Surgical Treatment of Nasal Polyposis

Abstract

Modern endonasal surgery that is widely being performed in the world today has been developed and transformed for more than 100 years. Numerous physiologists, anatomists, and surgeons such as Grunwald, Hilding, Killian, van Alyea, Hayek, Ingal, Moscher, and Onodi have paved the way for this development. In the first period of endonasal approach, complication rates were high related to limited view and lack of comprehensive anatomical knowledge. Nasal polyposis (NP) constitutes the subgroup of one-fifth of patients with chronic rhinosinusitis accompanying a more intense mucosal inflammation and more frequent relapse. Surgical and medical treatments or almost both treatments have a part in the treatment of NP. Nevertheless, the content, timing, and duration of treatment are contradictive. NP may be considered as a consequence of common phenotype generated in the nasal mucosa of many diseases or pathological processes, and the medical approach is basically paramount for treatment. Surgical treatment is used for patients who have resistance to maximal medical treatment and who are not able to use systemic steroid and for those with massive nasal polyposis with advanced nasal congestion. This treatment indicates a spectrum extending from simple polypectomy to radical “nasalization.” The most widespread surgical approach is “functional endoscopic sinus surgery” (FESS). There is no completely curative surgical method and the relapse rate is high. The main goals of FESS are to clean polyps and the polypoid mucosa, to increase ventilation by opening the sinus ostia, heal mucociliary clearance, and provide paranasal physiologic restoration. Furthermore, FESS states an approach rather than operation that can be standardized and it is quite difficult to do a randomized controlled study that is able to evaluate the results for NP treatment due to several reasons. In the surgical treatment of NP, FESS has supplanted conventional methods or techniques at the present time.