More aggressive FESS for recalcitrant CRS is the key
Reviewed by Joanna Stephens

This is an interesting paper assessing the effectiveness of endoscopic modified medial maxillectomy (MMM) in cases of recalcitrant chronic rhinosinusitis (CRS), (the technique was also used for tumours, cystic fibrosis, FB, odontogenic disease and AFS) in 551 patients. The technique preserves the lacrimal apparatus which forms the anterior border of dissection, and the anterior portion of the inferior turbinate overlying Hasner’s valve is also preserved. The authors defined successful treatment as a sinus with no evidence of mucostasis at three- and six-months follow-up, and improved SNOT 22 scores. There are several interesting points raised: the depth of the dependent portion of the maxillary sinus may produce a ‘sump’ effect and this therefore supports the use of MMM to eradicate this sump. Evidence which appears to support this is improved SNOT 22 scores in general, but a greater improvement in patients with a greater maxillary sinus depth preoperatively. Also interesting is the observation that at three months postop, almost a quarter of patients had endoscopic evidence of mucostasis whereas, by six months, this had decreased to <10%, suggesting that recovery of mucociliary function occurs over a prolonged period. Whilst a straightforward retrospective study with no control group or comparisons, it offers support for a more aggressive approach for patients with recalcitrant disease.

The modified medial maxillectomy as a radical or extended,-yet still functional-technique in sinus surgery.
Wong EH, Cavada MN, Orgain CA, et al.
AM J RHINOL ALLERGY
2022;37(4):476-84.