[Insufficiency of ethmoidectomy in the treatment of nasal polyposis]

The authors report 100 ethmoidectomies performed on 50 patients between 01/87 and 09/89. 75% have been treated anteriorly by systemic corticosteroids. 65% have had prior sinus surgery. Follow-up time ranged from 12 to 34 months (mean: 18 months). A regular treatment with intranasal steroid sprays was taken post-operatively by 96% of patients until three months and 48% until 18 months. 72% of patients considered the symptoms relief as satisfactorily (score of satisfaction greater than 8/10). Severe nasal obstruction, noted in 88% cases pre-operatively, reappeared in 26% 18 months post-operatively. Anosmia, encountered in 72% pre-operatively, disappeared post-operatively in one half of the cases with a good conservation of olfaction 18 months later. Anterior and/or posterior rhinorrhea, sneezing were also satisfactorily controlled. Results on facial pain were not significant. Endoscopic evaluation was performed by a physician who was not the surgeon. A normoplastic mucosa covered the ethmoid cavities in 40%. Localized oedema was observed in 38%. An asymptomatic recurrence, discovered on endoscopic examination, was present in 11%. The symptomatic recurrence rate was 11%. A CTscan control, performed the day of the endoscopic examination and analysed few weeks later, reinforced the degree of objectivity. A complete marsupialization of the ethmoid labyrinth without any remaining cell was confirmed in only 30%. Frequence and aspects of the opacities in the great sinuses were the same pre- and post-operatively. So, this study shows that the insufficiencies of the ethmoidectomy are 1) the difficulty to perform a complete marsupialization of the ethmoid 2) persistent opacities in the great sinuses 3) persistence of the mucosa disease after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)