Abstract
Objective: 1) To evaluate the clinical and radiological profile of massive allergic fungal sinusitis (AFS) in children. 2) To evaluate the efficacy of external open sinus surgery for recurrent massive AFS in children.
Method: Retrospective review of clinical and radiological records at tertiary care university hospital. Twelve pediatric patients (age 9-15 years, mean 13.2 years) of recurrent massive AFS who had skull-base erosion, intracranial extension with unilateral or bilateral intraorbital involvement on CT scan were included in study. All patients had undergone multiple unsuccessful endonasal operations (range, 3-5; mean, 3.8). Patients were operated by bilateral lateral rhinotomy and transfrontal approaches (3), transantral endoscopic approach (7), and combined lateral rhinotomy and transnasal approach (2). All patients received postoperative antibiotics and steroids. Postoperative follow-up was done, and symptoms were evaluated (range, 14-24 months; mean 17.5 months).
Results: Nasal obstruction and discharge were the most common presenting complaints. Aspergillus flavus was the most common fungus isolated. All the patients had subjective improvement of symptoms following surgery. Noncontrast CT scan done at least 1 year following surgery showed recidivism of disease in 8.3% cases.
Conclusion: Individualized external open sinus surgery for massive AFS is effective management for patients who have undergone repeated unsuccessful endonasal procedures. Rate of recidivisim (8.3 %) is less compared to that reported for endonasal procedures (10-100%). Morbidity, complications and cost of single external procedure for massive AFS is less as compared to repeated endonasal procedures.
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