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OTORINOLARINGOLOGIA

A Journal on Otorhinolaryngology, Head and Neck Surgery,
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Otorinolaringologia 2003 September;53(3):109-21

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

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


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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.

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