The location of the nose along with the protective function that exerts, render it extremely susceptible to a number of diseases. Morbidity of the nose and sinus diseases shows a continuous increase. Rhinosinusitis is the most frequently reported chronic disease in humans, whereas chronic rhinosinusitis affects 37 million American citizens per year. Undoubtedly, over the last two decades a significant progress has been achieved regarding comprehension of the pathogenesis and the various complicated immune mechanisms involved in the diseases of the nose and sinuses. Nevertheless, conservative treatment occasionally fails and surgical action is required. In the 80’s besides existing surgical techniques dealing with rhinological diseases, appeared a new one called, Functional Endoscopic Sinus Surgery or simply, FESS. Comprehension of the pathophysiology of nasal discharge, a more systematic approach in the diagnosis of inflammatory diseases of the nose and sinuses and construction of high ...
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The location of the nose along with the protective function that exerts, render it extremely susceptible to a number of diseases. Morbidity of the nose and sinus diseases shows a continuous increase. Rhinosinusitis is the most frequently reported chronic disease in humans, whereas chronic rhinosinusitis affects 37 million American citizens per year. Undoubtedly, over the last two decades a significant progress has been achieved regarding comprehension of the pathogenesis and the various complicated immune mechanisms involved in the diseases of the nose and sinuses. Nevertheless, conservative treatment occasionally fails and surgical action is required. In the 80’s besides existing surgical techniques dealing with rhinological diseases, appeared a new one called, Functional Endoscopic Sinus Surgery or simply, FESS. Comprehension of the pathophysiology of nasal discharge, a more systematic approach in the diagnosis of inflammatory diseases of the nose and sinuses and construction of high resolution rigid endoscopes, where the key factors that led to the development of this particular technique. Simultaneously, improvement in imaging methods, such as computed tomography, contributed to a better depiction of anatomical structures. Since its fearful appearance FESS has nowadays expanded and faces a wide spectrum of diseases, gathering a number of enthusiasts. Currently, we acknowledge that most inflammatory diseases of the nose and sinuses are rhinogenic, therefore FESS’ target is to remove anatomic obstructive abnormalities and diseased mucosa from key locations, thereby preserving as much as possible the integrity of nasal mucosa. In this way, we avoid older operative techniques that favored the creation of large smooth interconnecting cavities. In our study we followed and analyzed data from 87 adult patients with nose and paranasal sinus problems treated surgically. These patients were divided in two groups. In the first group n=46. We included patients who were treated with the classical technique of endonasal surgery at the Royal Sussex County Hospital, Brighton, United Kingdom. The second group consisted of patients who were treated using functional endoscopic techniques, at the university hospitals of Guy’s and St. Thomas. London, United Kingdom. The study intends to present LESS, to underscore its usefulness in a variety of diseases and its long term efficacy in relation to symptom improvement and recurrence. The patients were randomly selected from outpatient rhinology clinics. Most had already received some form of conservative treatment without significant improvement and were then submitted to guidelines by the supervising medical personnel. Initially, patients were asked to fill a questionnaire which apart from demographic data and personal history, was asking them to value numerically from 0-5 the severity of local symptoms along with symptoms related to their quality of life. Later, another questionnaire was filled by medical personnel intra-operatively. In the second one we recorded the dominant medical condition, the radiological findings from computed tomography, extent of surgery and intra-operative complications. In our results, no statistically significant difference was noted between the two groups regarding symptoms. Nasal corticosteroid sprays and antihistamine tablets prevailed pre-operative pharmaceutical treatment. Chronic rhinosinusutis and nasal polyposis were the diseases most commonly encountered. Assessment of CT findings according to Lund-Mackay staging system also did not show any difference between the two groups. Nevertheless, anterior ethmoidal cell involvement was noticed more often. This underlines the significant predisposing role of this particular area in the development of nose and sinus pathology. In our material there was a marked difference between the two groups regarding surgical procedures. Inferior meatal antrostomies were more frequently performed in the 1st group compared to the 2nd group where, infundibulotomy and anterior ethmoidal surgery dominated surgical practice. Generally speaking, classification and staging of a disease forms an indispensable prerequisite to check the validity of various surgical techniques. The fact that most rhinological conditions are multi factorial and some with an idiopathic character, render staging extremely difficult. Existence of various disease staging systems proves the above, simultaneously though impeding extraction of comparable results. Symptom improvement scores following surgery ranged from 76.2% to 84.4% for groups 1 and 2. respectively. It was also interesting to note that 56% of the asthmatic patients reported post-operative improvement of their lower airway symptoms. Complication rates were 8.4% and 4.8% respectively and were mainly of minor severity, except one case of CSF leak. Statistically important difference was observed with regard to post-operative packing, with the endoscopic group of patients requiring much less time, finally, recurrence rates after 20 months were 21% and 9.6% for groups 1 and 2 respectively, showing no statistically significant difference and in accordance with rates published internationally. In conclusion, functional endoscopic sinus surgery forms a useful tool and in the hands of well-trained surgeons can contribute safely and more effectively, compared to classical surgical techniques, in the treatment of various rhinological conditions. Mucosal preservation, dissection of the diseased parts only under direct vision and the ability for early detection of recurrences favor it against classical intranasal operations. Postoperative results on the quality of life of people suffering from rhinological conditions are very satisfactory. Nevertheless, the wide spectrum of symptoms along with the highly subjective description, the particular characteristics of rhinological diseases which render objective staging unattainable, form factors which impede considerably result estimation and drawing of safe conclusions. More time is definitely required until FESS with its characteristic functionality and in combination with better comprehension of the aetiology, consolidates as the therapeutic method of choice.
