Our Summary

This research paper talks about a surgical technique called nasalisation, which was first proposed in 1995 to treat a condition known as nasal polyposis. Initially, the technique involved making large openings in certain parts of the skull and removing part of the nose known as the middle turbinates. The main goal was to safely remove as much as possible of a tissue called the mucosa from a part of the skull called the ethmoid.

Recent discoveries about how the nose and sinuses develop and work have led to improvements in this technique. Scientists now know that the ethmoid is not a sinus, but a bone at the base of the skull that houses a special tissue called the olfactory mucosa, which helps us smell. In humans, this tissue is functional in one specific part of the olfactory area and non-functional, or vestigial, in the rest of the ethmoid bone.

Interestingly, nasal polyposis seems to be a specific disease of this non-functional olfactory tissue. Therefore, the goal of surgery for nasal polyposis is to remove as much of this non-functional tissue as possible without affecting the sense of smell.

Moreover, other parts of the sinuses are known to serve a respiratory function by producing, storing, and releasing a chemical called nitric oxide. The nasalisation technique has been updated to preserve this function as much as possible while removing the non-functional olfactory tissue.

The paper also suggests that the impact of surgery on the middle turbinates needs to be assessed further. While removing them might aid in getting rid of the non-functional tissue, preserving them could maintain the integrity of the olfactory area. The concept of nasalisation has thus been updated to align with the latest understanding of how the nose and sinuses develop and function.

FAQs

  1. What is the nasalisation technique used for?
  2. How has the nasalisation technique been updated in recent years?
  3. What is the aim of surgery for nasal polyposis?

Doctor’s Tip

A doctor may advise a patient undergoing nasal polyp removal to follow post-operative care instructions carefully, which may include keeping the nasal passages clean and moist, avoiding activities that could increase nasal pressure (such as heavy lifting or straining), and using any prescribed medications or nasal sprays as directed. It is important for the patient to attend follow-up appointments to monitor healing and ensure the best possible outcome.

Suitable For

Patients who are typically recommended nasal polyp removal are those who have nasal polyposis, which is a specific disease of the vestigial olfactory mucosa of the human ethmoid. The aim of surgery for nasal polyposis is to maximize resection of the vestigial olfactory mucosa while conserving olfactory function as much as possible. Patients with severe symptoms such as nasal congestion, difficulty breathing, loss of smell, and recurrent sinus infections may be candidates for nasal polyp removal surgery. Additionally, patients who do not respond to conservative treatments such as nasal corticosteroids, antibiotics, and nasal saline irrigations may also be recommended for nasal polyp removal.

Timeline

  • Before nasal polyp removal: The patient may experience symptoms such as nasal congestion, difficulty breathing through the nose, reduced sense of smell, postnasal drip, facial pain or pressure, and snoring. These symptoms may be chronic and impact the patient’s quality of life.

  • Nasal polyp removal surgery: The patient undergoes a surgical procedure to remove the nasal polyps. This may involve techniques such as nasalisation, which aims to resect the vestigial olfactory mucosa while conserving olfactory function as much as possible. The surgery may also involve resection of the middle turbinates and the mucosa of the lateral masses of the ethmoid.

  • After nasal polyp removal: The patient may experience some discomfort and swelling in the nasal area following the surgery. It may take some time for the nasal passages to fully heal and for the patient to experience relief from their symptoms. The patient may also undergo post-operative care and follow-up appointments to ensure proper healing and to monitor for any complications. Olfactory function may improve following surgery, but it can take time for the sense of smell to fully return.

What to Ask Your Doctor

  1. What are the risks and potential complications associated with nasal polyp removal surgery?
  2. What is the recovery process like after nasal polyp removal surgery?
  3. Will I need any follow-up appointments or additional treatments after the surgery?
  4. How will my sense of smell be affected by the surgery?
  5. Are there any lifestyle changes or precautions I should take after the surgery to prevent the recurrence of nasal polyps?
  6. How long will it take for me to see improvement in my symptoms after the surgery?
  7. Are there any alternative treatments or therapies that I should consider before opting for surgery?
  8. How experienced are you in performing nasal polyp removal surgeries?
  9. Can you explain the specific technique that will be used for my nasal polyp removal surgery?
  10. What are the success rates for nasal polyp removal surgeries, and what factors can affect the outcome of the procedure?

Reference

Authors: Jankowski R, Rumeau C, Nguyen DT, Gallet P. Journal: Eur Ann Otorhinolaryngol Head Neck Dis. 2018 Oct;135(5):327-334. doi: 10.1016/j.anorl.2018.05.006. Epub 2018 Jun 7. PMID: 29887213