Surgical Update

Abstract

Radical stripping of diseased sinus mucosa has been considered the correct surgical approach to chronic sinusitis on the basis that severe mucosal thickening was irreversible. Now, nasal endoscopy has disproved this belief by showing that chronic sinusitis is primarily a disease of obstruction, with inflammation as a secondary manifestation. Once obstruction is surgically corrected and ventilation restored, the mucosa may regain near-normal appearance and function. For chronic sinusitis that falls to respond to antibiotic therapy—and for recurrent acute sinusitis associated with abnormalities of the ostiomeatal complex—functional endoscopic sinus surgery offers the patient real hope of permanent relief from symptoms of sinusitis. Careful postoperative follow-up with endoscopic evaluation enhances effectiveness of this more recent approach to sinus surgery. The Importance of presurgical evaluation via endoscopy and computed tomography cannot be overemphasized.