Systematic Review to Improve FESS Outcomes in Cystic Fibrosis Patients

Abstract

Objective: 1) Review the literature for intraoperative techniques and postoperative practices after functional endoscopy sinus surgery (FESS) that may improve outcomes in patients with cystic fibrosis (CF). Method: A systematic review of the literature was performed. PubMed was searched from 1970-2011 using the terms “sinus surgery” and “cystic fibrosis” with papers limited to English. Abstracts were reviewed to identify relevant original and review manuscripts. Bibliographies of review articles were examined to identify additional manuscripts. Results: The initial PubMed search identified 183 articles. After reviewing the abstracts, selected studies were examined in detail and the bibliographies of review articles checked to identify any additional articles. Intraoperative techniques included medial maxillectomy, image guidance, and intraoperative antibiotic irrigation. Postoperative management included nasal saline irrigation, dornase alfa inhalation, and serial antibiotic lavage. Most studies were limited to case reviews with relatively small numbers of patients. Very few randomized controlled studies were identified. Conclusion: Despite the prevalence of recurrent sinonasal disease after FESS in CF patients, sparse Level I data exists to support perioperative techniques that improve outcomes in this population. Most recommendations are based on small case series. Multicenter studies to evaluate perioperative strategies that improve FESS outcomes in CF patients are warranted.