REVIEWS  CHRONIC RHINOSINUSITIS 

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

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.