Reboot Surgery

Abstract

Nasal polyps with type 2 inflammation are classically characterized by asthma comorbidity in up to 70% of patients and disease recurrence, with figures ranging from 38% to 60% at 12 months follow-up [1–4]. Clinical signs for treatment failure risk and disease recurrence are bronchial asthma, Aspirin or NSAID-Exacerbated Respiratory Disease (AERD, N-ERD), and atopy [5, 6]; peripheral blood, mucus, and mucosal eosinophilia and elevated blood and tissue IgE values—patterns of type 2T-cell inflammation—are biomarkers for more severe disease and nasal polyp recurrence [7]. Severe, difficult-to-treat CRSwNP subjects are therefore often repeatedly exposed to surgical management of various kinds. Surgical approaches have varied over the years, ranging from less extended “polyp extraction” to more extended “nasalization” procedures [8–10]. For CRSwNP, because of the high recurrence rates, more extended approaches have been proposed “to widely access the sinuses, open them for local treatment, and reduce the inflammatory load” [11]. Performing randomized controlled studies to compare different surgical techniques is demanding to perform, and reliable studies comparing different approaches including sufficient patients are lacking. Removal or “stripping of the mucosa” was not recommended due to fear of scarring, inflammation of the denuded bone, and non-functional mucosa [12], derived from single surgeons observations.