Endoscopic sinus surgery in previously irradiated patients

Purpose: Our purpose was to evaluate the safety and efficacy of endoscopic sinus surgery in irradiated patients with absolute indications for sinus su rgery. Patients and Methods: During 5 years at a tertiary referral center, more th an 200 patients received irradiation to a field that included the paranasal sinuses. Complaints related to the sinuses are common in such patients and often include crusting and increased mucus drainage. Six patients presente d with significant sinus infections in the absence of tumor recurrence and failed medical management. Additional problems included epiphora and nasal obstruction caused by cicatricial choanal stricture. Surgical interventions included ethmoidectomy, multiple osteotomies, debridement of scarred or de vitalized tissue, and dacryocystorhinostomy. Outcome measures included intr aoperative findings and complications, length of hospital stays, endoscopic assessments of the healing over 6 months postoperatively, and improvement or persistence of symptoms over 2 to 3 years of follow-up. Results: Surgery can be technically difficult because of derangements of no rmal anatomy and dehiscence of important structures. Although bleeding prob lems, prolonged admission, and delayed healing were noted in certain cases, they did not result in long-term morbidity. Conclusions: Endoscopic sinus surgery has become an invaluable tool in the treatment of refractory sinusitis. Our literature review has revealed no in formation, however, regarding endoscopic sinus surgery in previously irradi ated patients. Theoretically, such patients are at risk for healing problem s and anatomic derangements, which could lead to complications. There is, n evertheless, a theoretical benefit to avoiding external approaches in patie nts who might heal poorly.