Surgical Treatment Of Nasal Polyposis Research Articles

A comparison of use microdebrider with conventional endoscopic surgery for nasal polyps

Background: Nasal polyps are chronic and benign inflammatory lesions that arise from the mucous membrane of the nasal cavity and paranasal sinuses. And it represents a challenge in treatment due to its uncertain causes and recurrent relapse. Because of that the surgical treatment is considered as the best choice for the removal of nasal polyps. And, it contains endoscopic sinus surgery using either conventional instruments or the microdebrider which is an automatic device used to remove the obstructing tissue. And, it represents a modern technology in the treatment of nasal polyps. Objectives: Studying and comparing the microdebrider assisted endoscopic surgery and conventional methods using sinus endoscopes in the surgical management of nasal polyps, and evaluating the advantages of the microdebrider. Methods: The study was a comparative prospective study conducted at the department of ENT, tishreen university hospital, lattakia, Syria done between 2020 to 2021. 76 patients (46 male and 30 females) were enrolled in the study and divided into two groups depending on the used surgical method. Group1: conventional endoscopic sinus surgery method, Group2: microdebrider assisted endoscopic surgery. Then, comparing the results during and after 3 months of the surgery. Results: There were a significant difference between study groups in the mean time required for surgery (shorter in group2 with p-value <0.01) and the average intraoperative blood loss (less in group2 with p-value<0.01). Endoscopic sinus surgery with the microdebrider noted a low rate of postoperative synechiae formation after three monthes and there is no significant difference between the two groups in recurrence of nasal polyps after three monthes. Conclusion: Using the microdebrider in the surgical treatment of nasal polyposis is an effective and safe method because it has the advantage of saving time, decreasing blood loss during surgery, and reducing the rate of postoperative synechiae formation. but there is no significant difference in recurrence between the microdebrider and conventional methods.

Application of Functional Endoscopic Sinus Surgery with Navigation system in Medical University - Pleven: Pilot results

Background: Functional Endoscopic Sinus Surgery (FESS), supported by a navigation system, is a modern minimally invasive method for diagnosis and surgical treatment of nasal polyposis, acute and chronic sinusitis, benign and malignant tumors of the nasal cavities and skull base, congenital anomalies, severe epistaxis, and a number of other pathological processes in these anatomical areas. Advantages of the method are the improved orientation through navigation, reduced blood loss, sparing of neighboring tissues and structures, optimization of postoperative results, reduction of recovery period and pain as well as the optimized quality of life of the patient. Aim: Presentation of pilot results from the first surgical interventions under Work Package 3 “Endoscopic sinus surgery, supported by a navigation system, in ENT practice”, performed in the “Integrated Interdisciplinary Operating Unit with Navigation and Telesurgery Systems” built under the project BG05M2OP001–1.002–0010 “Center of Competence in Personalized Medicine, 3D and Telemedicine, Robot-assisted and Minimally Invasive Surgery” funded by the “Science and education for smart growth” Operational Program and the European Regional Development Fund. Results: The surgical interventions were performed without intraoperative and early postoperative complications; the recovery period was smooth. During the follow-up examinations, we observed good local postoperative status, optimal period of healing and absence of subjective complaints reported by the patients. Conclusion: Our pilot results support the advantages of navigated FESS for safer, more precise and sparing radical treatment of diseases of the nose and nasal cavities. Extended multidisciplinary studies are forthcoming within the project for overall assessment of the significance and applicability of the introduced method in different groups of patients.

Surgical Treatment of Nasal Polyposis: A Comparison between Cutting Forceps and Microdebrider

Nasal polyposis (NP) is defined as a specific form of chronic rhinosinusitis (CRS), characterized by bilateral and multifocal polyps. Functional endoscopic sinus surgery represents the gold standard therapy when medical treatment fails. The availability of different tools raises the question of which one provides significant advances in technique and surgical outcome. This study considered the outcome of the surgical treatment of NP in relation to several comorbidities and the surgical device used: the microdebrider versus the Blakesley traditional forceps. Other studies compared the two instruments but did not evaluate the clinical relevance of history of comorbidities such as asthma, allergy, and eosinophilia. A prospective randomized single-blind study was designed to analyze 311 cases of bilateral CRS with NP. Each patient served as his/her own control, meaning that one side was operated on using the Blakesley forceps and the opposite side using the microdebrider. The follow-up period was 13.3 ± 1.2 months. The Blakesley forceps caused a significantly lower NP recurrence rate than the microdebrider (p < 0.001), which was more effective in preventing synechia formation (p < 0.05). Only asthma was significantly associated with a higher recurrence rate, without being influenced by the instrument used (p < 0.001). The manual instrument allowed for a significantly lower recurrence incidence but yielded a higher rate of synechia formation compared with the microdebrider. Only asthma was significantly associated with a poorer clinical outcome, and gender, age, allergy, and eosinophilia did not affect the surgical prognosis.

Middle turbinate preservation versus middle turbinate resection in endoscopic surgical treatment of nasal polyposis

Middle turbinate preservation versus middle turbinate resection in endoscopic surgical treatment of nasal polyposis

Middle turbinate preservation versus middle turbinate resection in endoscopic surgical treatment of nasal polyposis

Conclusion. Relapse in patients affected by nasal polyposis and subjected to endoscopic surgery appears to be a relevant feature. Surgical treatment shows a significant increase in quality of life in all the patients aside from surgical technique used. Our results show a better control of relapse of nasal pathology in patients subjected to more radical surgery (group B) vs patients subjected to conservative surgery on middle turbinate (group A). Allergic patients in group B had a smaller number of relapses during the follow-up period compared with allergic patients in group A and this was statistically significant. Objectives. Different endoscopic surgical techniques have been applied for the treatment of nasal polyposis. During ethmoidectomy, some authors prefer to remove the middle turbinate while others preserve this structure. To date, there have been no studies comparing the results, in a homogeneous case series of patients operated exclusively for nasal polyposis, between those whose middle turbinate was resected and those whose middle turbinate was preserved. The aim of our study was to compare results in these two groups of patients. Patients and methods. A prospective study was performed. Nasal polyposis was studied on the basis of endoscopic examination and all the patients were classified on the basis of CT of paranasal sinuses using the Kennedy CT staging system. In the study group, only subjects affected by nasal polyposis with stage II–III at endoscopic evaluation and a Kennedy score of III–IV, affected by nasal polyposis, and not responsive to medical treatment were recruited. The presence of allergy was evaluated by skin prick test results and that of asthma by spirometric examination. Recurrence rates and quality of life were evaluated in a 3-year follow-up. Results. In total, 56 patients were selected and all were observed over a 3-year follow-up period. We identified two groups: group A, 34 patients (60.71%) affected by nasal polyposis who underwent endoscopic surgery with the conservation of middle turbinate; group B, 22 patients (39.29%) affected by nasal polyposis who underwent more radical endoscopic sinus surgery. Analyzing the entire study group, during the 3-year follow-up, 20 (35.71%) of the 56 patients had a relapse of nasal polyposis. Analyzing time to relapse curves in the allergic and non-allergic patients, we obtained a p value of 0.0589, i.e. at the limit of statistical significance. The comparison between preoperative and postoperative Cologne test in the whole study group was statistically significant for a symptomatic improvement (p<0.001). Trends within the two groups were also evaluated: there was a statistically significant difference in behavior upon time to relapse of the patients in group B vs group A (p=0.0102). The patients in group A developed nasal recurrence more frequently during the follow-up periods. In patients affected by allergy vs patients not affected by allergy in group A, a statistically significant difference was noted (p=0.0074); the allergic patients developed nasal recurrence more frequently during the follow-up period. We could not find a statistically significant difference between those patients affected by allergy and those not affected by allergy, as regards the number of relapses in patients in group B.

Influence of allergy in patients with nasal polyposis after endoscopic sinus surgery

Conclusion. Allergy does not modify the symptoms and steroid consumption (oral and local) of nasal polyposis (NP) patients after functional endoscopic sinus surgery (FESS). Objectives. To assess the role of allergy in the evolution after FESS of patients presenting with the diagnosis of NP. Patients and methods. This was a prospective study of 63 consecutive patients with NP (57% males, mean age 45.8 years), who were analyzed to detect whether the results of a surgical treatment of NP were influenced by the presence of positive allergic tests (Phadiatop®). Three nasal criteria were scored: nasal obstruction, posterior rhinorrhea, and the loss of smell. The frequency of asthma was evaluated. Medical treatment of NP after FESS consisted of washing of the nasal cavities, steroid spray, and oral steroid administration. The amount of consumption of steroids (prednisolone and beclomethasone) was studied. Results. Decrease of all nasal symptoms was not statistically different in the two groups of patients with and without allergy. Cumulative consumption of prednisolone and beclomethasone after surgery was similar in the two groups.

Evaluation of the surgical treatment of nasal polyposis. II: Influence of a non-specific bronchial hyperresponsiveness

Conclusion. Bronchial hyperresponsiveness (BHR) is not a risk factor for surgery in patients with nasal polyposis (NP). Objective. Management of NP should be primarily medical, and surgery should not be envisaged before a trial of dual steroid therapy. In patients with severe NP resistant to a strict medical treatment, endoscopic sinus surgery is performed, but no prognostic factor for efficacy of surgery is obvious. Some authors suggest that asthma could be a major risk for ineffectiveness of surgery. The aim of this study was to evaluate whether the presence of BHR can be considered a risk factor for ineffectiveness of surgery. Subjects and methods. Surgery (with associated medical treatment) was evaluated over a mean follow-up period of 74 months. A total of 63 subjects without and 131 subjects with BHR were operated according to a standardized protocol. Results. The present study shows that combined surgery and corticosteroid therapy is effective in the treatment of severe NP, producing significant and long-term improvements in symptoms and in the size of nasal polyps. BHR did not influence the outcome. Moreover, the mean amount of prednisolone and beclomethasone necessary after surgery was similar in the two groups.

Surgical treatment of nasal polyposis in patients with aspirin intolerance

It is not fully understood why humans possess paranasal sinuses and for many years there has been speculation as to their physiological significance.1 Much the same uncertainty holds true for...