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A Journal on Otorhinolaryngology, Head and Neck Surgery,
Plastic Reconstructive Surgery, Otoneurosurgery
Indexed/Abstracted in: EMBASE, Scopus
REVIEWS CHRONIC RHINOSINUSITIS
Otorinolaringologia 2003 September;53(3):109-21
Endonasal sinus surgery in patients with chronic rhinosinusitis
Gosepath J., Mann W. J.
Departmen of Otolaryngology, Head and Neck Surgery University of Mainz, School of Medicine, Mainz, Germany
Chronic rhinosinusitis (CRS) appears to be of increasing relevance epidemiologically. Presently, its prevalence is estimated at 14% of the population in the USA. Despite some progress in elucidating the etiology of the disease, for example by recent findings regarding the sometimes striking degree of eosinophilia as well as the role of aspirin intolerance (AI) and eicosanoid mediators, the exact pathophysiological mechanisms to a large extent still remain obscure. After the advent of endosopic and microscopic techniques, endonasal sinus surgery evolved to be the treatment of choice in CRS and nasal polyposis in all cases where conservative treatment has failed or resulted in only partial or temporary relief. Over time the surgical technique of endonasal sinus surgery has been described and evaluated by various investigators. Today, state of the art in surgical technique includes the ability to combine microscopic and endoscopic procedures. Whether a surgeon prefers one or the other as a standard technique certainly is related to personal experience using either of them. However the combination of both appears to be advantageous especially in difficult revision cases. Long term postoperative follow-up in large patient groups has revealed the efficacy of a minimally invasive approach to the paranasal sinuses as opposed to a radical procedure. Prospective studies indicated that postoperative improvement in terms of nasal symptoms and quality of life is identical after such rather limited interventions. The benefits of technical advances like powered instrumentation or computer aided surgery (CAS) are still controversially discussed, but certainly both can be very helpful in the hands of an experienced surgeon, especially for the sake of minimizing the surgical trauma, save surgical time and enhance the concept of performing endonasal surgery in a minimally invasive fashion. Regardless of all technical advances, in a modern protocol for patients suffering from CRS and nasal polyposis surgical therapy can only offer one option within a complex therapeutical concept. This concept needs to be individually tailored with respect to the heterogeneous etiologic aspects of the disease in this particular group of patients.