Management of recurrent sinus disease in children with cystic fibrosis: A combined approach

Abstract

Objective To determine whether a combined approach consisting of functional endoscopic sinus surgery (FESS), Caldwell-Luc operation, and medial maxillectomy is beneficial for children with cystic fibrosis (CF) with refractory sinonasal disease previously treated with endoscopic procedures alone. Study Design Retrospective review and comparison of outcomes of CA and FESS alone for each CF patient. Outcomes measured: sinonasal symptoms, endoscopic findings, number of hospitalizations, antibiotic courses, and forced expiratory volume in 1 second (FEV1). Setting Referral hospital. Results Fifteen children underwent CA between 1996 and 2000 (7 males, 8 females; 13.8 years mean age; 42 months average follow-up period). Significant decrease in number of hospitalizations and intravenous antibiotic courses, with increased mean FEV1 (from 70.2% preoperation to 89.3% postoperation, P <0.0001) were found. Marked clinical improvement persisted for several years. Conclusion Applying the CA after multiple failed endoscopic procedures in CF patients reduced morbidity and resulted in successful management of sinonasal disease. CA is suggested after multiple failed endoscopic procedures. Further studies of CA as a first-line procedure for difficult sinus cases in children with CF is recommended. EBM rating: C-4