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Practical Medical and Surgical Management of Chronic Rhinosinusitis pp 439–454Cite as

Surgery for Nasal Polyposis

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Abstract

Nasal polyposis in the setting of chronic rhinosinusitis (CRS) is a challenging disease process due to its higher rate of disease recurrence when compared to other forms of CRS. Preliminary research suggests, however, that a few key surgical decisions may help decrease the return of symptoms and rate of polyp recurrence. Certain preoperative risk factors (including asthma, eosinophilia, polyps, fungal sinusitis, narrow frontal recess, and Samter’s triad) can predict which patients have a greater chance of recurrence after a standard functional approach. In these more challenging situations, a more aggressive surgical approach is used in order to reduce the disease load, thereby reducing the incidence and severity of recurrence. In addition to a wide maxillary opening, the sphenoid sinus is widely opened from the skull base to the choana, the anterior and posterior ethmoid partitions are dissected to the skull base and laterally to the lamina papyracea, and the frontal sinus is opened widely with removal of all frontal cells. If necessary, a modified endoscopic Lothrop is performed in order to ensure a widely patent frontal sinus. The aim of a more aggressive surgical approach to nasal polyps is to maximize ostia size, clear the sinuses of the inflammatory load, and allow postoperative topical medications to reach all aspects of the sinuses and therefore reduce the incidence of polyp recurrence.

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Author information

Authors and Affiliations

  1. Department of Otolaryngology, St. Louis University Hospital, 6th Floor, Desloge Towers, 3635 Vista Avenue, St. Louis, MO, 63110, USA

    Joseph Brunworth MD

  2. Department of Otolaryngology – Head and Neck Surgery, University of Adelaide, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville, SA, 5011, Australia

    Peter John Wormald FRACS, FCS(SA), FRCS(Ed), MD

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  1. Joseph Brunworth MD
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  2. Peter John Wormald FRACS, FCS(SA), FRCS(Ed), MD
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Corresponding author

Correspondence to Peter John Wormald FRACS, FCS(SA), FRCS(Ed), MD .

Editor information

Editors and Affiliations

  1. Department of Otorhinolaryngology Head and Neck Surgery, Rush Center for Skull Base and Pituitary Surgery, Rush University Medical Center, Chicago, Illinois, USA

    Pete S. Batra

  2. Department of Otolaryngology and Head & Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA

    Joseph K. Han

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Brunworth, J., Wormald, P.J. (2015). Surgery for Nasal Polyposis. In: Batra, P., Han, J. (eds) Practical Medical and Surgical Management of Chronic Rhinosinusitis. Springer, Cham. https://doi.org/10.1007/978-3-319-16724-4_28

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  • DOI: https://doi.org/10.1007/978-3-319-16724-4_28

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-16723-7

  • Online ISBN: 978-3-319-16724-4

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