Year: 1999 Vol. 65 Ed. 3 - (2º)
Artigos Originais
Pages: 206 to 214
Endoscopic Surgery Children.
Author(s):
Elisabeth Araújo*,
Fábio Anselmi**,
Daiana P. Stolz***,
Bruno C. Palombini****.
Keywords: endoscopic surgery, rhinosinusitis in children, chronic rhinosinusitis
Abstract:
Introduction: Most rhinosinusitis in childhood is self-fmiting, and develops to spontaneous cure arcund 7 years of age. However, there is a group of children in whom rhinosinusitis is an aggravating factor, and may unbalance a borderline clinical condition. In such cases, the indication for endoscopic surgery of the paranasal sinuses (ESPS) should be considered. Subjects and methods: In this study, 126 pediatrac patients (ages 3 to 17 years) submitted to ESPS between 1989 and 1996, were analyzed. The mean postoperative follow up time was 22.7 months. These patients were referred by ENTs, pulmonologists and pediatricians, after undergoing several previous treatments without any clinical response. The patients were followed for a minimum period of 6 months, and the result of surgery was assessed by a questionnaire which analyzed the postoperative symptoms and the subjective evaluation by the parents, regarding the resulting benefit of the surgical procedure to the child's health. These postoperative results were evaluated according to the groups of predisposing factor.. Results: Among the characteristics of the group studied, asthma was found in 44 patients, allergy in 36, immunodeficiencies in 13, cystic fibrosis in 4, immotile cifa syndrome in 3, isolated chronic sinusitis in 19, mucocele in 3, and antrochoanal polyp in 4. The subjective evaluation of endoscopic surgery indicated that 37% (46) of the patients considered themselves cured of rhinosinusitis and 42% (53) showed improvement of therr clinical picture (78% good results). Analyzing the result., the patients in groups presenting chronic rhinosinusitis(64%), mucocele (100°/0), antrochoanal polyps (75%), without any other associated systemic diseases, presented the best results. Among the patients with asthma, 40% were cured and 43% showed an improvement of the sinus picture, with 83% good results. Patients with cystic fibrosis and immotile cilia syndrome had the worst results. Conclusion: Although the indications for endoscopic surgery of the paranasal sinuses in pediatric patients are more limited than in adults, they are reserved for cases of refractory rhinosinusitis which cause significant impact on the general health of the child. The postoperative results of endoscopic surgery in pediatric patients are associated to the presence of systemic co-morbidity.
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