xRead - Nasal Obstruction (September 2024) Full Articles

20426984, 2021, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/alr.22741 by Stanford University, Wiley Online Library on [01/07/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

586

International consensus statement on rhinosinusitis

Concurrent Septoplasty with Sinus Surgery Aggregate Level of Evidence: C (level 2, 2 studies; level 3, 2 studies; level 4, 12 studies; level 5, 1 study; Table XII-18). Benefit: Reduction in nasal obstruction, improved access for ESS, possibly reduced need for revision surgery. Harm: Risk of bleeding, postop discomfort/pain, septal hematoma, septal perforation, persistent obstruction, intranasal scarring, CSF leak. Cost: Cost is related to increased operative time when septoplasty is added to ESS. Benefit-Harm Assessment: Preponderance of ben efit over harm. Value Judgment: Septoplasty may be required dur ing ESS for surgical access. Patients with septal deviation and CRS may experience reduced nasal obstruction when septoplasty is performed at the time of ESS. The studies supporting septoplasty at the time of ESS presumably performed septo plasty when a clinically relevant septal deviation was encountered. Policy Level: Recommendation to perform septo plasty at the time of ESS when a clinically relevant septal deviation is present. Intervention: Septoplasty for clinically relevant septal deviation (either ES or CS) should be per formed at the time of ESS. XII.D.3 Middle Turbinate Preservation or Resection in Sinus Surgery Whether to routinely preserve or resect the middle turbinate (MT) during sinus surgery has been a topic of debate for decades. Moreover, partial or total resection of the MT have been performed in endoscopic surgery, which further complicates the interpretation of the lit erature. Whereas some studies showed beneficial effects of MT resection compared with MT preservation, several others showed no difference. 2039 These various arguments have been examined in the literature over the last 30 years and have shown limited effects of both preservation and resection, in several aspects: Quality of life (QoL) and Endoscopic Outcomes . Bet ter SNOT-22 improvement, and lower rhinorrhea and olfactory scores were found in radical ESS (ESS with MT resection) and radical ESS combined with Draf III in a randomized study compared to the ESS with MT

sinusotomy provided similar

irrigation delivery benefits to a Draf III sinusotomy.

proposed classification to the

extent of frontal sinus surgery.

Anterior ethmoidectomy for drainage of frontal sinuses appears to be an effective initial treatment option. “Cross-court Draf IIb”

Degree of distribution and rate of lavage increased with increasing dimensions of frontal recess.

Study Year LOE Study Design Study Groups Clinical Endpoint Conclusions Becker 2012 2007 4 Case-series 77 patients who

- Description of variations

benefit of the hybrid

procedure with a Draf III cavity.

Post-operative outcome, including revision surgery rate.

distribution of topical

irrigation in Draf IIa, IIb and III cavities.

Barham 1262 2016 5 Mechanism-based reasoning Cadaveric study Evaluate and compare

Compare therapeutic

“Cross-court Draf IIb” sinusotomy irrigant delivery.

modifications of

surgical approaches to Draf classification.

underwent anterior

ethmoidectomy for

chronic frontal sinusitis. Cadaveric study of

Description of

Bhalla 1263 2019 5 Mechanism-based reasoning

Eloy 2021 2016 5 Mechanism-based reasoning

TABLE XII-17 (Continued)