory patterns and anatomic variations may attribute to inflammatory disease. Infundibular pattern was identified in 11(14%), OMU pattern in 42(55%), SER pattern in 32(42%), SNP pattern in 16(21%) and sporadic or unclassifiable pattern in 10(13%). The OMU and SER patterns were seen simultaneously (pan sinusitis) in 25 (35%). Additional incidental Sino nasal anatomic variations were frequently encountered including some degree of nasal septal deviation in 45(59%) and concha bullosa in 32(42%). In patients with concha bullosa more severe patterns were seen with higher incidence. We found higher incidence of more severe patterns and higher incidence of anatomic variations specially septal deviation and concha bullosa in our study. Although our group was surgical but this seems not to be the only reason for dramatic high incidence of the most extensive inflammatory disease. This may perhapsbe due to delay in patients presentation in Iran.