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Endoscopic sinus surgery (ESS) is superior to conventional methods insofar as it both allows polypectomy and opens the middle meatal clefts (the typical area of formation). Recurrence after ESS is therefore lower. How extensive the operation should be is unclear due to a lack of specific research on the subject. Possibilities range from total removal to improving the ventilation of the sinuses. Complete removal does appear at least as good or better than improving ventilation, in what little research is available. In the hands of an experienced surgeon, complications are rare. Surgical microdebriders allow for swifter and less risky surgery, since they allow greater precision in incision and reduce blood loss, alongside providing a better view for the surgeon. The operation targets affected areas seen on CT imaging preoperatively. Certain conditions warrant surgery as first-line treatment, since steroid therapy is largely ineffective. Such conditions include CF, primary ciliary dyskinesia syndrome and Young’s syndrome. Following the removal of the lesions, the respiratory tract usually begins to recover. In this chapter, the best time to operate on nasal polyps is reviewed. |
