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Martin-Jimenez D, Moreno-Luna R, Cuvillo A, Gonzalez-Garcia J, Maza-Solano J, Sanchez-Gomez S. Endoscopic Extended Sinus Surgery for Patients with Severe Chronic Rhinosinusitis with Nasal Polyps, the Choice of Mucoplasty: A Systematic Review. Curr Allergy Asthma Rep 2023; 23:733-746. [PMID: 37991673 PMCID: PMC10739272 DOI: 10.1007/s11882-023-01113-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE OF REVIEW The advances in the knowledge of the molecular basis of the inflammatory response in chronic rhinosinusitis with nasal polyps (CRSwNP) have led the management of these patients towards personalized and precision medicine. Surgery has been positioned as a suitable alternative in patients who do not achieve control with appropriate medical treatment, but polypoid recurrences remain a constraint. The emergence of new surgical approaches based on patient phenotyping and the poor disease control associated with type 2 inflammatory phenotype makes it necessary to review the role of personalized and precision surgery in managing the disease. RECENT FINDINGS Surgical approaches based on wide resection of bony sinus structures and the treatment of mucosa lining the sinonasal cavity have been analyzed and compared with other techniques and seem to offer more favorable surgical outcomes and improved quality of life (QoL), in addition to lower relapse rates. The innovations with new complementary surgical techniques, such as reboot surgery adding an extended autologous mucosal graft from the nasal floor (mucoplasty), may benefit endoscopic and QoL outcomes in the most severe CRSwNP patients with type 2 phenotype. Using bilateral endonasal mucoplasty as a complementary technique to reboot surgery is a suitable technical choice that has improved short- and medium-term QoL and endoscopic outcomes for patients with severe CRSwNP. These results are likely due to a combination of the extension of reboot and the inherent inflammatory and healing properties of mucoplasty. We propose this technique as a valuable surgical resource, although more robust clinical studies are needed to evaluate its long-term benefits comprehensively.
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Affiliation(s)
- Daniel Martin-Jimenez
- Department of Otolaryngology, Head and Neck Surgery, Rhinology Unit, Virgen Macarena University Hospital, Doctor Fedriani Av. 3, Seville, 41009, Spain
| | - Ramon Moreno-Luna
- Department of Otolaryngology, Head and Neck Surgery, Rhinology Unit, Virgen Macarena University Hospital, Doctor Fedriani Av. 3, Seville, 41009, Spain
| | - Alfonso Cuvillo
- Unidad de Rinología y Asma, UGC ORL, Hospital Universitaro De Jerez, Instituto De Investigación Biomedica De Cadiz (INIBICA), Jerez, 11407, Spain
| | - Jaime Gonzalez-Garcia
- Department of Otolaryngology, Head and Neck Surgery, Rhinology Unit, Virgen Macarena University Hospital, Doctor Fedriani Av. 3, Seville, 41009, Spain
| | - Juan Maza-Solano
- Department of Otolaryngology, Head and Neck Surgery, Rhinology Unit, Virgen Macarena University Hospital, Doctor Fedriani Av. 3, Seville, 41009, Spain.
- Department of Surgery, University of Seville, C. San Fernando, 4, Sevilla, 41004, Spain.
| | - Serafin Sanchez-Gomez
- Department of Otolaryngology, Head and Neck Surgery, Rhinology Unit, Virgen Macarena University Hospital, Doctor Fedriani Av. 3, Seville, 41009, Spain
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Moreno-Luna R, Sánchez FM, Kaen A, Cabrerizo JRG, Castro NM, García JG, Aubá JMV, Ruiz-Valdepeñas EC, Cánovas IM, Del Cuvillo Bernal A, Piñero AG, Solano JMM, de Liesa RF, Sánchez-Gómez S, Alobid I. Usefulness of endonasal flaps and grafts in skull base surgery. Consensus document. Acta Otorrinolaringol Esp (Engl Ed) 2022; 73:323-335. [PMID: 36031110 DOI: 10.1016/j.otoeng.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/15/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Skull base reconstruction is one of the greatest challenges extended endonasal endoscopic surgery. Many grafts and flaps from the endonasal fossa have been demonstrated to be useful in the control of complications such a cerebrospinal fluid leaks. Review and analysis of these resources are necessary in skull base recontruction to improve outcomes. OBJECTIVES The target is to create a consensus document on the use of different endonasal flaps and grafts in the skull base surgery. MATERIAL AND METHODS Literature review of the most relevant free grafts and vascularized flaps from the endonasal fossa. Analysis using the Delphi method on the use of the different endonasal resources for endoscopic repair of skull base defects. RESULTS We obtained two results: 1) A selection of the most representative flaps and grafts from the endonasal fossa, describing origin, surface and indications, based on a literature review. 2) A consensus document, using Delphi methodology, with general considerations (2), recommendations (10) and limitations (6) of the different endonasal flaps and grafts. CONCLUSIONS We present the first consensus document in the field of extended endonasal endoscopic surgery using the Delphi method as a working tool. We highlight the usefulness of the nasoseptal flap together with other endonasal flaps and grafts for skull base reconstruction.
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Affiliation(s)
- Ramón Moreno-Luna
- Unidad de Rinología y Base de Cráneo, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Ariel Kaen
- Unidad de Base de Cráneo, Servicio de Neurocirugía, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Nieves Mata Castro
- Servicio de Otorrinolaringología, Hospital Universitario de Torrejón, Madrid, Spain
| | - Jaime González García
- Unidad de Rinología y Base de Cráneo, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - José Miguel Villacampa Aubá
- Servicio de Otorrinolaringología, Fundación Jiménez Díaz, Madrid, Spain; Comisión de Rinología, Alergia y Base de Cráneo Anterior, Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL y CCC)
| | | | - Irene Monjas Cánovas
- Servicio de Otorrinolaringología, Hospital General Universitario de Alicante, Alicante, Spain
| | - Alfonso Del Cuvillo Bernal
- Unidad de Rinología, Hospital Universitario de Jerez, Cádiz, Spain; Comisión de Rinología, Alergia y Base de Cráneo Anterior, Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL y CCC)
| | | | - Juan Manuel Maza Solano
- Unidad de Rinología y Base de Cráneo, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Rafael Fernández de Liesa
- Servicio de de Otorrinolaringología, Hospital Universitario Miguel Servet, Zaragoza, Spain; Comisión de Rinología, Alergia y Base de Cráneo Anterior, Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL y CCC)
| | - Serafín Sánchez-Gómez
- Unidad de Rinología y Base de Cráneo, Hospital Universitario Virgen Macarena, Sevilla, Spain; Comisión de Formación de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL y CCC)
| | - Isam Alobid
- Unidad de Base de Cráneo, Departamento de Otorrinolaringología, Hospital Clínic, Barcelona, Spain; Comisión de Rinología, Alergia y Base de Cráneo Anterior, Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL y CCC).
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Moreno-Luna R, Mariño Sánchez F, Kaen A, Gras Cabrerizo JR, Mata Castro N, González García J, Villacampa Aubá JM, Cárdenas Ruiz-Valdepeñas E, Monjas Cánovas I, Del Cuvillo Bernal A, García Piñero A, Maza Solano JM, Fernández de Liesa R, Sánchez-Gómez S, Alobid I. Usefulness of endonasal flaps and grafts in skull base surgery. Consensus document. Acta Otorrinolaringol Esp (Engl Ed) 2021; 73:S0001-6519(21)00041-8. [PMID: 34330369 DOI: 10.1016/j.otorri.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Skull base reconstruction is one of the greatest challenges extended endonasal endoscopic surgery. Many grafts and flaps from the endonasal fossa have been demonstrated to be useful in the control of complications such a cerebrospinal fluid leaks. Review and analysis of these resources are necessary in skull base recontruction to improve outcomes. OBJECTIVES The target is to create a consensus document on the use of different endonasal flaps and grafts in the skull base surgery. MATERIAL AND METHODS Literature review of the most relevant free grafts and vascularized flaps from the endonasal fossa. Analysis using the Delphi method on the use of the different endonasal resources for endoscopic repair of skull base defects. RESULTS We obtained two results: 1) A selection of the most representative flaps and grafts from the endonasal fossa, describing origin, surface and indications, based on a literature review. 2) A consensus document, using Delphi methodology, with general considerations (2), recommendations (10) and limitations (6) of the different endonasal flaps and grafts. CONCLUSIONS We present the first consensus document in the field of extended endonasal endoscopic surgery using the Delphi method as a working tool. We highlight the usefulness of the nasoseptal flap together with other endonasal flaps and grafts for skull base reconstruction.
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Affiliation(s)
- Ramón Moreno-Luna
- Unidad de Rinología y Base de Cráneo, Hospital Universitario Virgen Macarena, Sevilla, España
| | | | - Ariel Kaen
- Unidad de Base de Cráneo, Servicio de Neurocirugía, Hospital Universitario Virgen del Rocío, Sevilla, España
| | | | - Nieves Mata Castro
- Servicio de Otorrinolaringología, Hospital Universitario de Torrejón, Madrid, España
| | - Jaime González García
- Unidad de Rinología y Base de Cráneo, Hospital Universitario Virgen Macarena, Sevilla, España
| | - José Miguel Villacampa Aubá
- Servicio de Otorrinolaringología, Fundación Jiménez Díaz, Madrid, España; Comisión de Rinología, Alergia y Base de Cráneo Anterior. Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL y CCC)
| | | | - Irene Monjas Cánovas
- Servicio de Otorrinolaringología, Hospital General Universitario de Alicante, Alicante, España
| | - Alfonso Del Cuvillo Bernal
- Unidad de Rinología, Hospital Universitario de Jerez, Cádiz, España; Comisión de Rinología, Alergia y Base de Cráneo Anterior. Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL y CCC)
| | | | - Juan Manuel Maza Solano
- Unidad de Rinología y Base de Cráneo, Hospital Universitario Virgen Macarena, Sevilla, España
| | - Rafael Fernández de Liesa
- Servicio de de Otorrinolaringología, Hospital Universitario Miguel Servet, Zaragoza, España; Comisión de Rinología, Alergia y Base de Cráneo Anterior. Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL y CCC)
| | - Serafín Sánchez-Gómez
- Unidad de Rinología y Base de Cráneo, Hospital Universitario Virgen Macarena, Sevilla, España; Comisión de Formación de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL y CCC)
| | - Isam Alobid
- Unidad de Base de Cráneo, Departamento de Otorrinolaringología, Hospital Clínic, Barcelona, España; Comisión de Rinología, Alergia y Base de Cráneo Anterior. Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL y CCC).
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