Updating nasalisation: From concept to technique and results

Area of Science:

• Rhinology
• Evolutionary developmental biology (evo-devo)
• Surgical anatomy

Background:

• Nasalisation surgery, introduced in 1995, aimed for extensive ethmoid mucosa resection.
• Recent evo-devo findings redefine the ethmoid as a skull-base bone housing olfactory mucosa, not a paranasal sinus.
• Nasal polyposis is now understood as a disease of vestigial olfactory mucosa.

Purpose of the Study:

• To update the nasalisation surgical technique based on current evo-devo and sinus physiology knowledge.
• To refine surgical goals for nasal polyposis, emphasizing maximal vestigial olfactory mucosa resection.
• To conserve functional olfactory mucosa and paranasal sinus respiratory function.

Main Methods:

• Revising the nasalisation technique to align with evo-devo principles of nasal and sinus anatomy.
• Modifying surgical steps to ensure complete resection of vestigial olfactory mucosa.
• Evaluating the role of middle turbinate resection versus conservation.

Main Results:

• The updated nasalisation technique prioritizes complete resection of vestigial olfactory mucosa.
• The modified technique aims to preserve the function of maxillary, sphenoidal, and frontal sinus ostia.
• The role of middle turbinate surgery requires further evaluation for optimal outcomes.

Conclusions:

• Updating the nasalisation concept integrates evo-devo principles into rhinology.
• The revised technique aims for maximal disease removal while preserving crucial functions.
• This approach enhances the treatment strategy for nasal polyposis.