He said that he performs the procedure only after patients have received long-term medical treatment, including three courses of oral steroids per year for two years. He reserves the surgery only for those patients with major discomfort caused by the disease.
Explore This IssueAugust 2009
His preoperative assessment includes a nasal endoscopy, an evaluation of pulmonary function, and a review of environmental risks such as smoking and work hazards. Before we make a decision, we wait for many years, Dr. Klossek said.
The procedure involves a polypectomy with or without a shaver; a middle meatal antrostomy for remove of large polyps; opening and removal of the ethmoid mucosa; exposure of the orbital wall and the skull base; and a sphenoidotomy.
The standardized technique takes 90 minutes to complete, and eight weeks should be allowed for healing, Dr. Klossek said. Patients must take antibiotics for 10 days, oral steroids for six days, and topical steroids for life.
Dr. Klossek said he is referred 350 patients per year but performs surgery on only 10% to 15% of those.
In a retrospective study of surgery recipients between 1985 and 1998, there were no major complications within the first three months, but there were 43 instances of infections. Of the 563 patients with follow-up at 10 years, 1% had developed mucocele, 0.5% had frontal stenosis, and there were major relapses in 17%.
Dr. Klossek was careful to say that the procedure is not necessarily better than other approaches. It’s just a complement, he said. It’s not a battle between FESS and removal of ethmoid mucosa.
Part 2 of this article will discuss balloon catheterization and minimally invasive techniques.
©2009 The Triological Society