Revision sphenoidethmoidectomy

In 1981, a series of 236 intranasal ethmoidectomy (INE) procedures was reported with a complication rate of 1.8%. Special attention has subsequently been directed to the surgical failures; namely, recurrent nasal polyposis which accounted for approximately 17%. The reason for recurrence in most instances was felt due to failure to do a more thorough posterior ethmoidectomy and enter and clean out the sphenoid sinuses. Subsequently, in all revision cases where a more thorough sphenoidethmoidectomy (RSE) was performed, the overall long-term success rate raised to better than 90%. Attention to skeletonizing the middle turbinate by stripping mucosa and leaving a thin bony shell is an important technical factor. An attempt is made to leave some of this bony skeletonized medial wall of the middle turbinate as it represents the most crucial landmark in doing the surgery via the intranasal route. There still remains approximately 8% to 10% of this patient population with nasal polyposis and sinusitis of such severity that surgery has offered only a temporary measure of relief. In dealing with this group it may be necessary to see these patients postoperatively at four to six-week intervals, carefully suctioning the ethmoid labyrinth and occasionally doing minor office "touch-up" ethmoidectomy-polypectomy procedures to clean off redundant mucosa or early polyposis. This paper is written to offer a compromise to the two schools of intranasal ethmoidectomy surgery as to the necessity of removing the middle turbinate in its entirety.