Surgical management of rhinosinusitis

Rhinosinusitis, an inflammatory disease involving the nasal cavity and paranasal sinuses, affects millions of individuals and its costs run into the billions of dollars. The development of rigid nasal telescopes has revolutionized the diagnosis and treatment of this disease. Recent endoscopic evaluations have identified certain key areas within the nasal cavity that, when inflamed, lead to sinus ostial obstruction and subsequent sinus infection. The telescope's increased visualization capabilities permits the physician to better target and individualize patient care and the techniques that have grown out of this new tool allow for a more physiologic approach to surgical treatment. The pathophysiology of rhinosinusitis and its medical treatments are considered. Indications for surgical management are reviewed, with attention to nontraditional or extended applications of endoscopic techniques. Preoperative evaluation, including nasal endoscopy and radiographic imaging, as well as surgical technique and postoperative care are discussed. Evaluation of outcomes from surgical treatment in appropriately selected patients have demonstrated the success of this technique.