Surgical management of chronic rhinosinusitis in north western Nigeria and challenges for the future.

BACKGROUND: Rhinosinusitis is usually treated medically. Surgical management is indicated when medical treatment fails or becomes complicated. Appraisal of various surgical methods employed in the treatment of chronic rhinosinusitis is the subject of this paper from a University teaching hospital in north western Nigeria.

METHOD: This is a review of 75 patients who underwent various conventional surgical operations for rhinosinusitis over a 5.5 year period from September 1999 to February 2005 who were followed up for a minimum period of 2 years.

RESULTS: A total number of 177 surgical operations were carried out of which 75 patients either had some surgical procedures unilaterally, bilaterally or in combinations. There were thirty nine males (52%) and thirty six females (48%) with a male to female ratio of 1:1. Their age ranges from 8 years to 70 years with a mean of 31.1 years. The ages 21-40 years range constituted majority (65.3%) of the patients. Ninety-two operations (52%) were caldwell luc (CWL) which was the commonest operation followed by forty-one (23.2%) cases of inferior meatal antrostomy (IMA), thirty two (18.1%) cases of partial inferior anterior turbinectomy (PIT), Ten (5.6%) cases of frontoethmoidectomy (FTE) and Two( 1.1%) cases of submucous resection of the septum (SMR). The indications for surgery were mainly persistent symptoms despite adequate medical treatment with radiologically confirmed evidence of ninety-seven nose or sinus pathologies in the seventy-five patients operated. These were: Chronic rhinosinusitis (CRS) with snus opacity in fifty four (55.7%) cases, CRS with polyps in eighteen (18.6%) cases, CRS with hypertrophic turbinates causing nasal obstruction in sixteen (16.8%) cases, CRS with frontoethmoidal mucoceles in five (5.2%) cases and CRS with sino-cutaneous fistula in two (2.1%) cases. Paraesthesia of the upper incissors was the commonest complaint after surgery for chronic maxillary sinusitis but at the fronto-ethmoidal region after frontoethmoidectomy which usually improved gradually and eventually disappeared between 3 to 6 months. Symptom relief after surgery justified surgery in all patients while one case needed a revision surgery after two and a half years for a recurrent symptom. There has not been any need for further surgery for the rest of the cases after a minimum period of 2 years follow up.

CONCLUSION: Surgical management of rhinosinusitis in north western Nigeria was mainly for chronic rhinosinusitis and proved to be beneficial for relief of symptoms with minimal complications if patients are carefully selected either with failed medical treatment or with complications. The young population of twenty-one to forty years (65.3%) constituted the bulk of the patients with a peak at the 3rd decade anda mean age of 31.1 years.