Resident University of Pittsburgh Medical Center UPMC Pittsburgh Pittsburgh, Pennsylvania
Introduction: Modified endoscopic medial maxillectomy (MEMM) was first systematically studied for the treatment of chronic sinus disease in adult patients with cystic fibrosis chronic rhinosinusitis (CF-CRS) in 2012. It was determined that adult CF-CRS patients had improved sinonasal outcomes following MEMM in conjunction with endoscopic sinus surgery (ESS). A MEMM creates a common sinonasal cavity that facilitates more effective daily sinonasal irrigation delivery and in-office debridement. The objectives of the current study are to evaluate the surgical and medical outcomes for pediatric patients with CF-CRS who undergo MEMM and ESS for CF-CRS treatment.
Methods: An IRB approved retrospective chart review was performed on all pediatric patients with cystic fibrosis at a single tertiary care children’s hospital who underwent MEMM for treatment of CF-CRS with or without polyps. Demographics, operative notes, medications, hospitalizations, and clinic notes were assessed. Welch’s t-test was used to compare pre and postoperative means.
Results: Twenty-three patients, ages 2-22 years old with an average age at time of surgery of 11.88 years ± 4.64, underwent MEMM for CF- CRS between 2016-2021. 22 patients (96%) underwent ethmoidectomy, 18 (78%) underwent sphenoidotomy, and 16 (70%) underwent frontal sinusotomy as part of their MEMM procedure. There were no intraoperative or post-operative complications from surgery. One patient expired 8 months after surgery from acute respiratory distress syndrome. The average length of follow up was 25.7±16.7 months. 87.0% of patients (20/23) were able to tolerate in-office debridement following surgery. Five patients required a return to the OR: 4 for revision polypectomy only, 1 for debridement (could not tolerate in-office due to Autism diagnosis). The average of available SNOT-22 scores pre and postoperatively was 24.2±11.7 and 11.4 ± 8.5, respectively, p=0.07. FEV1% pre and postoperatively was 88%±14%, 88% ±11%, p=0.96.
Conclusion: This is the first paper to demonstrate that MEMM can safely be performed in a pediatric CF-CRS population. It allows for in-office debridement which is well tolerated in this age-group. It also facilitates effective sinonasal irrigation delivery to promote sinonasal mucosal clearance and decreased need for revision sinus surgery.