Abstract
A considerable number of patients with paranasal sinus carcinoma or nasopharyngeal carcinoma are treated with radiation therapy. However, endoscopic sinus surgery (ESS) is on rare occasions indicated for refractory sinusitis in patients after radiation therapy, however, the indication and complications of ESS are not well known. We report a case of ESS performed after radiation therapy for frontal sinus carcinoma. An 82-year-old woman was referred to our department for frontal sinus carcinoma. The locally advanced tumor successfully regressed with 60 Gy of radiation therapy. Eight months later, she developed acute sinusitis that was refractory to antibiotic treatment. ESS was performed to establish a drainage route and prevent the spread of infection through the bony defect of the anterior skull base into the intracranial space. ESS was performed safely with
no intraoperative complications, although tumor recurrence was found in the frontal sinus. After surgery,
edematous change was noted in the paranasal sinus mucosa and then subsided. It has been reported that ESS after radiation increases the risks of intraoperative complications and affects wound healing after ESS. Radiation hampers mucosal function, including mucociliary clearance in the paranasal sinuses, which may
prolong sinusitis after ESS. Refractory sinusitis after radiation therapy can be considered as an indication
for ESS, however, the effectiveness and complications of ESS need to be studied in a larger group of patients. We have reviewed the pathophysiology of the irradiated mucosa, and the surgical complications after ESS in patients with postirradiated paranasal sinuses.
