Abstract
The definition, pathophysiology and surgical approach of nasal polyposis (NP) are still under debate. In this chapter, NP is considered as a chronic inflammatory disease of the ethmoidal sinus mucosa characterised on nasal endoscopic examination by the presence, bilaterally, of non-infected white-oedematous polyps originating into the ethmoidal labyrinths and most of the time, arising from the middle and/or superior meatus and/or the sphenoethmoidal recess. This definition is aimed at stressing that NP is a specific disease that can easily be recognised among all other forms of rhinosinusitis and other nasal diseases. Our opinion is that sinus ventilation/drainage or obstruction in the ostio-meatal complex is a minor pathogenic factor in NP disease. Our hypothesis is that NP is a disease generated by remnants of vestigial olfactory mucosa scattered in the ethmoidal sinuses. Only people who have remnants develop NP. This vestigial olfactory mucosa has probably lost its histological features, but has kept some biological properties, among which is the ability to attract eosinophils. Olfaction is probably one of the oldest phylogenetic senses and eosinophils are probably one of the oldest cells of the innate immune system. Our hypothesis is that NP could be regarded as an inflammatory disease resulting from a dysfunction of the innate immune system associated to the olfactory organ. In this concept, the role of surgery for NP is to remove as much as possible of the vestigial ethmoidal mucosa. The role of the sinuses is still unclear and the need to retain more or less of the compartmentalisation of the ethmoidal labyrinths is also questionable. Our hypothesis is that, when dealing with the NP disease, complete removal of the bony lamellas partitioning the ethmoidal labyrinth is not more harmful than trying to restore ventilation/drainage in the different ethmoidal compartments. The combination of both hypotheses led us to propose the nasalisation procedure as a surgical approach for NP. The aim of the nasalisation procedure is to remove the ethmoidal mucosa as completely as possible without hazards, and to transform the ethmoidal labyrinth into a unique cavity opening into the nose (nasalisation). To achieve the nasalisation procedure, it is more important to know the anatomy of the ethmoidal walls than the compartmentalisation inside the ethmoidal labyrinth.The technical key point to safely perform a nasalisation procedure is to gently strip the mucosa to follow the bony structure of the medial orbital wall, ethmoidal roof and conchal lamina. Our results show that NP is a chronic disease which cannot be cured, but that the underlying chronic eosinophilic ethmoiditis disease seems to be better controlled after nasalisation than after ethmoidectomy. When the medical treatment with corticosteroids fails to stop the eosinophil attraction, the aim of surgery should be to remove as completely as possible the ethmoidal mucosa, which seems to be the main attractant for eosinophils.
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References
Bodino C, Jankowski R et al (2004) Surgical anatomy of the turbinal wall of the ethmoidal labyrinth. Rhinology 42(2):73–80
Boisson-Bertrand D, Bilbaut P et al (1989) Anesthesia of a patient with the Fernand-Widal syndrome. Cah Anesthesiol 37(8):577–580
Burgel PR, Cardell LO et al (2004) Intranasal steroids decrease eosinophils but not mucin expression in nasal polyps. Eur Respir J 24(4):594–600
Chobillon MA, Jankowski R (2004) Relationship between mucoceles, nasal polyposis and nasalisation. Rhinology 42(4):219–224
Corris PA, Dark JH (1993) Aetiology of asthma: lessons from lung transplantation. Lancet 341(8857):1369–1371
Hemmaoui B, Winkler-Parietti C, Jankowski R (2008). [Anatomical relationship between the frontal sinus ostium and the anterior ethmoidal artery : Surgical implications] Ann ORL Chir Cervicofac (Paris) 125 : 174-180 (Rapports endoscopiques entre l’ostium du sinus frontal et l’artère ethmoïdale antérieure : implications chirurgicales.)
Hotchkiss WT (1956) Influence of prednisone on nasal polyposis with anosmia; preliminary report. AMA Arch Otolaryngol 64(6):478–479
Jankowski R, Baudet B et al. Patients with naso-sinusal polyposis (NSP) show significantly higher blood eosinophil counts than controls. Is NSP an olfactory immune system related disease? Rhinology (personal data)
Jankowski R, Bodino C (2003) Evolution of symptoms associated to nasal polyposis following oral steroid treatment and nasalisation of the ethmoid–radical ethmoidectomy is functional surgery for NPS. Rhinology 41(4):211–219
Jankowski R, Bodino C (2003) Olfaction in patients with nasal polyposis: effects of systemic steroids and radical ethmoidectomy with middle turbinate resection (nasalisation). Rhinology 41(4):220–230
Jankowski R, Pigret D et al (1997) Comparison of functional results after ethmoidectomy and nasalisation for diffuse and severe nasal polyposis. Acta Otolaryngol 117(4):601–608
Jankowski R, Bouchoua F et al (2002) Clinical factors influencing the eosinophil infiltration of nasal polyps. Rhinology 40(4):173–178
Jankowski R, Pigret D et al. (2006) Comparison of radical (nasalisation) and functional ethmoidectomy in patients with severe sinonasal polyposis. A retrospective study. Rev Laryngol Otol Rhinol (Bord) 127(3):131–140
Jankowski R, Georgel T et al. (2007) Endoscopic surgery reveals that woodworkers’ adenocarcinomas originate in the olfactory cleft. Rhinology 45(4):308–314
Lecco V (1953) First results on the use of cortisone administered by aerosol in the treatment of nasal polyps. Arch Ital Otol Rinol Laringol 64(suppl 13):200–212
Lima NB, Jankowski R et al (2006) Respiratory adenomatoid hamartoma must be suspected on CT-scan enlargement of the olfactory clefts. Rhinology 44(4):264–269
Tao Z, Kong Y et al (2003) Effects of corticosteroid on eosinophils and expression of transforming growth factor beta 1 in nasal polyps. Lin Chuang Er Bi Yan Hou Ke Za Zhi 17(8):474–475
Taub SJ (1968) Dexamethasone nasal aerosol vs. placebo in the treatment of nasal polyposis. Eye Ear Nose Throat Mon 47(8):392–395
Watanabe K, Shirasaki H et al (2004) Effects of glucocorticoids on infiltrating cells and epithelial cells of nasal polyps. Ann Otol Rhinol Laryngol 113(6):465–473
Wei JL, Kita H et al (2003) The chemotactic behaviour of eosinophils in patients with chronic rhinosinusitis. Laryngoscope 113(2):303–306
Wenig BM, Heffner DK (1995) Respiratory epithelial adenomatoid hamartomas of the sinonasal tract and nasopharynx: a clinicopathologic study of 31 cases. Ann Otol Rhinol Laryngol 104(8):639–645
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Jankowski, R. (2010). Nasalisation in the Surgical Treatment of Nasal Polyposis. In: Önerci, T., Ferguson, B. (eds) Nasal Polyposis. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-11412-0_30
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DOI: https://doi.org/10.1007/978-3-642-11412-0_30
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