Sphenoidotomy kinetics in patients with chronic rhinosinusitis without nasal polyps.

Abstract

SUMMARYObjectiveStenosed sphenoid sinus ostia are among the most common findings in revision endoscopic sinus surgery. This study sought to identify the optimal intraoperative sphenoidotomy size for prevention of postoperative stenosis.Methods32 patients affected by chronic rhinosinusitis not associated with nasal polyps (CRSsNP) underwent 52 sphenoidotomies. Sphenoidotomy size was assessed using a ruler intraoperatively and at the first, third and sixth months postoperatively. Ostia sizes, SNOT-22 questionnaire findings, episodes of recurrent sinusitis and need for revision surgery were recorded.ResultsAll sphenoidotomies exhibited a significant size reduction (mean 43.4 ± 6.8%) at the first month postoperatively, with a tendency to enlarge at 3 months and stabilise at 6 months. Ostia larger than 61.3 mm2 did not exhibit stenoses postoperatively. Stenosis was observed in 11 sphenoidotomies (21.2%); however, only five presented with recurrent symptoms (9.6%), while three required revision sphenoid surgery (5.8%).ConclusionsSphenoidotomy size significantly reduced during the first postoperative month and then stabilised. A baseline sphenoidotomy size of 61.3 mm2 at the time of the operation seemed sufficient to prevent ostium stenosis. Half of stenosed ostia presented with recurrent symptoms.