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.

Summary

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.

中文翻译：

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内镜下扩大鼻窦手术治疗严重慢性鼻窦炎合并鼻息肉患者粘膜成形术的选择：系统评价

审查目的

对慢性鼻窦炎伴鼻息肉 (CRSwNP) 炎症反应分子基础知识的进步使得这些患者的治疗朝着个性化和精准医疗的方向发展。对于通过适当的药物治疗无法控制病情的患者，手术被认为是一种合适的替代方案，但息肉样复发仍然是一个限制因素。基于患者表型的新手术方法的出现以及与 2 型炎症表型相关的疾病控制不佳，使得有必要回顾个性化和精准手术在疾病管理中的作用。

最近的发现

基于广泛切除骨性窦结构和治疗鼻窦粘膜的手术方法已经被分析并与其他技术进行比较，除了较低的复发率之外，似乎可以提供更有利的手术结果并改善生活质量（QoL） 。新的补充手术技术的创新，例如重新启动手术，从鼻底添加延伸的自体粘膜移植物（粘膜成形术），可能有利于具有 2 型表型的最严重的 CRSwNP 患者的内镜检查和生活质量结果。

概括

使用双侧鼻内粘膜成形术作为重新启动手术的补充技术是一种合适的技术选择，可以改善严重 CRSwNP 患者的短期和中期生活质量和内镜结果。这些结果可能是由于重新启动的延长和粘膜成形术固有的炎症和愈合特性的结合。我们建议这项技术作为一种宝贵的手术资源，尽管需要更强有力的临床研究来全面评估其长期效益。