Functional Endoscopic Sinus Surgery Research Articles

Ciliary Functional Analysis in Chronic Rhinosinusitis with Polyps after Multimodal Intervention: Oral Corticosteroid, Functional Endoscopic Sinus Surgery, and Omalizumab Injection

Ciliary Functional Analysis in Chronic Rhinosinusitis with Polyps after Multimodal Intervention: Oral Corticosteroid, Functional Endoscopic Sinus Surgery, and Omalizumab Injection

Hand Motion Analysis Using Accelerometer-Based Sensors and Sheep’s Head Model for Basic Training in Functional Endoscopic Sinus Surgery

Hand Motion Analysis Using Accelerometer-Based Sensors and Sheep’s Head Model for Basic Training in Functional Endoscopic Sinus Surgery

LARGE INTRACEREBRAL HEMORRHAGE SECONDARY TO FUNCTIONAL ENDOSCOPIC SINUS SURGERY: RISKS IN APPROACHING ANTERIOR SKULL BASE

Rationale/objectiveThis is a rare case of a 54-years-old man affected by chronic erosive sinusitis who developed a large frontal intracerebral hemorrhage after functional endoscopic sinus surgery (FESS). The patient underwent urgent surgical hemorrhage evacuation and anterior skull-base bone defect repair. MethodsWe analyzed the possible causes of this complication following FEES, focusing on anterior skull base bone erosion by chronic sinusitis, anterior ethmoidal artery injury and/or aneurysm, and direct frontal lobe trauma. ResultsThe neurological outcome was good, and at three months follow-up, the patient showed only minor cognitive deficit and no cerebrospinal fluid leak. ConclusionDuring FESS, anatomical bone alteration of the anterior skull base such as in patients affected by chronic sinusitis, may increase the risk of severe complications such as intracerebral hemorrhage. A careful preoperative evaluation is mandatory.

Hyperuricemia Increases the Risk of Postoperative Recurrence in Chinese Patients with Chronic Rhinosinusitis.

Elevated serum uric acid is crucial in the pathophysiology of chronic inflammatory diseases. However, its impact on chronic rhinosinusitis (CRS) recurrence risk is unknown. This study investigates the association between elevated serum uric acid and the risk of CRS recurrence. A retrospective cohort study was conducted on 1004 CRS patients (including 638 males and 366 females) who received functional endoscopic sinus surgery. All patients were followed up for more than 2 years, and categorized into subgroups based on phenotype, gender, and postoperative recurrence. Cox regression analysis was performed to evaluate the associations between serum uric acid and the risk of CRS recurrence. After categorization, 104 males had hyperuricemia, and 54 females presented hyperuricemia. The rate of recurrent CRS in the hyperuricemia group was significantly higher compared to the non-hyperuricemia group in both males and females (P<0.05). In both male and female patients, the rate of hyperuricemia and uric acid levels were elevated in the recurrent CRS group in comparison with the non-recurrent CRS group (P<0.05). Unadjusted and adjusted Cox regression analysis demonstrated that serum uric acid was an independent risk factor for CRS recurrence (P<0.05). The receiver operator characteristic curve showed that serum uric acid was a potential biomarker for predicting the recurrence of CRS and its phenotypes in both genders (P<0.05). There is a close relationship between elevated serum uric acid and the recurrence risk of CRS and its phenotypes, suggesting that serum uric acid may be a novel biomarker for predicting recurrent CRS.

Microdebrider Assisted Endoscopic versus Conventional Sinus Surgery in Sinonasal Polyposis: A Comparative Study

For sinonasal polyposis, functional endoscopic sinus surgery or conventional is the standard surgical approach. Microdebrider assisted endoscopic sinus surgery provides patients with a better therapeutic approach. Objective: To assess and compare intraoperative, loss of smell, synechiae formation and polyp recurrence between microdebrider and conventional method in nasal polyposis patients. Methods: Cohort Study was carried out in Department of Ear Nose Throat, Shaikh Zayed Hospital, Lahore, 2022-2023. A total of sixty individuals with sinonasal polyposis, presenting in both genders, were included. Once written consent was obtained, the patient's comprehensive demographics were documented. Every patient was split evenly into two groups. Thirty patients each from Group A and Group B underwent endoscopic sinus surgery using traditional endoscopic tools and microdebrider respectively. Results were compared between the two groups in terms of synechiae production, length of operation, postoperative crusting, loss of smell, and intraoperative blood loss. Results: Age and gender differences between the two groups were not statistically significant (p-value &gt;0.05). Regarding synechiae and loss of scent, there was no discernible difference between the two groups. Conclusions: The endoscopic sinus surgery with microdebrider was more effective for sinonasal polyposis as compared to conventional procedure

The value of combined detection of specific immunoglobulin E, interleukin-6 and regulatory T cells in predicting the risk of postoperative recurrence in patients with eosinophilic chronic rhinosinusitis and nasal polyps

Background: To investigate the predictive value of specific immunoglobulin E (sIgE), interleukin-6 (IL-6) and regulatory T cells (Treg) on the risk of postoperative recurrence in patients with eosinophilic chronic sinusitis with nasal polyps (EcRswNP). Methods: A total of 198 patients with EcRswNP collected to our Hospital from January 2019 to December 2021 were selected as the research subjects. All patients underwent functional endoscopic sinus surgery. The patients were selected to recurrence group (RG, n = 48) and non-recurrence group (NRG, n = 150) on the basis of the recurrence after 1 year of follow-up. The related factors of postoperative recurrence of EcRswNP were analyzed.. The ROC was used to analyze the dangerous of sIgE, IL-6 and Treg in predicting postoperative recurrence of EcRswNP patients. Results: The proportion of asthma patients, nasal congestion VAS score and peripheral blood Eos% content in the RG were exceed than the NRG, and the Organization Neu % and peripheral blood Neu% levels were less than those in the NRGp (P all &lt; 0.05). The serum sIgE and serum IL-6 in the RG were exceed than the NRG, and the level of peripheral blood Treg was less than the NRG (P &lt; 0.05). Logistic regression analysis showed that high levels of serum sIgE, serum IL-6 and low Treg levels were risk factors for postoperative recurrence (P &lt; 0.05). ROC showed that the AUC of peripheral blood sIgE level, IL-6 and Treg levels alone in predicting the dangerous of postoperative recurrence in patients with EcRswNP were 0.786, 0.707 and 0.636, respectively (all P &lt; 0.05); The AUC of combined prediction of peripheral blood sIgE, IL-6 and Treg levels for postoperative recurrence dangerous in patients with EcRswNP was 0.973, indicating that the efficacy of jointed prediction was exceed than that of single prediction (P &lt; 0.05). Conclusions: The high levels of sIgE, IL6 and low Treg levels in patients with EcRswNP before operation will increase the risk of postoperative recurrence, which is a risk factor affecting postoperative recurrence, and the three indicators have good predictive value for predicting postoperative recurrence in patients with EcRswNP, and the combination of the three indicators has better value in predicting postoperative recurrence.

Development and validation of a nomogram for predicting poor operative visibility during FESS in Chinese adult patients with CRS.

The purpose of this study is to develop and evaluate a nomogram that is capable of predicting poor operative visibility during functional endoscopic sinus surgery. To identify potential risk factors, patients with chronic rhinosinusitis who underwent functional endoscopic sinus surgery (FESS) between January 2019 and December 2022 were selected from our hospital's electronic medical record system. Data on general patient information, clinical manifestations, clotting-related test indices, Lund-Machay score of sinuses CT scanning, Lund-kennedy score of nasal endoscopies, anesthesia methods, intraoperative blood pressure and heart rate, and Boezaart bleeding score were collected. Minimum absolute convergence and selection operator (LASSO) regression, as well as multivariate logistic regression, were used to determine the risk factors. A nomogram was developed in order to predict poor operating visibility during FESS, and its performance was evaluated utilizing both the training and verification datasets via various measures including receiver operating characteristic (ROC) curve analysis, area under the curve (AUC), Hosmer-Lemeshow goodness-of-fit test, calibration curve, and decision curve analysis. Of the 369 patients who met the inclusion criteria, 88 of them exhibited POV during FESS. By deploying LASSO and multivariate logistic regression analyses, six risk factors were identified and used to construct a nomogram for predicting POV during FESS. These factors include prothrombin time (PT), prothrombin activity (PTA), Lund-Mackay score (LMS), Lund-Kennedy score (LKS), anesthetic method, and intraoperative hypertension. The AUC of the training set was found to be 0.820 while that of the verification set was 0.852. The Hosmer-Lemeshow goodness-of-fit test and calibration curve analysis revealed good consistency between predicted and actual probabilities. Also, the decision curve demonstrated that the nomogram had a high degree of clinical usefulness and net benefit. The constructed nomogram has a strong ability to predict the poor intraoperative field in patients with chronic rhinosinusitis, which can help preoperative judgment of high-risk patients and provide evidence for perioperative management and preoperative plan formulation.

Clinical Outcomes of Severe Rhinosinusitis Complicated with Cavernous Sinus Syndrome.

Background: Various diseases involving the cavernous sinus can cause a condition called cavernous sinus syndrome (CSS), which is characterized by ophthalmoplegia or sensory deficits over the face resulting from the compression effect of internal structure. While tumor compression is the most reported cause of CSS, statistical data on CSS caused by infections are limited. Its risk factors, treatment methods, and clinical outcomes are not well-documented. Methods: In this retrospective study, we reviewed the data of patients admitted to a tertiary medical center from 2015 to 2022 with a diagnosis of acute and chronic sinusitis and at least one diagnostic code for CSS symptoms. We manually reviewed whether patients were involved in two or more of the following cranial nerves (CN): CN III, CN IV, CN V, or CN VI, or at least one of these nerves with a neuroimaging-confirmed lesion in the cavernous sinus. Results: Nine patients were diagnosed with rhinosinusitis-related CSS. The most common comorbidity was type 2 diabetes, and the most common clinical manifestations were diplopia and blurred vision. The sphenoid sinus was the most affected sinus. One patient expired due to a severe brain abscess infection without surgery. The remaining patients underwent functional endoscopic sinus surgery, and 50% of the pathology reports indicated fungal infections. Staphylococcus spp. was the most cultured bacteria, and Amoxycillin/Clavulanate was the most used antibiotic. Only four patients had total recovery during the follow-up one year later. Conclusions: CSS is a rare but serious complication of rhinosinusitis. Patients with diabetes and the elderly may be at a higher risk for this complication. Even after treatment, some patients may still have neurological symptoms.

Outcome of Post Functional Endoscopic Sinus Surgery Nasal Irrigation with Normal Saline Versus Normal Saline with Budesonide in Patients with Sinonasal Polyposis: A Randomized Control Trial

Outcome of Post Functional Endoscopic Sinus Surgery Nasal Irrigation with Normal Saline Versus Normal Saline with Budesonide in Patients with Sinonasal Polyposis: A Randomized Control Trial

Camera sheath with transformable head for minimally invasive surgical instruments

Introduction This paper presents a camera sheath that can be assembled to various minimally invasive surgical instruments and provide the localized view of the instrument tip. Material and methods The advanced transformable head structure (ATHS) that overcomes the trade-off between the camera resolution and the instrument size is designed for the sheath. Design solutions to maintain the alignment between the camera’s line of sight and the instrument tip direction during the transformation of the ATHS are derived and applied to the prototype of the sheath. Results The design solution ensured proper alignment between the line of sight and the tip direction. The prototype was used with the curved micro-debrider blades in simulated functional endoscopic sinus surgery (FESS). Deep regions of the sinus that were not observable with the conventional endoscopes was accessed and observed using the prototype. Conclusions The presented camera sheath allows the delivery of the instrument and camera to the surgical site with minimal increase in port size. It may be applied to various surgeries to reduce invasiveness and provide additional visual information to the surgeons.

CORRELATION OF CLINICAL SYMPTOMS AND COMPUTER TOMOGRAPHY SCAN FINDINGS WITH HISTOPATHOLOGY IN PATIENTS WITH CHRONIC RHINOSINUSITIS

Objectives: To determine the correlation between clinical symptoms, computer tomography scan (CT-scan), and histopathologic findings of chronic rhinosinusitis (CRS). Methods: A prospective, case-by-case study on 33 patients with CRS who were diagnosed and treated by functional endoscopic sinus surgery at the Department of Otolaryngology, Military Hospital 103 from January 2022 to August 2022. Results: There was an inverse correlation between sex and the number of Eosinophil cells/HPF cells, with p &lt; 0.05; a moderate correlation between the SNOT-20 score and HPF cells (r = 0.4) and the degree of inflammation (r = 0.39), with p &lt; 0.05; a moderate correlation between sneezing symptoms and smell disorders with HPF cells, r = 0.33 and r = 0.39 (p &lt; 0.05); a low or moderate correlation between other functional symptoms and histopathological indicators (p &lt; 0.05); a moderate correlation between the Lund-Kennedy score and the inflammation of the mucosa with r = 0.47, p &lt; 0.05; a correlation between the degree of nasal polyps and histological indicators, but not statistically significant p &gt; 0.05; a correlation between the average level of Lund-Mackay score and the degree of inflammation (r = 0.35), p &lt; 0.05. Lund-Mackay score is positively correlated with HPF cells and negatively correlated with epithelial layer thickness, but not statistically significant p &lt; 0.05. Conclusion: Mucosal eosinophilia moderately correlates with signs, but there was no correlation with the Lund-Kennedy score or Lund-Mackay score. Levels of inflammation are moderately correlated with objective disease severity as clinical symptoms, Lund-Kennedy score, and Lund-Mackay score.

Ultrasound Guided Maxillary Nerve Block for Perioperative Pain Management for Patients Undergoing Endoscopic Sinus Surgery: Randomized Control Trial

Background: Proper perioperative pain management remains a cornerstone of well-conducted functional endoscopic sinus surgery (FESS). In such a context, proper pain management entails the adequate provision of prolonged postoperative analgesia, the avoidance of overusing opioids, and consequently limiting their unwanted side effects. Objectives: We aimed to evaluate the effect of bilateral ultrasound-guided suprazygomatic maxillary nerve block (MNB) on postoperative pain in patients undergoing FESS. Methods: Patients eligible for FESS were randomized into two groups: the MNB group (n = 30), who underwent bilateral ultrasound-guided suprazygomatic maxillary nerve block after induction of anesthesia, and a control group (n = 30), who received multimodal analgesia, including opioids. Postoperatively, patients were observed for 48 hours. Pain scores were evaluated upon arrival to the sPACU and at 2, 6, 12, 24, 36, and 48 hours postoperatively, particularly at the time of removal of the hemostatic agent after 36 hours postoperatively. Total rescue analgesia, postoperative complications (including nausea and vomiting [PONV], hypotension, bradycardia, headache), and patient satisfaction were also diligently recorded. Results: Sixty patients who were candidates and underwent FESS surgery were enrolled randomly in both groups. The NRS pain score in the MNB group was significantly lower than that of the control group (P &lt; 0.001), especially the NRS during the removal of the hemostatic agent at T10 was significantly lower in the MNB group (P &lt; 0.001). However, at the 24 - hour point post-surgery, there were no significant differences between both groups (P = 0.568). Total rescue analgesia required was significantly lower in the MNB group compared with the control group (P &lt; 0.001) throughout the first 48 hours postoperatively. The percentage of patients with no postoperative complications (nausea, vomiting, and headache) was higher in the MNB group (76.7 %) compared with the control group (40 %). Patient satisfaction was statistically significantly higher in the MNB group (P &lt; 0.001). Conclusions: Bilateral ultrasound-guided suprazygomatic MNB appeared to be safe and advantageous, as its use was associated with a decrease in total analgesic consumption, a reduction in postoperative morbidities such as pain, nausea, and vomiting, and greater patient satisfaction.

Evaluation of Effectiveness of Sinus Surgery in Chronic Rhinosinusitis Patients using Sinonasal Outcome Index-22, modified Lund Mackay Score and Rhinosinusitis Disability Index

Functional endoscopic sinus surgery (FESS) is done in patients with chronic rhinosinusitis (CRS) not responding to medical therapy. This study aims to evaluate the subjective, objective and overall quality of life improvement in CRS patients following FESS surgery. Sinonasal outcome index-22, modified Lund-Mackay score and Rhinosinusitis Disability Index were used to evaluate subjective, objective and overall quality of life in patients with CRS. The questionnaires were asked before the surgery and three months after surgery. A total of 110 patients were enrolled in the study. All three types of evaluation showed improvement following FESS surgery. FESS in CRS patients refractory to medical management caused significant improvement in symptom intensity, endoscopic score and overall quality of life.

Bilateral antrochoanal polyp: a rare entity

Antrochoanal polyps (ACPs) are benign polyps that arises from inflamed and edematous mucosa of maxillary antrum. They arise most commonly from posterior wall of maxillary sinus. They occur more commonly in children and young adults without any sex predilection. The etiopathogenesis of ACPs is not clear but chronic sinusitis and allergy have been implicated. Patient usually present with nasal obstruction, may also have symptoms of epistaxis, rhinorrhoea, foreign body sensation. The diagnosis of the disease is done based on endoscopic examination of nasal cavities, computed tomography (CT) scan findings, and histopathologic results. ACPs are usually unilateral but can be bilateral in extremely rare cases. Based on adequate history and clinico-radiological examination misdiagnosis can be avoided which may lead to no improvement of symptoms and mandating revision surgery. Treatment of ACPs is always surgical. Functional endoscopic sinus surgery (FESS) and powered instrumentation during FESS is safe and effective method. Treating surgeon should focus on detecting the exact origin and extent of polyp to prevent recurrence. We herein presented extremely rare case of bilateral ACP in a 46 years female.

Real-Life Study of Patient Preference for Dupilumab or Revision Surgery for Recurrent Chronic Rhinosinusitis with Nasal Polyps.

(1) Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) has a high rate of recurrence in patients, despite therapy with local corticosteroids and functional endoscopic sinus surgery. Dupilumab, a recombinant monoclonal human IgG4 antibody directed against the IL-4 receptor α that inhibits both IL-4 and IL-13 signal transduction, is available for symptomatic therapy. Patient preference between repeated surgery and injection therapy with Dupilumab is not known. (2) Methods: Patients who had experienced at least one surgical intervention for nasal polyps and were treated with Dupilumab for at least 3 months completed a retrospective patient questionnaire. (3) Results: In a cohort of 75 previously operated CRSwNP patients, 91.5% preferred therapy with Dupilumab to repeated surgery for nasal polyps. Preference for Dupilumab in the subgroups of patients with concomitant Non-steroidal Anti-inflammatory Drugs Exacerbated Respiratory Disease (N-ERD) (n = 32), patients with concomitant asthma (n = 25), and patients without concomitant disease (n = 18) was 100%, 96%, and 72%, respectively. (4) Conclusions: Patient preference for Dupilumab over repeat surgery is strongest in previously operated CRSwNP patients with concomitant asthma or N-ERD, but remains very high in patients without concomitant disease.

A comparative study between the effect of intravenous versus intranasal dripping of dexmedetomidine on intraoperative blood loss during functional endoscopic nasal sinus surgery

ABSTRACT Background Functional endoscopic sinus surgery (FESS) is considered one of the most common ENT procedures. The main obstacle is impaired vision owing to excessive bleeding. Many drugs have been used to control such issues. Dexmedetomidine has a great affinity to α2-adrenergic receptors. This research evaluated the hypotensive effect of intravenous against the intranasal dexmedetomidine in FESS. Materials and methods Patients randomized into 2 equal groups:Dexmedetomidine intravenous group (IV group) (n = 35): IV dexmedetomidine 1 μg/kg in 100 ml of normal saline (0.9%) was infused 15 min before starting anesthesia, followed by 0.5 μg/kg/h. At the same time, intranasal saline was given as a placebo.Dexmedetomidine intranasal group (IN group) (n = 35):IN dexmedetomidine (2 μg/kg) was given 15 min before induction, 1 ml in each nostril. At the same time, the patient received 100 ml of saline (0.9%)15 min before anesthesia, followed by IV saline as a placebo. The primary outcome was Boezaart’s grading scale. Other outcomes were the recorded hemodynamics, surgical satisfaction, sedation score, and adverse events. Results The calculated blood loss and Boezaart’s scale were lower in the IV group (p value < 0.001). Also, the IV group’s mean arterial blood pressure (MAP) and heart rate were significantly lower. The total intraoperative fentanyl dose was lower in the IV group. Surgeon satisfaction and sedation scores were significantly higher in the IV group. Conclusions Intravenous dexmedetomidine provides a better surgical field, more surgeon satisfaction, and lower blood loss for FESS.

Evaluating the efficacy of nasal irrigation in postoperative functional endoscopic sinus surgery patients: a systematic review and meta-analysis.

Functional endoscopic sinus surgery (FESS) is a mainstay surgical intervention for chronic rhinosinusitis with nasal polyposis (CRSwNP). Nasal irrigation, particularly with normal saline, is a widely recommended postoperative care modality. This systematic review and meta-analysis aimed to assess the efficacy of various nasal irrigation solutions in postoperative FESS patients. A comprehensive search was conducted in multiple databases for randomized controlled trials investigating normal saline and various substances for nasal irrigation post-FESS. The systematic review followed PRISMA guidelines, and the meta-analysis used R software for data synthesis. Outcome measures included SNOT-22 and LKES scores. The Cochrane tool was employed to evaluate the potential for bias. Results from 14 studies, focusing on six each for SNOT-22 and LKES, revealed a significant reduction in symptoms and endoscopic scores with various solutions compared to normal saline. The meta-analysis using the random-effects model indicated a negative standardized mean difference (SMD) of - 0.69(95% CI [- 1.64; 0.27], p = 0.157) for symptoms and endoscopic scores (SMD = - 0.48, 95% CI [- 1.32; 0.36], z = - 1.12, p = 0.264). Subgroup analyses highlighted budesonide's efficacy over normal saline, but substantial heterogeneity and potential publication bias were noted. Nasal irrigation with various solutions postoperative FESS patients demonstrated significant improvements in patient-reported symptoms and endoscopic scores compared to normal saline. Budesonide appeared particularly effective. However, high heterogeneity and potential publication bias warrant cautious interpretation. Standardized outcome measures and further research are needed to strengthen the evidence.

Comparison of dexmedetomidine and propofol infusion on intraoperative haemodynamics during functional endoscopic sinus surgery under general anaesthesia- A randomized controlled trial

Functional endoscopic sinus surgery (FESS) is a surgical technique to treat sinonasal diseases. Intraoperative bleeding is one of the major challenges, which hinder the confined area of visibility and prolongs the procedure. Intraoperative induced hypotension can reduce intraoperative bleeding, to provide clear surgical field for dissection and hence decreasing operative time. So, we compared effect of dexmedetomidine and propofol infusion on the intraoperative haemodynamics during functional endoscopic sinus surgery (FESS). To study the effect of intravenous (IV) dexmedetomidine and propofol infusion on intraoperative haemodynamics under general anaesthesia in functional endoscopic sinus surgery(FESS). Secondary aim was to study estimated blood loss if any. To study the effect of I.V. dexmedetomidine and propofol infusion on intraoperative haemodynamics under general anaesthesia in functional endoscopic sinus surgery (FESS). Patients were divided randomly by sealed envelope method into two groups with 30 patients in each group. Group D patients received dexmedetomidine 1ug/kg as a loading dose over 20 minutes followed by 0.3 ug/kg/hr infusion for maintainence. Group P patients received propofol 2mg/kg as a loading dose followed by 100-200 ug/kg/min infusion for maintenance. The findings in our study highlights that dexmedetomidine infusion decreases haemodynamic parameters like arterial blood pressure and heart rate more as compared to propofol infusion during FESS. The effect on hemodynamics sustained and consistent without requirement of additional hypotensive agents. So altogether, this lead to better surgical field. Use of dexmedetomidine is a safe and effective method to control bleeding and improve the quality of surgical field and intraoperative haemodynamics.

Comparison between Manuka Honey and Baby Shampoo Nasal Douching Procedures After Functional Endoscopic Sinus Surgery: a Prospective Comparative

Comparison between Manuka Honey and Baby Shampoo Nasal Douching Procedures After Functional Endoscopic Sinus Surgery: a Prospective Comparative

Evaluation of lamina papyracea dehiscence with paranasal computed tomography.

The lamina papyracea is the thin line between the ethmoid sinus and the medial orbital wall. Knowledge of the presence of the lamina papyracea dehiscence (LPD) bears critical importance to prevent misdiagnosis of fractures at this level and to define the anatomy before sinonasal surgery, including Functional Endoscopic Sinus Surgery (FESS). The present study is therefore intended to determine the incidence of LPD in paranasal computed tomography, to identify its imaging characteristics in CT, and to compare with the literature. The current study included patients who underwent paranasal CT scanning for any reason in our clinic between January 2018 and January 2022. Patients were evaluated in terms of age, gender, and presence of LPD. Patients with dehiscence were evaluated in terms of age, gender, dehiscence localization (right, left), tissue at the level of dehiscence, dehiscence size, and dehiscence grade. 1000 patients with a mean age of 32. ± 16.3 (min = 18-max = 79) were included in the study. 20 patients (2%) were found to have LPD. Of those with LPD, 14 (70%) were grade 1, 4 (20%) were grade 2 and 2 (10%) were grade 3. Again of those with LPD, 14 (70%) had LPD localized on the right and 6 (30%) had LPD on the left. In 12 (60%) of the patients with LPD, herniated tissue was detected. Among these patients with herniation, fatty tissue herniation was observed in 10 (83.3%) and medial rectus muscle herniation was observed in 2 (16.7%). Comprehensive evaluation for and identification of LPD are very important before possible sinus surgery.