Free nasal floor mucosal grafting after endoscopic total ethmoidectomy for severe nasal polyposis: a pilot study

Abstract

Background:We report a novel surgical technique based on an endonasal free mucosal graft (mucoplasty) for improving clinical results and local healing in chronic rhinosinusitis with nasal polyps (CRSwNP).Methods: Patients diagnosed with bilateral CRSwNP scheduled for endoscopic sinus surgery were included. They underwent complete removal of anterior and posterior ethmoid cells, in addition to bilateral type III frontal sinusotomy. An endoscopic mucoplasty was performed in the left nasal cavity, whereas the right nasal cavity served as control. Patients were evaluated before surgery and 6 months after operation, including Sino-Nasal Outcome Test (SNOT-22), Visual Analogue Scale (VAS) for olfaction, endoscopic evaluation using the Modified und-Kennedy (MLK) scoring system and healing evaluation. Results:Ten patients (mean age 53.6 years) were included. A significa t decrease of SNOT-22 score from 57.0 (21.1) to 20.3 (20.6) (P = 0.024) and a non-significa t decrease of VAS for olfaction score from 9.3 (0.5) to 4.6 (3.9) were found. Preoperative mean MLK score was 4.9 (0.7) in the right nostril and 4.8 (1.0) in the left one. After operation, there was a greater decrease of MLK score in the left nostril than in the right (1.9 [1.0] vs. 1.3 [0.8], P = 0.034). Better healing was proved in the nostril with the mucoplasty. Conclusion:Endonasal mucoplasty could be an effective, safe and feasible complementary surgical procedure in the treatment of CRSwNP. The reduced local edema associated with lower amount of secretions may confer a better control in the frontal recess, orbital wall and nasal roof.

Radioanatomical study of the extended free nasal floor mucosal graft and its clinical applications

“…4 Comparing the left grafted nostril with the right non grafted nasal cavity, that served as control, better postoperative healing was observed at 6 months, with a decrease in local edema. 4 At 1 year of follow-up, an improvement in quality of life was observed in this group, thus reinforcing the usefulness of this graft. 16 The EEM could offer the opportunity to cover a larger surface of the skull base for better local healing (Figure 3).…”

“…repair materials for endoscopic closure of skull-based defects in lowgrade fistulas, 1 during non-complicated transsellar surgery, 2 for the closure of septal perforations, 3 and as complementary treatments in chronic rhinosinusitis with nasal polyps (CRSwNP). 4 Free grafts used as a cover for the ethmoidal basicranial roof, after performing a complete ethmoid-sphenoidotomy, have shown to improve local healing with less edema. 4 Free endonasal mucosal grafts have no vascular pedicle to preserve and, in contrast to other vascularized flaps, there are no spatial limitations at the time of placing the graft inside the nasal cavity.…”

“…4 Free grafts used as a cover for the ethmoidal basicranial roof, after performing a complete ethmoid-sphenoidotomy, have shown to improve local healing with less edema. 4 Free endonasal mucosal grafts have no vascular pedicle to preserve and, in contrast to other vascularized flaps, there are no spatial limitations at the time of placing the graft inside the nasal cavity.…”

“…Details of the surgical procedure have been previously reported. 4 All participants were fully informed of their participation in the study, the surgical procedure to perform and they signed a written informed consent. The study was approved by the Ethics Committee for Clinical Research of the Hospital Virgen Macarena, Seville, Spain.…”

Olfactory changes after endoscopic sinus surgery for chronic rhinosinusitis: A meta‐analysis

“…Fourteen cohorts from 13 studies used the VAS to report postoperative olfactory changes in CRS patients. 9,10,14,15,[19][20][21][22]30,34,[39][40][41] Significant heterogeneity was found, and a random-effects model was used. Quantitative analysis identified 946 patients with CRS, with an improvement of −1.93 per item in the standardised mean difference (95% CI: −2.45 to −1.40, P = .000) ( Figure 5).…”