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Inicio Acta Otorrinolaringológica Española Creation and validation of a radiological checklist for functional endoscopic si...
Journal Information
Vol. 72. Issue 5.
Pages 305-311 (September - October 2021)
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Vol. 72. Issue 5.
Pages 305-311 (September - October 2021)
Original article
Creation and validation of a radiological checklist for functional endoscopic sinonasal surgery. A YO-IFOS initiative
Creación y validación de un checklist radiológico para cirugía endoscópica nasosinusal. Una iniciativa de YO-IFOS
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Christian Calvo-Henríqueza,b,
Corresponding author
, Byron Maldonado-Alvaradoa,b, Carlos Chiesa-Estombaa,c, Miguel Mayo-Yáñeza,d, Gabriel Martínez-Capoccionia,b, Jerome R. Lechiena,e, Alberto Ruano-Ravinaf,g, Cristóbal López-Cortijoh, Carlos Martin-Martini
a Rhinology Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS) Study Group, Spain
b Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Spain
c Service of Otolaryngology, Donostia University Hospital, Spain
d Service of Otolaryngology, Hospital Complex of La Coruña, Spain
e Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, University of Paris Saclay, France
f Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Spain
g CIBER de Epidemiología y Salud Pública, CIBERESP, Spain
h Department of Otolaryngology-Head and Neck Surgery, Hospital Puerta de Hierro de Madrid, Spain
i Department of Otolaryngology, University of Santiago de Compostela, Spain
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Tables (2)
Table 1. Checklist score.
Table 2. Sinonasal radiological checklists. SSD (statistically significant difference).
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Abstract
Background

Functional endoscopic sinus surgery might lead to dangerous complications. Studying and analysing preoperative CT scans provides surgeons with a precise knowledge of their patient's anatomy, thus reducing the risk of potential complications. Checklists highlighting key anatomical areas have been published and proven useful. However, none of these are widely accepted or systematically used in daily practice.

Objective

In this paper, the rhinology group of the Young-Otolaryngologists of the International Federations of Otorhinolaryngological Societies (YO-IFOS) aim to create and validate a new checklist designed to be fast and user friendly for daily practice.

Methods

Two CT sinonasal scans were selected as test cases. Forty otolaryngologists were selected from five tertiary referral hospitals. It was a cross-sectional study; each participant was their own control. All participants completed a questionnaire after the analysis of both CT scans to prevent learning bias. The evaluation included ten items critical in endoscopic sinus surgery according to previous publications.

Results

There were 80 evaluations. There was a significant increase in the number of correctly identified critical structures with the use of the checklist (p=.009). There was a statistically significant difference in low- experience evaluators, while it was not statistically significant for experienced surgeons. The most unanswered structures were suprabullar recess, dangerous v2 nerve, anterior ethmoid artery, dangerous vidian nerve and Onodi cell. The most wrongly identified structures were Keros type, septal deviation and cribiform middle turbinate.

Conclusion

The YO-IFOS radiological checklist has proven a useful tool for correctly studying sinonasal anatomical variations. There is a clear learning component in the use of the checklist although it does not in any way exempt specialists from thorough study of sinonasal anatomy. Given the risk-benefit ratio, we strongly suggest the routine use of the checklist to systematically assess CT-scans prior to endoscopic sinonasal surgery.

Keywords:
FESS
Sinus surgery
Radiological checklist
Sinonasal anatomical variations
Key anatomical areas
Endoscopic surgery
Cerebrospinal fluid leak
Sinonasal radiology
Sinus radiology
Resumen
Objetivo

La cirugía endoscópica nasosinusal (CENS) tiene complicaciones peligrosas. El estudio peroperatorio de la tomografía nasosinusal otorga un conocimiento preciso de la anatomía del paciente, reduciendo así el riesgo de complicaciones. Se han publicado listas de comprobación para cirugía nasosinusal, y estas han demostrado su utilidad. En este trabajo, desde el grupo de rinología de Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), se diseñó y validó una lista de comprobación con el objetivo de ser amplia, cómoda y práctica para uso en la práctica clínica diaria.

Métodos

Se seleccionaron 2 tomografías nasosinusales como caso problema. Cuarenta otorrinolaringólogos fueron reclutados de 5 centros de tercer nivel. Se diseñó un estudio cruzado, por lo que cada participante fue su propio control. Todos los participantes completaron una evaluación tras el análisis de ambos casos con el objetivo de evitar sesgo de aprendizaje.

Resultados

Se completó un total de 80 evaluaciones. El uso del checklist supuso una mejoría en el número de variantes peligrosas identificadas (p=0,009). La diferencia fue estadísticamente significativa para evaluadores poco experimentados, pero no para los experimentados. Las variantes con mayor número de respuestas en blanco fueron el receso suprabullar, el nervio V2, la arteria etmoidal anterior, el nervio vidiano y la celda de Onodi. Las estructuras con mayor número de error fueron Keros, desvío septal e inserción del cornete medio en lámina cribosa.

Conclusión

El checklist radiológico nasosinusal de YO-IFOS ha demostrado ser una herramienta válida para el estudio peroperatorio de la tomografía nasosinusal. Dado la relación riesgo-beneficio recomendamos el uso rutinario del checklist radiológico para el estudio de la tomografía nasosinusal de manera sistemática previo a la CENS.

Palabras clave:
CENS
Cirugía nasosinusal
Checklist radiológico
Variante anatómica nasosinusal
Área anatómica crítica
Cirugía endoscópica
Fístula de líquido cefalorraquídeo
Radiología nasosinusal
Radiología sinusal

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