Revision Endoscopic Sinonasal Surgery | Acta Otorrinolaringológica Española

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Cortes coronales de paciente sometido a cirugía endoscópica nasosinusal hace 10 años. Se observa remanente de apófisis unciforme y celdilla frontal tipo III de Kuhn." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Pablo Cantillano, Fabián Rubio, Alfredo Naser, Rodolfo Nazar" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Pablo" "apellidos" => "Cantillano" ] 1 => array:2 [ "nombre" => "Fabián" "apellidos" => "Rubio" ] 2 => array:2 [ "nombre" => "Alfredo" "apellidos" => "Naser" ] 3 => array:2 [ "nombre" => "Rodolfo" "apellidos" => "Nazar" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S217357351730008X" "doi" => "10.1016/j.otoeng.2017.01.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357351730008X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001651916300152?idApp=UINPBA00004N" "url" => "/00016519/0000006800000001/v1_201701300029/S0001651916300152/v1_201701300029/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173573517300078" "issn" => "21735735" "doi" => "10.1016/j.otoeng.2017.01.005" "estado" => "S300" "fechaPublicacion" => "2017-01-01" "aid" => "712" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Acta Otorrinolaringol Esp. 2017;68:9-14" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 606 "formatos" => array:3 [ "EPUB" => 26 "HTML" => 365 "PDF" => 215 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Absence of Chromosomal Translocations and Protein Expression of ALK in Sinonasal Adenocarcinomas" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "9" "paginaFinal" => "14" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Ausencia de translocaciones cromosómicas y de expresión proteica de ALK en los adenocarcinomas nasosinusales" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 842 "Ancho" => 2050 "Tamanyo" => 240643 ] ] "descripcion" => array:1 [ "en" => "(A) Example of a FISH result where 1–2 pairs of red signals and adjacent green signals were observed. (B) Example of a FISH result where 2–3 pairs of red signals and adjacent green signals were observed. (C) Example of a FISH result where 3–6 pairs of red signals and adjacent green signals were observed. The colour of this figure can only be appreciated in the electronic version of the article." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Esteban Pacheco, José Luis Llorente, Alejandro López-Hernández, Cristina García-Inclán, María Costales, Sira Potes Ares, Fernando López, Blanca Vivanco, Mario A. Hermsen" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Esteban" "apellidos" => "Pacheco" ] 1 => array:2 [ "nombre" => "José Luis" "apellidos" => "Llorente" ] 2 => array:2 [ "nombre" => "Alejandro" "apellidos" => "López-Hernández" ] 3 => array:2 [ "nombre" => "Cristina" "apellidos" => "García-Inclán" ] 4 => array:2 [ "nombre" => "María" "apellidos" => "Costales" ] 5 => array:2 [ "nombre" => "Sira" "apellidos" => "Potes Ares" ] 6 => array:2 [ "nombre" => "Fernando" "apellidos" => "López" ] 7 => array:2 [ "nombre" => "Blanca" "apellidos" => "Vivanco" ] 8 => array:2 [ "nombre" => "Mario A." "apellidos" => "Hermsen" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001651916300127" "doi" => "10.1016/j.otorri.2016.02.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001651916300127?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173573517300078?idApp=UINPBA00004N" "url" => "/21735735/0000006800000001/v1_201702170013/S2173573517300078/v1_201702170013/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Revision Endoscopic Sinonasal Surgery" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "1" "paginaFinal" => "8" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Pablo Cantillano, Fabián Rubio, Alfredo Naser, Rodolfo Nazar" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Pablo" "apellidos" => "Cantillano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Fabián" "apellidos" => "Rubio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Alfredo" "apellidos" => "Naser" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:4 [ "nombre" => "Rodolfo" "apellidos" => "Nazar" "email" => array:1 [ 0 => "rnazars@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Universidad de Chile, Santiago, Chile" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Otorrinolaringología, Hospital Clínico Universidad de Chile, Santiago, Chile" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cirugía endoscópica nasosinusal de revisión" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1661 "Ancho" => 750 "Tamanyo" => 131205 ] ] "descripcion" => array:1 [ "en" => "(A and B) CT scan of the nose and paranasal cavities. Coronal slices of the patient who underwent endoscopic sinonasal surgery 10 years previously. Remnants of uncinate apophasis and type III Kuhn frontal air cells may be observed." ] ] ] "textoCompleto" => "IntroductionEndoscopic sinonasal surgery (ESS) is the procedure of choice in the treatment of chronic rhinosinusitis (CRS) and nasal polyposis (NP) refractory to medical treatment.<a class="elsevierStyleCrossRef" href="#bib0035">1</a> It is a safe and effective procedure for the treatment of these conditions, with a success rate ranging between 76% and 97.5%, which may drop to between 50% and 70% in the presence of NP,<a class="elsevierStyleCrossRef" href="#bib0035">1</a> among other factors.The following factors have been reported to have an effect on the success rate of this procedure: spread of the disease and inflammation shown by CT scan, a medical history of previous ESS, with or without polypectomy, allergy, asthma (50% success in asthmatic patients vs 88% in non asthmatic patients), sensitivity to aspirin, cystic fibrosis, ciliary dyskinesia, presence of NP (commonly considered a predictor of poor results on ESS review) and depression.<a class="elsevierStyleCrossRef" href="#bib0035">1</a>Patients who do not respond sufficiently to ESS undergo one or more ESS revision surgeries (RESS), with or without a prior period of medical treatment. It has been reported in the literature that from 2.5% to 24% of patients will require some type of revision surgery.<a class="elsevierStyleCrossRef" href="#bib0040">2</a> It has been estimated that the average time between each ESS is 4.8±3.6 years (range between 0.7 and 18.6 years), with the time being shorter in patients who are smokers (2.8 years in smokers vs 4.3 years in non smokers).<a class="elsevierStyleCrossRef" href="#bib0045">3</a>Like all medical procedures RESS have well established indications, including: (1) incomplete previous surgery; (2) complications resulting from previous surgery; (3) recurrent or persistent sinus disease and (4) histological evidence of neoplasia.<a class="elsevierStyleCrossRef" href="#bib0050">4</a> The most common causes of RESS are those derived from the first three points mentioned above which are recurrent NP, synechiae in the middle meatus and stenosis or obstruction of the ostium of the maxillary and/or frontal sinus<a class="elsevierStyleCrossRef" href="#bib0035">1</a> (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1A, B and 2</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>The possible causes of poor results from primary surgery have been studied through the sinonasal anatomy of patients who have undergone RESS. The 2011 study by Khalil et al.<a class="elsevierStyleCrossRef" href="#bib0055">5</a> provided radiologic classification of patients who had undergone RESS. The results were as follows: residual frontal air cells (96%), posterior ethmoid air cells (96%) and persistent anterior air cells (92.1%), residual uncinate process (57.1%), significant septal deviation (15.9%) and middle lateral conchae (11.1% of the sides studied).In 2004, Musy and Kountakis<a class="elsevierStyleCrossRef" href="#bib0060">6</a> conducted a study in which they also studied the radiologic and intraoperative anatomy of this group of patients. Their findings were as follows: lateralised middle turbinate (78%), incomplete anterior ethmoidectomy (64%), healed frontal recess (50%), retained agger nasi cells (49%), incomplete posterior ethmoidectomy (41%), stenosis of antrostomy of the middle meatus (39%), retained uncinate process (37%) and recurrent polyposis (37%). To a lesser extent, they also found persistent sphenoidal disease and stenosis of the sphenoidal ostium.In the study referred to above<a class="elsevierStyleCrossRef" href="#bib0060">6</a> the procedures carried out during the RESS were also analysed, with the following results: anterior ethmoidectomy (96%), frontal sinus surgery (95%), posterior ethmoidectomy (74%), antrostomy (68%), uncinectomy (53%), sphenoidotomy (52%) and turbinectomy (10%).This aim of this study is to analyse the clinical, anatomical, radiological and histological features of the group of patients who underwent RESS in our centre, and also analyse the procedures carried out during surgical intervention, during a three-year period.Material and MethodsThis retrospective descriptive study was performed by analysing the information of clinical files of patients who had undergone RESS during a three-year period, from between 1st January 2012 and 31st December 2014, in our centre.Initially the whole database corresponding to patients who underwent ESS during this period was analysed, and as a result patients who underwent RESS were identified. Once the group of patients who had undergone RESS had been established, their data were clinically, anatomically, radiologically and histologically reviewed in accordance with the availability of said information for each patient. This information was obtained from analysis of pre-and-post-surgical medical care and the radiological findings from CR scans of paranasal cavities (both the radiological report, the description of the images by the ENT specialist treating the patient and the review of imaging by researchers). Intraoperative anatomical findings and procedures performed were also studied (by means of review of surgical protocols) and biopsies obtained previously or during surgery.All data were put onto a table to facilitate their analysis and proceed to characterise this patient group. Due to its descriptive nature, it was not the aim of this study to characterise primary ESS patients, or compare both groups using statistical methods.ResultsTotal PatientsDuring the period between 1st January 2012 and 31st December 2014 a total of 299 ESS were performed in our centre, 27 of which (9%) corresponded to RESS. The average age of the patients who underwent RESS was 45.89 years (range between 12 and 66 years). Distribution by gender of the patients shows a mild male predominance (male: female ratio of 1.4:1).The most common preoperative diagnosis in these patients was polypoid CRS, followed by non polypoid CRS, inverted papilloma, mucous cyst, antrochoanal polyp and finally otontogenic sinusitis. Postoperative diagnoses by order of frequency of occurrence were as follows: polypoid CRS inverted papilloma, mucous cyst, non polypoid CRS, antrochoanal polyp and otontogenic sinusitis. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> contains pre and postoperative diagnoses obtained in this study and the data referred to in the literature.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Effective follow-up time after primary ESS was analysed (or the previous RESS if applicable), with this time being on average 11.9 months (range of between 3 and 23 months). The time interval between primary ESS (or prior RESS) and RESS was on average 6.1 years (range of between 3 and 10 years).The symptoms most frequently manifested by patients were nasal obstruction, followed by rhinorrhea and facial algia or cephalgia. Less common symptoms were otalgia, facial oedema, and cacosmia. The disease also presented asymptomatically. The list of symptoms by order of frequency is found in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>In 13 cases premedication for RESS was administered; of these cases, 6 were treated with systemic corticosteroids, 4 with oxymetazoline, 2 with montelukast and in one case amoxicillin/clavulanic acid were used. The other patients did not use previous medication or did not record its usage.With regard to intraoperative anatomical events, the most commonly observed was stenotic antrostomy or that which required widening (81.5%), followed secondly by incomplete anterior ethmoidectomy and persistent uncinate process (both in 59.3% of cases). Incomplete anterior ethmoidectomy ranked third in frequency at 51.9%. The details from the intraoperative anatomical findings are contained in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>, and compared with data from the literature.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>From a radiological viewpoint, in the CT scan analysis of paranasal cavities, the most common findings corresponded to persistence of anterior (70.4%) and posterior (63%) ethmoid air cells. In the images the presence of persistent uncinate process was described in 8 patients (29.6%), whilst the lateralised middle turbinate was described in 4 patients (14.8%). It may be noted that there was no reported presence of Haller air cells. <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> contains the radiological events described in patients who underwent RESS.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>An antrostomy or widening of an antrostomy was performed in 26 of 27 patients during surgery, accounting for 96.3%. The second surgery most commonly performed was anterior ethmoidectomy in two thirds of the patients (66.7%). A polypectomy was performed in 59.3% of patients, and 51.9% of patients underwent procedures which involved frontal recess. An uncinectomy was performed during surgery in 13 patients (48.1%) and posterior ethmoidectomy was performed on 12 patients (44.4%). These findings are presented in <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> and compared to those in the literature.<elsevierMultimedia ident="tbl0025"></elsevierMultimedia>Out of the total patients analysed in this study, 15 biopsies provided information regarding chronic, nonspecific inflammation, 9 of which corresponded to inflammatory polyps and 7 to inverted papilloma.Breakdown by DiagnosisThe breakdown of patients according to their postoperative diagnosis into the groups of inverted papilloma (5 patients), polypoid CRS (15 patients) and non polypoid CRS (3 patients), was obtained from the following results: patients with inverted papilloma and polypoid CRS were similar in average age (48.4) and (48.8) and age range (29–66 years) and (27–66 years), respectively whilst patients with non polypoid CRS were younger (mean age of 38.3, range of 26–46 years). With regards to gender distribution, the first 2 groups were predominantly male (3:2 and 4:1 ratio respectively) and the third group was predominantly female (1:2 ratio). The range of effective time of control in patients with inverted papilloma was 3–11 months and that of polypoid CRS was 4–27 months. It was not possible to calculate the average of the 3 groups and the range of the non polypoid CRS patients due to the fact that not all of the patients’ medical files contained these data. Time between surgery in the group of inverted papilloma was 52.2 months on average (range from 3 to 120 months), and it was not possible to calculate the mean in other groups for the reasons already stated (the range for polypoid CRS was from 8 to 240 months and for non polypoid CRS from 36 to 84 months).The most common symptoms in patients with inverted papilloma was nasal obstruction and rhinorrhea (2 patients per condition), followed by roncopathy and facial algia (one patient). Only one patient was symptom free. Furthermore, in the polpypoid CRS group 11 patients suffered from nasal obstruction, 4 from rhinorrhea and posterior discharge, 2 from hyposmia and 1 each from facial oedema, nasal congestion, headaches and anosmia. No patients were asymptomatic. In the non polypoid CRS group the most frequently reported symptoms were nasal obstruction, hyposmia, rhinorrhea, facial algia, posterior discharge and cacosmia (all with a frequency of one patient in each).Regarding premedication, only 2 patients with inverted papilloma received any medication (one patient was administered oxymetazoline and another betametasone and moxifloxacin). However, premedication was more frequent in the polypoid CRS group (3 patients received prednisone, two received injectable Dacam Rapilento, one Iliadin and another Montelukast). In the non polypoid CRS group only one patient received premedication recorded on file (amoxicillin/clavunlanic acid). The main anatomical and radiological findings together with the surgeries performed in the 3 groups are shown in <a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a> by the frequency in which they were reported.<elsevierMultimedia ident="tbl0030"></elsevierMultimedia>In the inverted papilloma group the pathological anatomy results confirmed the diagnosis in 3 patients. In the polypoid CRS patients the presence of polyps was described in 5 patients and they all presented with chronic inflammation. In the non polypoid CRS group chronic inflammation was described in all patients, with no other findings.DiscussionIn our centre a total of 299 ESS were performed, over a period of 3 years. Of these surgeries 27 corresponded to RESS, equivalent to 9%. This percentage of RESS is in keeping with that established in the literature.<a class="elsevierStyleCrossRef" href="#bib0040">2</a>In our data we observed a substantial difference between effective control time after the primary ESS, compared with the average time to elapse between this surgery and RESS (11.9 months vs 6.1 years). On average, patients who underwent primary ESS withdrew from their medical check-ups before a year had passed since surgery and consulted again 6 years later for a condition that required resolution with new surgery.The time elapsing between both operations in our series, on average is greater than that described in the literature, but when comparing the range of this time, it is generally observed that it is earlier than the range of time recorded (3 months to 10 years in our series vs 0.7 to 18.6 years in the literature).<a class="elsevierStyleCrossRef" href="#bib0045">3</a> It may be inferred from this that in our centre there was a tendency towards early revision surgery although further in-depth analysis of the various medical and non-medical variables which may have had some effect on this decision would need to be performed. It should be considered that we do not have data regarding the frequency of patients who were active smokers in our series, a factor which has an effect on the time elapsing between one operation and another, as these patients generally require earlier revision surgery.<a class="elsevierStyleCrossRef" href="#bib0045">3</a>On comparing our data with those available in the literature reviewed for this study,<a class="elsevierStyleCrossRefs" href="#bib0055">5,6</a> we may observe greater frequency of maxillary compromise in our patients, which is reflected by a larger percentage of procedures carried out in the maxillary sinuses during surgery. By contrast, there are fewer procedures which involve the ethmoidal, sphenoidal and frontal sinuses. The frequency of persistent uncinate process and uncinectomy observed is relatively similar to that described in the literature, but it should be taken into consideration that in our hospital uncinectomy is included within the concept of antrostomy which was the most commonly performed procedure, and the frequency of uncinectomy may therefore be underestimated in our series. There was a greater frequency of polyposis, inverted papilloma and mucous cyst than in the literature, together with their respective surgical procedures such as polypectomy and mucous cyst marsupialisation.Notwithstanding, analysing the findings from radiological events it was observed that the changes in the maxillary sinus rank third in frequency, not first as was to be expected since it is the sinus most commonly compromised in surgical protocols. Ethmoidal compromise ranks first and second (anterior and posterior air cells respectively) despite the fact its frequency is even lower than that reported in the literature regarding the compromise observed during surgery.With regard to the pre and post surgical diagnoses, polypoid rhinosinusitis corresponds to the primary diagnosis in both scenarios, with regards to frequency. It was observed that inverted papilloma was a less frequent diagnosis prior to surgery and increases in frequency after surgery, at the same time as non polypoid rhinosinusitis drops in frequency. By this we may infer that inverted papilloma is a pathology of difficult preoperative diagnosis. It is more frequently diagnosed on physical examination which may be interpreted as an increase in its diagnosis after surgical intervention. Furthermore, the incidence of inverted papilloma is even greater when the findings from differed biopsies are considered. In our series, only 2 patients were diagnosed with inverted papilloma prior to surgery, and this increased to 5 patients after surgery and to 7 patients when the histological report was available.The differences between our series and the literature regarding anatomical findings and surgical procedures performed may possibly be explained by the number of patients analysed. Our series has a small number of patients who underwent RESS. There is therefore a need for studies with a larger patient sample, either multicentre to reduce the time necessary to accumulate a suitable sample size, or studies with a longer duration. Furthermore, this study is retrospective, with no established data recording protocol and no patient follow-up, thus minimising the reaching of conclusions from this study. Due to its descriptive nature, no formal statistical analysis was made to establish the meaning of the differences recorded compared with the literature, and it is therefore possible that several of the differences established in this study were not statistically significant.It should also be emphasised that, as has been expressed above, the patient profile with diseases such as inverted papilloma and sinonasal polyposis is different to that of patients who only present with chronic sinusitis without polyps, i.e. the average age is older in the first 2 groups and very similar between them, whilst the patients without polyposis are younger patients and with less range of time elapsing between one operation and another. The lower upper limit is that of the first 2 groups, which may indicate earlier consultation or enquiry about the persistence of the disease in these patients compared with others, with the result that they develop fewer inflammatory changes at the time of secondary surgery. In future studies, we believe it would be of interest to classify each group of patients and have a higher number of patients to better define these differences.All of the above leads to the question of whether to pursue a more aggressive approach in primary surgery to reach those cavities most frequently compromised in revision surgery, and thus prevent the need for further surgery. Better follow-up of these patients is also required and improved adherence to treatment administered.We believe further investigation on this matter needs to be conducted for a better understanding of the profile of this patient group and to generate cost-effective measures designed to reduce the number of patients who undergo revision surgery. In this context, our hospital has a rhinology/sinusitis committee, in which the ENT team is dedicated to sinonasal pathology and meets weekly to discuss the most complex and/or controversial cases attended to in our hospital. A joint decision is then reached on which guidelines to follow for the patient. The authors propose that this event be used to create and apply a system of standardised registration to record future structured information on these patients, which would result in more complete data in future studies, whether these be retrospective or prospective, on RESS and pathologies relevant to the said procedure. We hope this proposal may be applied to other hospitals nationally and even internationally, where similar committees exist, so that more enhanced studies may take place in the future.ConclusionEndoscopic sinonasal surgery is frequently performed in ENT departments, with a small percentage of patients requiring revision surgery. In our series the presence of sinonasal polyps was a major cause RESS indication, as were radiological and/or anatomical (intraoperative) events of stenotic antrostomy and incomplete (anterior and posterior) ethmoidectomy. All of the above leads to procedures being performed more frequently within surgery (antrostomy, ethmoidectomy and polyp resection, in general). Furthermore, the time elapsed from primary to revision surgery is generally extensive for these patients, who may withdraw from medical follow-up and adhere poorly to treatment, especially those patients with more intense inflammatory conditions, such as polyposis and inverted papilloma.Periodical long term follow-up and control, particularly in the most severe forms of the disease are essential to obtain optimal therapy and correct long term management, are is the classification of each group of rhinosinusal diseases.Endoscopic revision surgery is a challenge for surgeons dedicated to paranasal cavity surgery, with regards to optimising medical management and indicating the surgery at the right moment.Finally, it is highly important to define the type for revision surgery to be performed to attempt to reduce further surgical interventions in the future.Conflict of InterestsThe authors have no conflict of interests to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres802197" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec800627" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres802198" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec800626" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and Methods" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Total Patients" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Breakdown by Diagnosis" ] ] ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of Interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-08-03" "fechaAceptado" => "2016-02-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec800627" "palabras" => array:4 [ 0 => "Endoscopic sinonasal surgery" 1 => "Sinusitis" 2 => "Polyposis" 3 => "Endoscopy" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec800626" "palabras" => array:4 [ 0 => "Cirugía endoscópica nasosinusal" 1 => "Sinusitis" 2 => "Poliposis" 3 => "Endoscopia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Introduction and objectivesEndoscopic sinonasal surgery is the procedure of choice in the treatment of chronic rhinosinusitis and sinonasal polyposis refractory to medical treatment, with high rates of success (76%–97.5%). However, 2.5%–24% of those patients will require revision surgery (RESS). In this study, we present the clinical, anatomical, radiological and histological features of patients receiving RESS in our centre during a 3-year period. MethodsA retrospective review of clinical, anatomical, radiological and histopathological data of patients receiving revision endoscopic sinonasal surgery between 2012 and 2014 was carried out. ResultsFrom 299 surgery procedures performed, 27 (9%) were revision surgeries. The mean patient age was 46 years, with a male/female ratio of 1.4/1. The most frequent preoperative and postoperative diagnosis was chronic polypoid rhinosinusitis. The mean time since the previous surgery was 6.1 years, with 11.9 months of mean follow-up since that surgery. Stenotic antrostomy was found during revision in 81.5% of the patients and incomplete anterior ethmoidectomy and persistent uncinate process, in 59.3%. In radiology, 70.4% of patients had persistent anterior ethmoidal cells. Antrostomy or widening of antrostomy was performed in 96.3% of cases and anterior ethmoidectomy or completion of it was performed in 66.7%. ConclusionsPolyps, stenotic antrostomy and incomplete ethmoidectomy were the most frequent causes of revision surgery, in concordance with the procedures performed. The patients had long periods of time without follow-up between surgeries. Further investigation is necessary to generate measures to reduce the number of revision surgeries." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "Introducción y objetivosLa cirugía endoscópica nasosinusal es el procedimiento de elección para tratar la rinosinusitis crónica y poliposis nasosinusal refractarias a tratamiento médico, con un alto porcentaje de éxito (76 a 97,5%). Sin embargo, de 2,5 a 24% de los pacientes requieren cirugía de revisión. En este estudio describimos las características clínicas, anatómicas, radiológicas e histológicas de pacientes sometidos a cirugía de revisión en nuestro centro, en un período de 3 años. MétodosRevisión retrospectiva de datos clínicos, anatómicos, radiológicos e histopatológicos de pacientes sometidos a revisión entre 2012 y 2014. ResultadosDe 299 procedimientos quirúrgicos realizados, 27 (9%) fueron de revisión. La edad promedio de los pacientes fue 46 años, con una relación hombre:mujer de 1,4:1. El diagnóstico preoperatorio y postoperatorio más frecuente fue rinosinusitis crónica poliposa. El tiempo promedio desde la cirugía previa fue de 6,1 años, con 11,9 meses de seguimiento promedio desde esa cirugía. Un 81,5% de los pacientes presentaba antrostomía estenótica durante la revisión, y un 59,3% etmoidectomía anterior incompleta y proceso unciforme persistente. El 70,4% de los pacientes tenía celdillas etmoidales anteriores persistentes en radiología. Se realizó en un 96,3% de los casos antrostomía o ampliación de esta, y en un 66,7% se realizó o se completó la etmoidectomía anterior. ConclusionesLas causas más frecuentes de revisión fueron los pólipos, antrostomía estenótica y etmoidectomía incompleta, concordante con los procedimientos realizados. Los pacientes tuvieron largos períodos sin seguimiento entre cirugías. Es necesario continuar la investigación para generar medidas que reduzcan el número de cirugías de revisión." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Cantillano P, Rubio F, Naser A, Nazar R. Cirugía endoscópica nasosinusal de revisión. Acta Otorrinolaringol Esp. 2017;68:1–8." ] ] "multimedia" => array:8 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1661 "Ancho" => 750 "Tamanyo" => 131205 ] ] "descripcion" => array:1 [ "en" => "(A and B) CT scan of the nose and paranasal cavities. Coronal slices of the patient who underwent endoscopic sinonasal surgery 10 years previously. Remnants of uncinate apophasis and type III Kuhn frontal air cells may be observed." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 733 "Ancho" => 750 "Tamanyo" => 65757 ] ] "descripcion" => array:1 [ "en" => "CT scan of the nose and paranasal cavities. Sagittal slice of patient who underwent endoscopic sinonasal surgery 10 years previously. Persistent type III Kuhn frontal air cells may be observed, with secondary inflammatory compromise. This was the indication for revision endoscopic sinonasal surgery." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Preoperative diagnosis \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cases \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Postoperative diagnosis \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cases \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chronic polypoid rhinosinusitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Polypoid chronic rhinosinusitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Non polypoid rhinosinusitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Inverted papilloma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mucous cyst \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mucous cyst \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Inverted papilloma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Non polypoid chronic rhinosinusitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Antrochoanal polyp \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Antrochoanal polyp \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Otontogenic sinusitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Otontogenic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1346437.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Pre and Post Operative Diagnoses in Decreasing Order of Frequency." ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Symptoms \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cases \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nasal obstruction nasal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rhinorrhea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Facial algia or cephalgia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Posterior discharge \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anosmia or hyposmia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Otalgia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Facial oedema \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cacosmia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Asymtomatic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1346434.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Most Common Symptoms Presented in the Patients Analysed, in Decreasing Order of Frequency." ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Note: The events described by Khalil et al. were compared as were those of Musy and Kountakis. The events not described or found are noted with a (−) sign." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Anatomical events \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Present study \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Khalil et al.<a class="elsevierStyleCrossRef" href="#bib0055">5</a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Musy and Kountakis<a class="elsevierStyleCrossRef" href="#bib0060">6</a> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Stenoic antrostomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Incomplete anterior ethmoidectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Persistent uncinate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Incomplete posterior ethmoidectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Polyposis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Compromised frontal recess \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Others \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sphenoid compromise \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lateralised middle turbinate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Amputated middle turbinate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Inverted papilloma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mucous cyst \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Recirculation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Significant septal deviation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Retained Agger nasi \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1346438.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Anatomical Events Described in the Surgical Protocols, in Decreasing Order of Frequency." ] ] 5 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Radiological findings \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cases \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Persistent anterior ethmoid sinuses \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Persistent posterior ethmoid sinuses \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Maxillary sinus compromise \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Frontal recess residual air cells \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Septal deviation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Persistent uncinate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Polyposis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Compromise of the sphenoid sinus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Occupation of the sinusal cavity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Others \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Compromise of the frontal sinus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lateralised middle turbinate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Speno ethmoid recess compromise \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1346439.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Radiological Findings Observed in CT Scan of Paranasal Cavities, in Decreasing Order of Frequency." ] ] 6 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at5" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Note: They are compared with the results from Musy and Kountakis. The procedures not performed or not described are noted with a (−) sign." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Procedure performed \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Present study \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Musy and Kountakis<a class="elsevierStyleCrossRef" href="#bib0060">6</a> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Antrostomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anterior ethmoidectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Polyps resection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Frontal sinustomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Uncinectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Posterior ethmoidectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Shenoidotomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Turbinectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mucous cyst marsupialisation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Others \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1346435.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Procedures Performed Carried Out During Endoscopic Revision Surgery, in Decreasing Order of Frequency." ] ] 7 => array:8 [ "identificador" => "tbl0030" "etiqueta" => "Table 6" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at6" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Main findings \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Diagnosis</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Inverted papilloma \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Polypoid CRS \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Non polypoid CRS \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Anatomical findings</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Stenoid antrostomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Incomplete anterior ethmoidectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Incomplete posterior ethmoidectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Persistent uncinate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Synechiae \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mucous cyst \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Changed frontal recess \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sphenoid disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lateralised middle turbinate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Amputated middle turbinate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Recirculation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Radiological findings</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Incomplete anterior ethmoidectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Incomplete posterior ethmoidectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Maxillary residual air cells \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Septal deviation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lateralised middle turbinate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Persistent uncinate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Residual spheno-ethmoidal recess air cells \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Frontal residual air cells \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sphenoid residual air cells \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Obstructed sphenoid ostium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Surgery performed</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Antrostomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anterior ethmoidectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Posterior ethmoidectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Uncinectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; 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Revision Endoscopic Sinonasal Surgery

Cirugía endoscópica nasosinusal de revisión

Pablo Cantillanoa, Fabián Rubiob, Alfredo Naserb, Rodolfo Nazarb,

Corresponding author

rnazars@gmail.com

Corresponding author.

a Universidad de Chile, Santiago, Chile

b Departamento de Otorrinolaringología, Hospital Clínico Universidad de Chile, Santiago, Chile

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        "titulo" => "Cirug&#237;a endosc&#243;pica nasosinusal de revisi&#243;n"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">&#40;A and B&#41; CT scan of the nose and paranasal cavities&#46; Coronal slices of the patient who underwent endoscopic sinonasal surgery 10 years previously&#46; Remnants of uncinate apophasis and type III Kuhn frontal air cells may be observed&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Endoscopic sinonasal surgery &#40;ESS&#41; is the procedure of choice in the treatment of chronic rhinosinusitis &#40;CRS&#41; and nasal polyposis &#40;NP&#41; refractory to medical treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> It is a safe and effective procedure for the treatment of these conditions&#44; with a success rate ranging between 76&#37; and 97&#46;5&#37;&#44; which may drop to between 50&#37; and 70&#37; in the presence of NP&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> among other factors&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The following factors have been reported to have an effect on the success rate of this procedure&#58; spread of the disease and inflammation shown by CT scan&#44; a medical history of previous ESS&#44; with or without polypectomy&#44; allergy&#44; asthma &#40;50&#37; success in asthmatic patients vs 88&#37; in non asthmatic patients&#41;&#44; sensitivity to aspirin&#44; cystic fibrosis&#44; ciliary dyskinesia&#44; presence of NP &#40;commonly considered a predictor of poor results on ESS review&#41; and depression&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Patients who do not respond sufficiently to ESS undergo one or more ESS revision surgeries &#40;RESS&#41;&#44; with or without a prior period of medical treatment&#46; It has been reported in the literature that from 2&#46;5&#37; to 24&#37; of patients will require some type of revision surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> It has been estimated that the average time between each ESS is 4&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;6 years &#40;range between 0&#46;7 and 18&#46;6 years&#41;&#44; with the time being shorter in patients who are smokers &#40;2&#46;8 years in smokers vs 4&#46;3 years in non smokers&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Like all medical procedures RESS have well established indications&#44; including&#58; &#40;1&#41; incomplete previous surgery&#59; &#40;2&#41; complications resulting from previous surgery&#59; &#40;3&#41; recurrent or persistent sinus disease and &#40;4&#41; histological evidence of neoplasia&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> The most common causes of RESS are those derived from the first three points mentioned above which are recurrent NP&#44; synechiae in the middle meatus and stenosis or obstruction of the ostium of the maxillary and&#47;or frontal sinus<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1A&#44; B and 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The possible causes of poor results from primary surgery have been studied through the sinonasal anatomy of patients who have undergone RESS&#46; The 2011 study by Khalil et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> provided radiologic classification of patients who had undergone RESS&#46; The results were as follows&#58; residual frontal air cells &#40;96&#37;&#41;&#44; posterior ethmoid air cells &#40;96&#37;&#41; and persistent anterior air cells &#40;92&#46;1&#37;&#41;&#44; residual uncinate process &#40;57&#46;1&#37;&#41;&#44; significant septal deviation &#40;15&#46;9&#37;&#41; and middle lateral conchae &#40;11&#46;1&#37; of the sides studied&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In 2004&#44; Musy and Kountakis<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> conducted a study in which they also studied the radiologic and intraoperative anatomy of this group of patients&#46; Their findings were as follows&#58; lateralised middle turbinate &#40;78&#37;&#41;&#44; incomplete anterior ethmoidectomy &#40;64&#37;&#41;&#44; healed frontal recess &#40;50&#37;&#41;&#44; retained <span class="elsevierStyleItalic">agger nasi</span> cells &#40;49&#37;&#41;&#44; incomplete posterior ethmoidectomy &#40;41&#37;&#41;&#44; stenosis of antrostomy of the middle meatus &#40;39&#37;&#41;&#44; retained uncinate process &#40;37&#37;&#41; and recurrent polyposis &#40;37&#37;&#41;&#46; To a lesser extent&#44; they also found persistent sphenoidal disease and stenosis of the sphenoidal ostium&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In the study referred to above<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> the procedures carried out during the RESS were also analysed&#44; with the following results&#58; anterior ethmoidectomy &#40;96&#37;&#41;&#44; frontal sinus surgery &#40;95&#37;&#41;&#44; posterior ethmoidectomy &#40;74&#37;&#41;&#44; antrostomy &#40;68&#37;&#41;&#44; uncinectomy &#40;53&#37;&#41;&#44; sphenoidotomy &#40;52&#37;&#41; and turbinectomy &#40;10&#37;&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">This aim of this study is to analyse the clinical&#44; anatomical&#44; radiological and histological features of the group of patients who underwent RESS in our centre&#44; and also analyse the procedures carried out during surgical intervention&#44; during a three-year period&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and Methods</span><p id="par0045" class="elsevierStylePara elsevierViewall">This retrospective descriptive study was performed by analysing the information of clinical files of patients who had undergone RESS during a three-year period&#44; from between 1st January 2012 and 31st December 2014&#44; in our centre&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Initially the whole database corresponding to patients who underwent ESS during this period was analysed&#44; and as a result patients who underwent RESS were identified&#46; Once the group of patients who had undergone RESS had been established&#44; their data were clinically&#44; anatomically&#44; radiologically and histologically reviewed in accordance with the availability of said information for each patient&#46; This information was obtained from analysis of pre-and-post-surgical medical care and the radiological findings from CR scans of paranasal cavities &#40;both the radiological report&#44; the description of the images by the ENT specialist treating the patient and the review of imaging by researchers&#41;&#46; Intraoperative anatomical findings and procedures performed were also studied &#40;by means of review of surgical protocols&#41; and biopsies obtained previously or during surgery&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">All data were put onto a table to facilitate their analysis and proceed to characterise this patient group&#46; Due to its descriptive nature&#44; it was not the aim of this study to characterise primary ESS patients&#44; or compare both groups using statistical methods&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Total Patients</span><p id="par0060" class="elsevierStylePara elsevierViewall">During the period between 1st January 2012 and 31st December 2014 a total of 299 ESS were performed in our centre&#44; 27 of which &#40;9&#37;&#41; corresponded to RESS&#46; The average age of the patients who underwent RESS was 45&#46;89 years &#40;range between 12 and 66 years&#41;&#46; Distribution by gender of the patients shows a mild male predominance &#40;male&#58; female ratio of 1&#46;4&#58;1&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The most common preoperative diagnosis in these patients was polypoid CRS&#44; followed by non polypoid CRS&#44; inverted papilloma&#44; mucous cyst&#44; antrochoanal polyp and finally otontogenic sinusitis&#46; Postoperative diagnoses by order of frequency of occurrence were as follows&#58; polypoid CRS inverted papilloma&#44; mucous cyst&#44; non polypoid CRS&#44; antrochoanal polyp and otontogenic sinusitis&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> contains pre and postoperative diagnoses obtained in this study and the data referred to in the literature&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Effective follow-up time after primary ESS was analysed &#40;or the previous RESS if applicable&#41;&#44; with this time being on average 11&#46;9 months &#40;range of between 3 and 23 months&#41;&#46; The time interval between primary ESS &#40;or prior RESS&#41; and RESS was on average 6&#46;1 years &#40;range of between 3 and 10 years&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The symptoms most frequently manifested by patients were nasal obstruction&#44; followed by rhinorrhea and facial algia or cephalgia&#46; Less common symptoms were otalgia&#44; facial oedema&#44; and cacosmia&#46; The disease also presented asymptomatically&#46; The list of symptoms by order of frequency is found in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">In 13 cases premedication for RESS was administered&#59; of these cases&#44; 6 were treated with systemic corticosteroids&#44; 4 with oxymetazoline&#44; 2 with montelukast and in one case amoxicillin&#47;clavulanic acid were used&#46; The other patients did not use previous medication or did not record its usage&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">With regard to intraoperative anatomical events&#44; the most commonly observed was stenotic antrostomy or that which required widening &#40;81&#46;5&#37;&#41;&#44; followed secondly by incomplete anterior ethmoidectomy and persistent uncinate process &#40;both in 59&#46;3&#37; of cases&#41;&#46; Incomplete anterior ethmoidectomy ranked third in frequency at 51&#46;9&#37;&#46; The details from the intraoperative anatomical findings are contained in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#44; and compared with data from the literature&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">From a radiological viewpoint&#44; in the CT scan analysis of paranasal cavities&#44; the most common findings corresponded to persistence of anterior &#40;70&#46;4&#37;&#41; and posterior &#40;63&#37;&#41; ethmoid air cells&#46; In the images the presence of persistent uncinate process was described in 8 patients &#40;29&#46;6&#37;&#41;&#44; whilst the lateralised middle turbinate was described in 4 patients &#40;14&#46;8&#37;&#41;&#46; It may be noted that there was no reported presence of Haller air cells&#46; <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> contains the radiological events described in patients who underwent RESS&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">An antrostomy or widening of an antrostomy was performed in 26 of 27 patients during surgery&#44; accounting for 96&#46;3&#37;&#46; The second surgery most commonly performed was anterior ethmoidectomy in two thirds of the patients &#40;66&#46;7&#37;&#41;&#46; A polypectomy was performed in 59&#46;3&#37; of patients&#44; and 51&#46;9&#37; of patients underwent procedures which involved frontal recess&#46; An uncinectomy was performed during surgery in 13 patients &#40;48&#46;1&#37;&#41; and posterior ethmoidectomy was performed on 12 patients &#40;44&#46;4&#37;&#41;&#46; These findings are presented in <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> and compared to those in the literature&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Out of the total patients analysed in this study&#44; 15 biopsies provided information regarding chronic&#44; nonspecific inflammation&#44; 9 of which corresponded to inflammatory polyps and 7 to inverted papilloma&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Breakdown by Diagnosis</span><p id="par0105" class="elsevierStylePara elsevierViewall">The breakdown of patients according to their postoperative diagnosis into the groups of inverted papilloma &#40;5 patients&#41;&#44; polypoid CRS &#40;15 patients&#41; and non polypoid CRS &#40;3 patients&#41;&#44; was obtained from the following results&#58; patients with inverted papilloma and polypoid CRS were similar in average age &#40;48&#46;4&#41; and &#40;48&#46;8&#41; and age range &#40;29&#8211;66 years&#41; and &#40;27&#8211;66 years&#41;&#44; respectively whilst patients with non polypoid CRS were younger &#40;mean age of 38&#46;3&#44; range of 26&#8211;46 years&#41;&#46; With regards to gender distribution&#44; the first 2 groups were predominantly male &#40;3&#58;2 and 4&#58;1 ratio respectively&#41; and the third group was predominantly female &#40;1&#58;2 ratio&#41;&#46; The range of effective time of control in patients with inverted papilloma was 3&#8211;11 months and that of polypoid CRS was 4&#8211;27 months&#46; It was not possible to calculate the average of the 3 groups and the range of the non polypoid CRS patients due to the fact that not all of the patients&#8217; medical files contained these data&#46; Time between surgery in the group of inverted papilloma was 52&#46;2 months on average &#40;range from 3 to 120 months&#41;&#44; and it was not possible to calculate the mean in other groups for the reasons already stated &#40;the range for polypoid CRS was from 8 to 240 months and for non polypoid CRS from 36 to 84 months&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The most common symptoms in patients with inverted papilloma was nasal obstruction and rhinorrhea &#40;2 patients per condition&#41;&#44; followed by roncopathy and facial algia &#40;one patient&#41;&#46; Only one patient was symptom free&#46; Furthermore&#44; in the polpypoid CRS group 11 patients suffered from nasal obstruction&#44; 4 from rhinorrhea and posterior discharge&#44; 2 from hyposmia and 1 each from facial oedema&#44; nasal congestion&#44; headaches and anosmia&#46; No patients were asymptomatic&#46; In the non polypoid CRS group the most frequently reported symptoms were nasal obstruction&#44; hyposmia&#44; rhinorrhea&#44; facial algia&#44; posterior discharge and cacosmia &#40;all with a frequency of one patient in each&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Regarding premedication&#44; only 2 patients with inverted papilloma received any medication &#40;one patient was administered oxymetazoline and another betametasone and moxifloxacin&#41;&#46; However&#44; premedication was more frequent in the polypoid CRS group &#40;3 patients received prednisone&#44; two received injectable Dacam Rapilento&#44; one Iliadin and another Montelukast&#41;&#46; In the non polypoid CRS group only one patient received premedication recorded on file &#40;amoxicillin&#47;clavunlanic acid&#41;&#46; The main anatomical and radiological findings together with the surgeries performed in the 3 groups are shown in <a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a> by the frequency in which they were reported&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">In the inverted papilloma group the pathological anatomy results confirmed the diagnosis in 3 patients&#46; In the polypoid CRS patients the presence of polyps was described in 5 patients and they all presented with chronic inflammation&#46; In the non polypoid CRS group chronic inflammation was described in all patients&#44; with no other findings&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">In our centre a total of 299 ESS were performed&#44; over a period of 3 years&#46; Of these surgeries 27 corresponded to RESS&#44; equivalent to 9&#37;&#46; This percentage of RESS is in keeping with that established in the literature&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">In our data we observed a substantial difference between effective control time after the primary ESS&#44; compared with the average time to elapse between this surgery and RESS &#40;11&#46;9 months vs 6&#46;1 years&#41;&#46; On average&#44; patients who underwent primary ESS withdrew from their medical check-ups before a year had passed since surgery and consulted again 6 years later for a condition that required resolution with new surgery&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">The time elapsing between both operations in our series&#44; on average is greater than that described in the literature&#44; but when comparing the range of this time&#44; it is generally observed that it is earlier than the range of time recorded &#40;3 months to 10 years in our series vs 0&#46;7 to 18&#46;6 years in the literature&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> It may be inferred from this that in our centre there was a tendency towards early revision surgery although further in-depth analysis of the various medical and non-medical variables which may have had some effect on this decision would need to be performed&#46; It should be considered that we do not have data regarding the frequency of patients who were active smokers in our series&#44; a factor which has an effect on the time elapsing between one operation and another&#44; as these patients generally require earlier revision surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">On comparing our data with those available in the literature reviewed for this study&#44;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">5&#44;6</span></a> we may observe greater frequency of maxillary compromise in our patients&#44; which is reflected by a larger percentage of procedures carried out in the maxillary sinuses during surgery&#46; By contrast&#44; there are fewer procedures which involve the ethmoidal&#44; sphenoidal and frontal sinuses&#46; The frequency of persistent uncinate process and uncinectomy observed is relatively similar to that described in the literature&#44; but it should be taken into consideration that in our hospital uncinectomy is included within the concept of antrostomy which was the most commonly performed procedure&#44; and the frequency of uncinectomy may therefore be underestimated in our series&#46; There was a greater frequency of polyposis&#44; inverted papilloma and mucous cyst than in the literature&#44; together with their respective surgical procedures such as polypectomy and mucous cyst marsupialisation&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Notwithstanding&#44; analysing the findings from radiological events it was observed that the changes in the maxillary sinus rank third in frequency&#44; not first as was to be expected since it is the sinus most commonly compromised in surgical protocols&#46; Ethmoidal compromise ranks first and second &#40;anterior and posterior air cells respectively&#41; despite the fact its frequency is even lower than that reported in the literature regarding the compromise observed during surgery&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">With regard to the pre and post surgical diagnoses&#44; polypoid rhinosinusitis corresponds to the primary diagnosis in both scenarios&#44; with regards to frequency&#46; It was observed that inverted papilloma was a less frequent diagnosis prior to surgery and increases in frequency after surgery&#44; at the same time as non polypoid rhinosinusitis drops in frequency&#46; By this we may infer that inverted papilloma is a pathology of difficult preoperative diagnosis&#46; It is more frequently diagnosed on physical examination which may be interpreted as an increase in its diagnosis after surgical intervention&#46; Furthermore&#44; the incidence of inverted papilloma is even greater when the findings from differed biopsies are considered&#46; In our series&#44; only 2 patients were diagnosed with inverted papilloma prior to surgery&#44; and this increased to 5 patients after surgery and to 7 patients when the histological report was available&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">The differences between our series and the literature regarding anatomical findings and surgical procedures performed may possibly be explained by the number of patients analysed&#46; Our series has a small number of patients who underwent RESS&#46; There is therefore a need for studies with a larger patient sample&#44; either multicentre to reduce the time necessary to accumulate a suitable sample size&#44; or studies with a longer duration&#46; Furthermore&#44; this study is retrospective&#44; with no established data recording protocol and no patient follow-up&#44; thus minimising the reaching of conclusions from this study&#46; Due to its descriptive nature&#44; no formal statistical analysis was made to establish the meaning of the differences recorded compared with the literature&#44; and it is therefore possible that several of the differences established in this study were not statistically significant&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">It should also be emphasised that&#44; as has been expressed above&#44; the patient profile with diseases such as inverted papilloma and sinonasal polyposis is different to that of patients who only present with chronic sinusitis without polyps&#44; i&#46;e&#46; the average age is older in the first 2 groups and very similar between them&#44; whilst the patients without polyposis are younger patients and with less range of time elapsing between one operation and another&#46; The lower upper limit is that of the first 2 groups&#44; which may indicate earlier consultation or enquiry about the persistence of the disease in these patients compared with others&#44; with the result that they develop fewer inflammatory changes at the time of secondary surgery&#46; In future studies&#44; we believe it would be of interest to classify each group of patients and have a higher number of patients to better define these differences&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">All of the above leads to the question of whether to pursue a more aggressive approach in primary surgery to reach those cavities most frequently compromised in revision surgery&#44; and thus prevent the need for further surgery&#46; Better follow-up of these patients is also required and improved adherence to treatment administered&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">We believe further investigation on this matter needs to be conducted for a better understanding of the profile of this patient group and to generate cost-effective measures designed to reduce the number of patients who undergo revision surgery&#46; In this context&#44; our hospital has a rhinology&#47;sinusitis committee&#44; in which the ENT team is dedicated to sinonasal pathology and meets weekly to discuss the most complex and&#47;or controversial cases attended to in our hospital&#46; A joint decision is then reached on which guidelines to follow for the patient&#46; The authors propose that this event be used to create and apply a system of standardised registration to record future structured information on these patients&#44; which would result in more complete data in future studies&#44; whether these be retrospective or prospective&#44; on RESS and pathologies relevant to the said procedure&#46; We hope this proposal may be applied to other hospitals nationally and even internationally&#44; where similar committees exist&#44; so that more enhanced studies may take place in the future&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusion</span><p id="par0175" class="elsevierStylePara elsevierViewall">Endoscopic sinonasal surgery is frequently performed in ENT departments&#44; with a small percentage of patients requiring revision surgery&#46; In our series the presence of sinonasal polyps was a major cause RESS indication&#44; as were radiological and&#47;or anatomical &#40;intraoperative&#41; events of stenotic antrostomy and incomplete &#40;anterior and posterior&#41; ethmoidectomy&#46; All of the above leads to procedures being performed more frequently within surgery &#40;antrostomy&#44; ethmoidectomy and polyp resection&#44; in general&#41;&#46; Furthermore&#44; the time elapsed from primary to revision surgery is generally extensive for these patients&#44; who may withdraw from medical follow-up and adhere poorly to treatment&#44; especially those patients with more intense inflammatory conditions&#44; such as polyposis and inverted papilloma&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Periodical long term follow-up and control&#44; particularly in the most severe forms of the disease are essential to obtain optimal therapy and correct long term management&#44; are is the classification of each group of rhinosinusal diseases&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Endoscopic revision surgery is a challenge for surgeons dedicated to paranasal cavity surgery&#44; with regards to optimising medical management and indicating the surgery at the right moment&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Finally&#44; it is highly important to define the type for revision surgery to be performed to attempt to reduce further surgical interventions in the future&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of Interests</span><p id="par0195" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
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          "identificador" => "xres802197"
          "titulo" => "Abstract"
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              "titulo" => "Introduction and objectives"
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          "titulo" => "Resumen"
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              "titulo" => "Introducci&#243;n y objetivos"
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              "titulo" => "M&#233;todos"
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          "titulo" => "Palabras clave"
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          "titulo" => "Introduction"
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          "titulo" => "Material and Methods"
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              "titulo" => "Breakdown by Diagnosis"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2015-08-03"
    "fechaAceptado" => "2016-02-08"
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          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec800627"
          "palabras" => array:4 [
            0 => "Endoscopic sinonasal surgery"
            1 => "Sinusitis"
            2 => "Polyposis"
            3 => "Endoscopy"
          ]
        ]
      ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
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          "palabras" => array:4 [
            0 => "Cirug&#237;a endosc&#243;pica nasosinusal"
            1 => "Sinusitis"
            2 => "Poliposis"
            3 => "Endoscopia"
          ]
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      ]
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Endoscopic sinonasal surgery is the procedure of choice in the treatment of chronic rhinosinusitis and sinonasal polyposis refractory to medical treatment&#44; with high rates of success &#40;76&#37;&#8211;97&#46;5&#37;&#41;&#46; However&#44; 2&#46;5&#37;&#8211;24&#37; of those patients will require revision surgery &#40;RESS&#41;&#46; In this study&#44; we present the clinical&#44; anatomical&#44; radiological and histological features of patients receiving RESS in our centre during a 3-year period&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A retrospective review of clinical&#44; anatomical&#44; radiological and histopathological data of patients receiving revision endoscopic sinonasal surgery between 2012 and 2014 was carried out&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">From 299 surgery procedures performed&#44; 27 &#40;9&#37;&#41; were revision surgeries&#46; The mean patient age was 46 years&#44; with a male&#47;female ratio of 1&#46;4&#47;1&#46; The most frequent preoperative and postoperative diagnosis was chronic polypoid rhinosinusitis&#46; The mean time since the previous surgery was 6&#46;1 years&#44; with 11&#46;9 months of mean follow-up since that surgery&#46; Stenotic antrostomy was found during revision in 81&#46;5&#37; of the patients and incomplete anterior ethmoidectomy and persistent uncinate process&#44; in 59&#46;3&#37;&#46; In radiology&#44; 70&#46;4&#37; of patients had persistent anterior ethmoidal cells&#46; Antrostomy or widening of antrostomy was performed in 96&#46;3&#37; of cases and anterior ethmoidectomy or completion of it was performed in 66&#46;7&#37;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Polyps&#44; stenotic antrostomy and incomplete ethmoidectomy were the most frequent causes of revision surgery&#44; in concordance with the procedures performed&#46; The patients had long periods of time without follow-up between surgeries&#46; Further investigation is necessary to generate measures to reduce the number of revision surgeries&#46;</p></span>"
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          1 => array:2 [
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            "titulo" => "Methods"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n y objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La cirug&#237;a endosc&#243;pica nasosinusal es el procedimiento de elecci&#243;n para tratar la rinosinusitis cr&#243;nica y poliposis nasosinusal refractarias a tratamiento m&#233;dico&#44; con un alto porcentaje de &#233;xito &#40;76 a 97&#44;5&#37;&#41;&#46; Sin embargo&#44; de 2&#44;5 a 24&#37; de los pacientes requieren cirug&#237;a de revisi&#243;n&#46; En este estudio describimos las caracter&#237;sticas cl&#237;nicas&#44; anat&#243;micas&#44; radiol&#243;gicas e histol&#243;gicas de pacientes sometidos a cirug&#237;a de revisi&#243;n en nuestro centro&#44; en un per&#237;odo de 3 a&#241;os&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Revisi&#243;n retrospectiva de datos cl&#237;nicos&#44; anat&#243;micos&#44; radiol&#243;gicos e histopatol&#243;gicos de pacientes sometidos a revisi&#243;n entre 2012 y 2014&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">De 299 procedimientos quir&#250;rgicos realizados&#44; 27 &#40;9&#37;&#41; fueron de revisi&#243;n&#46; La edad promedio de los pacientes fue 46 a&#241;os&#44; con una relaci&#243;n hombre&#58;mujer de 1&#44;4&#58;1&#46; El diagn&#243;stico preoperatorio y postoperatorio m&#225;s frecuente fue rinosinusitis cr&#243;nica poliposa&#46; El tiempo promedio desde la cirug&#237;a previa fue de 6&#44;1 a&#241;os&#44; con 11&#44;9 meses de seguimiento promedio desde esa cirug&#237;a&#46; Un 81&#44;5&#37; de los pacientes presentaba antrostom&#237;a esten&#243;tica durante la revisi&#243;n&#44; y un 59&#44;3&#37; etmoidectom&#237;a anterior incompleta y proceso unciforme persistente&#46; El 70&#44;4&#37; de los pacientes ten&#237;a celdillas etmoidales anteriores persistentes en radiolog&#237;a&#46; Se realiz&#243; en un 96&#44;3&#37; de los casos antrostom&#237;a o ampliaci&#243;n de esta&#44; y en un 66&#44;7&#37; se realiz&#243; o se complet&#243; la etmoidectom&#237;a anterior&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Las causas m&#225;s frecuentes de revisi&#243;n fueron los p&#243;lipos&#44; antrostom&#237;a esten&#243;tica y etmoidectom&#237;a incompleta&#44; concordante con los procedimientos realizados&#46; Los pacientes tuvieron largos per&#237;odos sin seguimiento entre cirug&#237;as&#46; Es necesario continuar la investigaci&#243;n para generar medidas que reduzcan el n&#250;mero de cirug&#237;as de revisi&#243;n&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Cantillano P&#44; Rubio F&#44; Naser A&#44; Nazar R&#46; Cirug&#237;a endosc&#243;pica nasosinusal de revisi&#243;n&#46; Acta Otorrinolaringol Esp&#46; 2017&#59;68&#58;1&#8211;8&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">&#40;A and B&#41; CT scan of the nose and paranasal cavities&#46; Coronal slices of the patient who underwent endoscopic sinonasal surgery 10 years previously&#46; Remnants of uncinate apophasis and type III Kuhn frontal air cells may be observed&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">CT scan of the nose and paranasal cavities&#46; Sagittal slice of patient who underwent endoscopic sinonasal surgery 10 years previously&#46; Persistent type III Kuhn frontal air cells may be observed&#44; with secondary inflammatory compromise&#46; This was the indication for revision endoscopic sinonasal surgery&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Preoperative diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Postoperative diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chronic polypoid rhinosinusitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Polypoid chronic rhinosinusitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Non polypoid rhinosinusitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Inverted papilloma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mucous cyst&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mucous cyst&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Inverted papilloma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Non polypoid chronic rhinosinusitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Antrochoanal polyp&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Antrochoanal polyp&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Otontogenic sinusitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Otontogenic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Pre and Post Operative Diagnoses in Decreasing Order of Frequency&#46;</p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Symptoms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nasal obstruction nasal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rhinorrhea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Facial algia or cephalgia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Posterior discharge&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anosmia or hyposmia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Otalgia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Facial oedema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cacosmia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Asymtomatic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Note</span>&#58; The events described by Khalil et al&#46; were compared as were those of Musy and Kountakis&#46; The events not described or found are noted with a &#40;&#8722;&#41; sign&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Anatomical events&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Present study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Khalil et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Musy and Kountakis<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Stenoic antrostomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Incomplete anterior ethmoidectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Persistent uncinate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Incomplete posterior ethmoidectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Polyposis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Compromised frontal recess&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Others&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sphenoid compromise&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lateralised middle turbinate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Amputated middle turbinate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Inverted papilloma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mucous cyst&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Recirculation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Significant septal deviation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Retained <span class="elsevierStyleItalic">Agger nasi</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Radiological findings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Persistent anterior ethmoid sinuses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Persistent posterior ethmoid sinuses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Maxillary sinus compromise&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Frontal recess residual air cells&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Septal deviation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Persistent uncinate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Polyposis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Compromise of the sphenoid sinus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Occupation of the sinusal cavity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Others&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Compromise of the frontal sinus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lateralised middle turbinate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Speno ethmoid recess compromise&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Note</span>&#58; They are compared with the results from Musy and Kountakis&#46; The procedures not performed or not described are noted with a &#40;&#8722;&#41; sign&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Procedure performed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Present study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Musy and Kountakis<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Antrostomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">96&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anterior ethmoidectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Polyps resection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Frontal sinustomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Uncinectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Posterior ethmoidectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Shenoidotomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Turbinectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mucous cyst marsupialisation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Others&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Procedures Performed Carried Out During Endoscopic Revision Surgery&#44; in Decreasing Order of Frequency&#46;</p>"
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            "identificador" => "at6"
            "detalle" => "Table "
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Main findings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Diagnosis</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Inverted papilloma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Polypoid CRS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Non polypoid CRS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Anatomical findings</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Stenoid antrostomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Incomplete anterior ethmoidectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Incomplete posterior ethmoidectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Persistent uncinate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Synechiae&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mucous cyst&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Changed frontal recess&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sphenoid disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lateralised middle turbinate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Amputated middle turbinate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Recirculation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Radiological findings</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Incomplete anterior ethmoidectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Incomplete posterior ethmoidectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Maxillary residual air cells&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Septal deviation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lateralised middle turbinate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Persistent uncinate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Residual spheno-ethmoidal recess air cells&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Frontal residual air cells&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sphenoid residual air cells&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Obstructed sphenoid ostium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Surgery performed</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Antrostomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Anterior ethmoidectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Posterior ethmoidectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Uncinectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Turbinectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mucous cyst rupture&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Frontal sinusotomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sphenoidotomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Frontal mini-trephination&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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Article information

ISSN: 21735735
Original language: English

DOI:10.1016/j.otoeng.2017.01.006

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