Atlas of Nose and Paranasal Surgeries

ATLAS OF NOSE AND PARANASAL SURGERIES 10 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 f. Wide left sphenoidotomy showing the optico-carotid recess posterolaterally, skull base superiorly, and orbit laterally. g. Revision endoscopic sinus surgery ( ESS ) for polyps requiring an aggressive approach. Picture shows the suction curette approaching the polypoid tissue ( P ) near the anterior ethmoidal artery ( AEA ) that lies on a mesentery along the skull base. This case required a frontal drill-out as well as trimming of the middle turbinate ( MT ). The septum ( S ) is marked for reference. ...(continued) Upon pas ing he xil a of the middl turbi ate, the most commonly encountered drainage pathway is located posterior and medial to the agger nasi/frontal ethmoid cel s. However, certain predisposing factors may cause th dr inage pathway to run anterior or lateral suc as an intersinu s ptal cell. In the case of polyps, the bony divisions on the preoperative CT scan can be difficult to discern and must be looked at with caution. Indications Indications to proceed with surgery for nasal polyposis are largely dependent on patient symptoms, the two most common symptoms being nasal airway obstruction and loss of the sense of smell. Other symptoms may include allergic symptoms (sneezing, ocular/nasal pruritus, rhinorrhea, etc.), recurrent bouts of sinusitis Fig. 28.4 Revision ESS for polyps requiring an aggressive approach. Picture shows the suction curette approaching the polypoid tissue ( P ) near the anterior ethmoidal artery ( AEA ) that lies on a mesentery along the skull base. This case required a frontal drill-out as well as trimming of the middle turbinate ( MT ). The septum ( S ) is marked for reference 443 t ing the s ll base laterally ESS for . Picture rette ypoid nterior A ) that along the required well as dle septum erence sal Polyposis f g