الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The frontal recess and frontal sinus remain the most challenging region of sinus surgery due to the variability and very complex nature of the cellular patterns seen in this region .The key aim of operating in the frontal recess is not only to relieve obstruction of the outflow tract and thereby definitively treat the existing disease from an anatomical perspective, but also, and more importantly, prevention of recurrent disease.
Frontal sinus disease is present in 48% to 63%of all revision sinus cases, suggesting that frontal sinusitis is a significant factor in overall failures. Revision frontal sinus surgery remains one of the greatest challenges facing the skilled endoscopic surgeon. Primary endoscopic sinus surgery has a long-term success rate greater than 90%; therefore, patients requiring revision frontal sinus surgery represent a subset of patients with advanced or poorly controlled disease.
The aim of the current study was to detect possible causes of persistent or recurrent frontal sinus disease radio-logically and intra-operatively at the frontal recess and /or frontal sinus at the time of the revision surgery.
The Study was performed on 20 patients who were attending Otorhinolaryngology clinic (at the Main hospital of university of Alexandria) who had a history of previous frontal sinus surgery (open or endoscopic) and still had persistent or recurrent symptoms refractory to medical treatment postoperatively.
All patients had a preoperative non contrast multi-planner CT nose and paranasal sinuses with axial ,coronal and sagittal reconstruction before the time of the revision surgery. The commonest findings identified in revision cases are: recurrent mucosal diseases , A partially amputated middle turbinate or lateralization of the entire middle turbinate, residual superior portion of the uncinate , Scarring , osteoneogenesis and/or retained cells e.g. remnant ethmoid bulla cap , un-dissected Agger nasi or frontal cells.
At the time of the revision surgery, intra-operative common causes of frontal recess and/or frontal sinus persistent obstruction were evaluated : Persistent polyps, Remnant Agger nasi, Remnant cap of ethmoid bulla , medially displaced superior remnant of the uncinate process , Retained frontal cells, Retained supraorbital ethmoid cells, Iatrogenic scarring of the frontal recess and ostium and /or lateralized middle turbinate.
So, to increase the chance of success at the time of revision surgery, thorough evaluation of the patients should be performed to detect the cause underlying failure of the previous operation. Multiple findings can be identified by the preoperative CT and intra-operatively that contribute to frontal recess obstruction. So, a comprehensive approach to address all factors is necessary to prevent surgical failure among patients presenting for revision surgery.