Chronic infectious rhinosinusitis with Pseudomonas aeruginosa is common in cystic fibrosis and may result in allograft infection after lung transplantation. Sinus surgery followed by nasal care may reduce these adverse effects. Sinus surgery was performed in 37 patients with cystic fibrosis after transplantation. Bacteriology of sinus aspirates (n=771) and bronchoalveolar lavage (BAL) (n=256) was correlated with clinical data. Sinus surgery was successful in 54% and partially successful in 27% of patients. A significant correlation between negative sinus aspirates and negative BAL and between positive sinus aspirates and positive BAL (P<0.0001) was found. Successful sinus management led to a lower incidence of tracheobronchitis and pneumonia (P=0.009) and a trend toward a lower incidence of bronchiolitis obliterans syndrome (P=0.23). Sinus surgery followed by daily nasal douching may control posttransplant lower airway colonization and infection. In the long term, this concept may lead to less bronchiolitis obliterans syndrome by decreasing bronchiolar inflammation.

In keeping with our experience, the endonasal endoscopic approach, often in combination with a medial maxillectomy, is favored for the treatment of sinonasal papilloma because of a lower recurrence rate and a better cosmetic result. In some larger tumors and lesions in difficult locations, better visualization can be obtained by a combined external and endonasal approach.

Intractable posterior epistaxis (PE) is a frequent emergency for which different treatment modalities are available. While nasal packing causes extreme discomfort and angiography with consecutive selective embolization is not available everywhere, recent studies emphasize the value of sphenopalatine artery (SPA) occlusion by different techniques and indicate success rates of 13-33%. In our institution, previously endoscopic management of PE consisted either of isolated coagulation of an identified bleeding source (group A) or cutting and coagulation of arterial branches running through the sphenopalatine foramen (SPF) (group B). According to our neuroradiological and rhinological experience we developed a modification of SPA transsection and coagulation following identification of the division in conchal and septal branches of the SPA (group C). During a 26-month period the success rates of these three techniques in 95 patients were compared prospectively. The three modalities revealed a re-bleeding rate of 3 out of 21 (21%) in group A, 1 in 6 (16.7%) in group B and 3 in 69 (4.3%) in group C. At the level of the SPF, 36 out of 69 patients had one conchal branch, whereas 30 (43.5%) had two and 3 (4.4%) had three. If SPA transsection and coagulation for intractable PE is adopted the anatomic varieties of the SPA with its division in conchal and septal branches have to be taken into account. According to our experience the septal branch of the SPA plays a major role in PE. Its occlusion significantly improves the success rate of PE treatment.

We showed, for the first time, that the insertion of a graft that consisted of a PDS flexible plate enveloped in temporoparietal fascia via a hemitransfixion incision was feasible and resulted in complete mucosal closure of nasal septal perforations in most patients. By performing the hemitransfixion incision, we avoided any visible nasal scars.

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