Abstract
It has been reported recently that the incidence of severe sinusitis has decreased, and that chronic sinusitis has become milder. Many patients still require surgical treatment, however, and the number of conservative operations is increasing. In our department, the number of radical operations has decreased substantially over the past few years, whereas there has been an increase in the number of patients who have been treated by means of endonasal sinus operation with reconstruction of the nasal cavity (Takahashi method), a conservative transnasal operation. The main reason for this is the recent development of endoscopy, which has solved the problems of residual mucous membrane and insufficient size of the natural opening by the successful enlargement of a sufficient operative field, and thus made possible the accurate microperation. The development of endoscopy has also made possible the detailed pre-operative observation of the lesion, thus widening the indications of this method of surgery. The fact that the conventional method, which consists mainly of a radical operation based on the “single cavity” concept, has produced a number of undesirable post-operative effects, including recurrence of the condition, might also be an important factor.
We are performing bilateral endonasal sinus operation with reconstruction of the nasal cavity, which comprises a nasoseptal operation based on the principle, advocated by Takahashi, that the concept of nasal surgery should be that the complete nasal sinus consists of the right and left paranasal sinuses together with the nasal septum, and on the full understanding of their function. Many problems relating to paranasal operations have still to be resolved. However, an examination of the results of 555 cases treated with endoscopic sinus operation at our clinic between 1978 shows that, as far as improvement in general subjective symptoms is concerned, approximately 91.5% of the patients treated with endonasal sinus operation during the past 11 years were satisfied with the post-operated results. This is a higher percentage than that obtained from conventional methods of operation at the Jikei Medical Hospital. Only 6.1% of patients were not satisfied. The operation's effects on the constriction of the nasal cavity, which is one of the major subjective symptoms, were maintained for ten years or more.
These findings may indicate that endoscopic sinus operation is one of the most effective and least invasive methods of improving subjective symptoms.
