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Clinical Challenges
October 2002

Comments About Postoperative Care After Endoscopic Sinus Surgery

Author Affiliations
 

KAREN H.CALHOUNMD

 

RONALD B.KUPPERSMITHMD

Arch Otolaryngol Head Neck Surg. 2002;128(10):1207-1208. doi:10.1001/archotol.128.10.1207

Dr Erica Thaler's article reviewing postoperative care after ESS is a well-done review. Her conclusion that each patient be individualized after 1 or 2 initial postoperative visits is appropriate. Specific comments based on long-term experience with ESS are offered.

The background information offered by Dr Thaler nicely summarizes the functional philosophy of ESS. There is no question that doing less surgery and preserving mucosa leads to better, faster healing and less need for postoperative care. However, in cases with remarkable disease and extensive surgery, postoperative debridement is more important to aid healing. Again, timing is up to each practitioner and dependent on how healing is progressing. It is impressive how each individual patient heals. Some patients require no postoperative debridement and others, multiple. The usual number necessary is 2 or 3. Factors involved in healing that help determine the need for postoperative care are extent of disease, preservation of the middle turbinate (partial or whole), extensive mucosal removal, revision surgery with previously scarred or obstructed ostia, stenting or spacers, frontal sinus surgery, obvious evidence of obstruction, scarring, infection, age, sex, and underlying medical problems. Any or several of the above factors may determine the need for debridement. For instance, most cases of failure in ESS are related to lateralization of the whole or part of the middle turbinate. The prevention of the associated scarring and obstruction is a priority of postoperative debridement and key to successful surgery.

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