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Published on: June 20, 2018
Repetitive endoscopic sinus surgery failure: a role for radical surgery?
Ward J M Videler1, Volkert B Wreesmann, Freerk W van der Meulen
1Department of Otorhinolaryngology-Head and Neck Surgery, Academic Medical Center, Amsterdam, The Netherlands. W.J.Videler@amc.uva.nl
Summary
Radical surgery, like Denker's procedure, offers significant symptom relief for chronic rhinosinusitis patients unresponsive to endoscopic sinus surgery (ESS). This approach improves congestion, rhinorrhea, and obstruction, providing a viable option for refractory cases.
Area of Science:
- Otolaryngology
- Surgical Innovation
Background:
- Chronic rhinosinusitis (CRS) and nasal polyposis often require endoscopic sinus surgery (ESS).
- A subset of patients remains refractory to ESS, necessitating alternative treatments.
- Radical surgical approaches are considered for severe, recurrent cases to reduce inflammation and improve sinus drainage.
Purpose of the Study:
- To evaluate the efficacy of Denker's procedure as a radical surgical option for patients with refractory chronic rhinosinusitis.
- To assess symptom improvement in patients who have failed previous endoscopic sinus surgery (ESS).
Main Methods:
- A prospective, questionnaire-based study involved 23 patients undergoing Denker's procedure.
- Symptom evaluation (congestion, rhinorrhea, nasal obstruction, olfaction) was performed pre-operatively and at 12 months and 2 years post-operatively.
Main Results:
- Significant improvements were observed in rhinorrhea (70%, P=0.001), feelings of congestion (74%, P=0.02), and nasal obstruction (60%, P=0.03).
- Olfactory perception and asthma symptoms did not show significant improvement.
- The Denker's procedure demonstrated positive outcomes for key sinonasal symptoms in this refractory patient group.
Conclusions:
- Radical surgery, specifically Denker's procedure, can be an effective treatment for chronic rhinosinusitis cases that are resistant to conventional endoscopic sinus surgery (ESS).
- This radical approach offers a viable solution for patients experiencing recurrent failures with ESS, addressing persistent sinonasal symptoms.
