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Sinus problems. CT scan, mucosal thickening, maxillary spine resected. Previous sinus surgery. Treatment options?

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Hi I had a sinus surgery about two years ago but recently have had pressure on my forehead (especially on my right side near the eye. Also in the below, is the “left” actually referring to my right side?). Hence, I took a CT scan again. Below are the findings:
The patient is status post bilateral partial ethmoidectomies and antrectomies since the prior examination. There is mucosal thickening superficial to an agger nasi cell on the left although the frontoethmoid recess is otherwise clear. The frontal sinuses are otherwise clear. There is no nasal or nasopharyngeal mass. The previously seen deviation of the maxillary spine is no longer present. Maxillary spine appears to have been resected. There is no bony destruction or expansion. The intraorbital contents are unremarkable as is the orbital apex and sella turcica. Middle ear cavity and mastoid air cells are grossly clear.
Would you be able to interpret this in a detailed and understandable way? Also, my doctor recommended that I have another surgery to clean my sinuses (especially frontal). Do you think this is necessary? If not, what other options are there to relieve the pressure?

Thank you.
Posted Sun, 22 Apr 2012 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 9 hours later

Thank you for your query.

1. Your Scan findings suggest that you have undergone a mini-FESS (Function Endoscopic Sinus Surgery) on the maxillary and anterior ethmoid sinuses on both sides. A Septoplasty has been done, however there is no mention of the septum or of all the changes expected post SMR (SubMucus Resection).

2. A CT Scan is traditionally reported with the axial images seen from the foot end of the patient. Hence 'left' of the image is the patient's 'right' and vice versa. Coronal images are seen from the front facing the patient and the same rule applies. However, the reporting is done as per the patient's 'right' and 'left' in the true sense. Older Scan machines required the patient to be placed prone (stomach down) doe a sinus scan and hence often messed up the labeling. At such times of doubt, I co-relate the clinical findings such as DNS (Deviated Nasal Septum) or side of symptoms with the images. Newer multi-slice Ct Scan Machines do not have this problem as the patient is supine (on his/er back) at all times.

3. Your frontal sinuses are clear in this CT Scan. Hence you should have a trial with medication before considering repeat surgery, especially in the narrow frontal area.

4. Para sagittal scan images are a must before any attempt at frontal sinus surgery. This is because the frontal cells and frontal sinus drainage pathway is three dimensional.

5. You may share the CT Scan images, preferably from a CD/DVD, via a free file sharing site such as WWW.WWWW.WW or WWW.WWWW.WW for an accurate assesment. Give the link over here for me to access them.

6. The need for the surgery is better critically analyzed by the examining surgeon. If there is a sure need, Balloon Sinuplasty is a new option.

Hope I have answered your query. If you have any follow up queries I will be available to answer them.

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