Department of Otorhinolaryngology - Head and Neck Surgery,
University of Brescia,
L. Pianta, Departmemt of Otorhinolaryngology, University of Brescia,
1. Pang KP, Woodson BT. Expansion sphincter pharyngoplasty: a new
technique for the treatment of obstructive sleep apnea. Otolaryngol
Head Neck Surg. 2007;137:110-114
2. Vicini C, Hendawy E, Campanini A, et al. Barbed reposition pharyn-
goplasty (BRP) for OSAHS: a feasibility, safety, efficacy and teacha-
bility pilot study. "We are on the giant’s shoulders". Eur
Arch Otorhinolaryngol. 2015;272:3065-3070.
3. Mantovani M, Rinaldi V, Torretta S, Carioli D, Salamanca F, Pignataro
L. Barbed Roman blinds technique for the treatment of obstructive
sleep apnea: how we do it? Eur Arch Otorhinolaryngol.
4. Vignatelli L, Plazzi G, Barbato A, et al. Italian version of the Epworth
sleepiness scale: external validity. Neurol Sci. 2003;23:295-300.
5. Kezirian EJ, Hohenhorst W, de Vries N. Drug-induced sleep endo-
scopy: the VOTE classification. Eur Arch Otorhinolaryngol.
6. Salamanca F, Costantini F, Mantovani M, et al. Barbed anterior
pharyngoplasty: an evolution of anterior palatoplasty. Acta Otorhino-
laryngol Ital. 2014;34:434-438. http://www.ncbi.nlm.nih.gov/
pubmed/25762837. Accessed November 9, 2016.
7. Sher AE, Schechtman KB & Piccirillo JF. The efficacy of surgical
modifications of the upper airway in adults with obstructive sleep
apnea syndrome. Sleep. 1996;19:156-177. http://www.ncbi.nlm.nih.
gov/pubmed/8855039. Accessed October 3, 2014.
8. Seif F, Patel SR, Walia H, et al. Association between obstructive
sleep apnea severity and endothelial dysfunction in an increased
background of cardiovascular burden. J Sleep Res. 2013;22:443-451.
9. Wu J, Zhao G, Li Y, et al. Apnea–hypopnea index decreased signifi-
cantly after nasal surgery for obstructive sleep apnea: a meta-analy-
sis. Medicine. 2017;96:e6008.
10. Richard W, Venker J, den Herder C, et al. Acceptance and long-term
compliance of nCPAP in obstructive sleep apnea. Eur Arch Otorhino-
Accepted: 12 October 2017
A retrospective review of six hundred and nineteen cases to
determine the prevalence and factors associated with revision
endoscopic sinus surgery in AFRS vs NON-AFRS patients
Chronic rhinosinusitis (CRS) is an inflammatory disease of the nose
and paranasal sinus mucosa.
Failing medical management, CRS
patients may need to undergo functional endoscopic sinus surgery
(FESS) with the goal of clearing obstructions, facilitating natural
mucociliary clearance mechanisms and improving sinonasal airway
The success rate of FESS has been found to be
Failure of FESS has been associated with
the presence of residual air cells, abnormally constricted maxillary or
frontal sinus ostia, a displaced uncinate process and underlying recal-
citrant biological characteristics (eg, CRSwNP [CRS with nasal poly-
posis] or AFRS [allergic fungal rhinosinusitis]).
for failure may include improper surgical techniques, poor medical
management or inadequate postoperative follow-up.
senting with CRS symptoms after failed primary FESS often need to
undergo revision functional endoscopic sinus surgery (rFESS) for
completion surgery and symptom resolution. It has been found that
many patients undergoing rFESS have a more severe form of CRS
and mucosal disease right before rFESS than before primary sur-
Revision functional endoscopic sinus surgery is considered
more difficult to perform, potentially due to previous resection of
crucial anatomic landmarks, increased intraoperative bleeding, osteo-
neogenesis and presence of adhesions.
The purpose of this study is to determine the incidence of and
factors associated with rFESS cases that presented at a tertiary rhi-
Ethics approval was obtained from the University of British Colum-
bia Clinical Research Ethics Board (#H14-03352).
CORRESPONDENCE: OUR EXPERIENCE