Literature Review: A Roundup of Important Recent Studies

Study design: Retrospective review of a nationwide database of endoscopic sinus surgery procedures. Major post-operative complications, including hemorrhage requiring blood transfusion, CSF leak and orbital injury, were analyzed by searching the database for ICD-9 and CPT codes.

Setting: Department of Otolaryngology, University of Colorado Anschutz Medical Campus, Aurora; Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California; Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City.

Synopsis: Data analyses of patients undergoing endoscopic sinus surgery, comprising 62,823 patients, were reviewed for the years 2003 to 2007. The overall major complication rate was found to be 1 percent. CSF leak was encountered in 0.17 percent; orbital injury in 0.07 percent; and hemorrhage requiring transfusion in 0.76 percent. Stratified for age, CSF leak was seen less frequently in the pediatric population, while orbital injury occurred more frequently in children younger than 12 years of age. Meaningful assessment of the impact of image guidance in reducing complications could not be achieved.

Bottom line: Major complications from endoscopic sinus surgery appear to have declined compared with even the best of earlier studies from the late 1990s. The most common complication is post-operative hemorrhage requiring transfusion, followed by CSF leak, then orbital injury—which together comprise fewer than 1 percent of total cases.

Reference: Ramakrishnan VR, Kingdom TT, Nayak JV, et al. Nationwide incidence of major complications in endoscopic sinus surgery. Int Forum Allergy Rhinol. 2012;2(1):34-39.

—Reviewed by Brent Senior, MD

First Review of Frontal Sinus Inverted Papilloma Surgical Management

What is the best surgical management of frontal sinus (FS) inverted papilloma (IP), according to a review of the literature?

Background: IP is a benign sinonasal tumor with an estimated incidence of 01.74/100,000 cases a year. Surgical resection is important due to IP’s aggressive nature, propensity for recurrence and potential to harbor squamous cell carcinoma. Between 1 and 16 percent of IPs originate in the frontal sinus. Management of FS IP remains a significant surgical challenge.

Study design: Literature review.

Setting: Department of Otolaryngology-Head and Neck Surgery, Comprehensive Skull Base Program and Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas.

Synopsis: In 11 studies, 49 cases were deemed adequate for analysis. The surgical approach to FS included endoscopic frontal sinusotomy (EFS) in 42.9 percent of patients, endoscopic modified Lothrop procedure in 20.4 percent, osteoplastic flap in 26.5 percent and EFS combined with other endoscopic approaches (above/below) in 10.2 percent. There was a high prevalence of secondary disease (51 percent) and frequent involvement of bilateral FSs (16.3 percent). The overall rate of recurrence was 22.4 percent, with no variables found to be statistically significant between recurrence and non-recurrence. The authors said the data in their study represent an aggregate of multiple studies from different surgeons, with inherent biases on the optimal management strategy for FS IP, which is therefore a limitation of this study.