Atlas of Nose and Paranasal Surgeries

ATLAS OF NOSE AND PARANASAL SURGERIES 9 Authors: J. Brunworth, P.J. Wormald. Title: Surgery for Nasal Polyposis Book: Practical Medical and Surgical Management of Chronic Rhinosinusitis DOI: 10.1007/978-3-319-16724-4_28 © Springer International Publishing Switzerland 2015 The figure shows progression of surgery for polyps. ( b ) Polyps in the middle meatus. ( c ) Representative piece taken for histology. ( d ) Microdebrider usage. ( e ) Exposed uncinate and bulla ethmoidalis. The remainder of the surgery is carried out in the same manner as non-polyp patients. (continued)... ...(continued) 442 e hmoidalis (Fig. 28.2 ). The surgery is now conducted as if the patient did not have polyps and the anatomy is dealt with in the same way as patients without polyps. In patients who have ad pr vious surgery, normal anatomical landmarks are often absent or obscured and surgery is conducted by first finding the most consistent landmarks. In these cases, the safest method is to start posteriorly and proceed along the skull base into the frontal sinus. First, the polyps are debrided and the middle turbinate or its remnant is identified. Next the posterior choanae are identi- Fig. 28.2 Progression of surgery for polyps. ( a ) Polyps in the middle meatus. ( b ) Representative piece taken for histology. ( c ) Microdebrider usage. ( d ) Exposed uncinate and bulla ethmoidalis. The remainder of the surgery is carried out in the same manner as non-polyp patients J. Brunworth and P.J. Wormald b d c e