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Master Thesis

Facteurs de risque d’échec des sinusotomies frontales par voie endonasale : étude rétrospective de 82 cas

Abstract : Because of its complex anatomy, its close relationship with high importance structures, frontal sinus surgery remain a real challenge for the ENT surgeon. The advent of endoscopic sinus surgery with the techniques described by W. Draf have proven their efficiency and reliability by reducing morbidity compared to prior. Few data are available on the factors that may contribute to their failure and the choice between different techniques are still poorly codified. The purpose of this study was to identify the risk factors for failure of DRAF II and III and to specify the use of each procedure according to the different indications. We conducted a retrospective study from 2011 to 2016 that included all patients in our department operated from DRAF Type II and III, with a minimum follow-up of 6 months, regardless of indication. Of the 82 patients included, 33% had Chronic Rhinosinusitis (CR), 32% mucoceles, 27% cancers, 6% benign tumors and 2% of sinus aspergilloma. Twenty-three patients (28%) underwent one or more revision surgeries with a total of 29 procedures. Clinical factors significantly associated with revison in univariate analysis were mucoceles and RSC (p: 0.0047), type of intervention DRAF I and DRAF III (p: 0.012), presence of previous surgeries (p: 0.0205) and asthma (p: 0.0177). On pre-operative exams CT and MRI a frontal spine> 8 mm and an "accessible dimension" <5 mm were significantly associated with a higher risk of failure. The most important risk factors for revision are the inflammatory pathologies specific to the sinonasal mucosa (RSC and mucocele). For these patients, it seems that performing DRAF III as first-line therapy is more appropriate.
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Master Thesis
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Submitted on : Monday, November 27, 2017 - 4:07:53 PM
Last modification on : Tuesday, December 12, 2017 - 1:20:25 AM


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Sylvain Champel. Facteurs de risque d’échec des sinusotomies frontales par voie endonasale : étude rétrospective de 82 cas . Médecine humaine et pathologie. 2017. ⟨dumas-01649611⟩



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