Rhinology Unit, Department of Otolaryngology, Hospital Universitario Virgen de la Macarena, Seville, Spain.
Division of Otolaryngology/Head and Neck Surgery, Department of Surgery, Albany Medical Center, Albany, NY, USA.
Rhinology. 2019 Jun 1;57(3):219-224. doi: 10.4193/Rhin18.178.
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).
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.
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.
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.
我们报告了一种基于经鼻内镜游离黏膜移植物（黏膜成形术）的新型手术技术，用于改善慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）的临床结果和局部愈合。
纳入了诊断为双侧 CRSwNP 并计划行内镜鼻窦手术的患者。他们接受了完全切除前、后筛窦细胞，以及双侧 III 型额窦切开术。在左侧鼻腔进行内镜下黏膜成形术，而右侧鼻腔作为对照。患者在术前和术后 6 个月接受评估，包括 Sino-Nasal Outcome Test（SNOT-22）、嗅觉视觉模拟量表（VAS）、改良的Und-Kennedy（MLK）评分系统内镜评估和愈合评估。
10 例患者（平均年龄 53.6 岁）纳入研究。SNOT-22 评分从术前的 57.0（21.1）显著下降至术后的 20.3（20.6）（P=0.024），而嗅觉 VAS 评分从术前的 9.3（0.5）下降至术后的 4.6（3.9），但无统计学差异。右侧鼻腔术前 MLK 评分为 4.9（0.7），左侧鼻腔为 4.8（1.0）。术后左侧鼻腔 MLK 评分下降幅度大于右侧（1.9[1.0]比 1.3[0.8]，P=0.034）。黏膜成形术侧鼻腔的愈合更好。
经鼻内镜黏膜成形术可能是治疗 CRSwNP 的一种有效、安全且可行的辅助手术。局部水肿减轻和分泌物减少可能有助于更好地控制额隐窝、眶壁和鼻顶。
