Mucocele development after endoscopic sinus surgery for nasal polyposis: A long-term analysis

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From: Ear, Nose and Throat Journal(Vol. 97, Issue 9)
Publisher: Sage Publications, Inc.
Document Type: Report
Length: 3,570 words
Lexile Measure: 1570L

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Abstract

The aim of the present study was to determine the prevalence of long-term mucocele development after functional endoscopic sinus surgery (FESS) for nasal polyposis, to search for a statistical relationship with preoperative variables and to analyze the management of this complication. A retrospective analysis of 153 patients who underwent FESS for nasal polyposis, with a minimum of 7 years of follow-up, was performed. Mucocele diagnosis was based on regular clinical and radiologic evaluation. Univariate and multivariate statistical analysis was performed. The postoperative mucocele rate was 13.1% (20 patients). The mean delay between surgery and mucocele diagnosis was 6.25 years. A high preoperative Lund-Mackay score (>19) was a risk factor for postoperative mucocele (p = 0.04). Asthma and aspirin intolerance did not increase the risk of this complication. Endoscopic marsupialization of mucoceles was successful in 19 patients, with only one recurrent frontal mucocele. One patient required external approaches for two frontal mucoceles. In conclusion, mucocele risk after FESS for nasal polyposis is significant, especially in case of a high preoperative Lund-Mackay score (>19). Long-term clinical follow-up is recommended, imaging being prescribed based on symptoms or abnormal findings on clinical examination. Endoscopic marsupialization is very effective, but frontal mucoceles are more likely to recur.

Introduction

Functional endoscopic sinus surgery (FESS) is now widely accepted in the setting of medical treatment failure in patients with nasal polyposis. (1,2) Nevertheless, the extent of surgery is still debated, ranging from polypectomy to radical ethmoidectomy. (3) In our experience, FESS has shown to be effective to control nasal polyp recurrence with good functional results. (4) Although the incidence of major and minor immediate complications of FESS have been well documented, (5,6) only a few studies have documented long-term complications.

One of the most threatening scenarios after FESS is mucocele development because of the associated visual and neurologic risks. (7,9) This long-term complication can occur many years after surgery. (10,11) Sinus or ethmoid cell obstruction after mucosal trauma and mucosal inflammation have an important pathophysiologic role in mucocele formation; (12,14) therefore, patients who undergo FESS for nasal polyposis might be at higher risk of postoperative mucocele.

Based on a retrospective analysis of 153 patients who underwent FESS for nasal polyposis with a minimum follow-up of 7 years, we aimed to: (1) determine the prevalence of long-term mucocele development, (2) search for potential statistical relationships with various variables, and (3) analyze the management and ultimate outcome of this long-term complication.

Patients and methods

Diagnostic criteria and patient selection. Our retrospective study included 153 patients with nasal polyposis who had failed medical treatment (twice-daily washing of the nasal cavities with sterile saline solution, twice daily intranasal beclomethasone spray in each nasal cavity, and oral steroid administration [i.e., prednisone, 1 mg/kg body weight per day for a 6-day period]). These patients were consecutively managed with FESS by the same physician (P.B.) from 1991 to 2008. FESS was suggested to the patient if more than three systemic courses of prednisone per year had proved to be necessary to achieve a...

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Gale Document Number: GALE|A558921695