title: Centripetal endoscopic sinus surgery in chronic rhinosinusitis: a 6-year experience.
abstract: BACKGROUND
  Despite technical advances in the tools designed to facilitate endoscopic nasosinusal surgery, the approach used, functional endoscopic sinus surgery, has not undergone major modifications since it was first described in the late 1980s. Centripetal endoscopic sinus surgery (CESS) is a new approach based on taking the medial wall of the orbit and the anterior cranial base as constant dissection landmarks. The aim of this study was to evaluate the long-term outcome of CESS in chronic rhinosinusitis (CRS) by measuring clinical and objective improvement, the need for revision surgery, and the complication rate.
  
  
  METHODS
  We reviewed 114 patients with CRS with or without polyps who underwent CESS at our center between May 2006 and December 2011. CRS was assessed using the Lund-Mackay staging system. The follow-up period ranged from 18 to 84 months (May 2013).
  
  
  RESULTS
  Of 114 patients, 83 presented CRS with nasal polyposis, 12 had CRS without nasal polyposis, 17 had Samter's triad, and 2 had antrochoanal polyps. Postoperative evaluation of nasal obstruction and olfaction showed a significant and lasting improvement in these symptoms. Only four patients (3.5%) have required revision surgery, to date.
  
  
  CONCLUSIONS
  CESS provided a lasting improvement in patients with CRS, by dramatically reducing the number of reinterventions. This approach is especially indicated in difficult cases, such as recurrent nasal polyposis and massive polyposis, because the dissection is based on constant borders and not influenced by previous surgery or disease extension.
authors.affiliation: Department of Otolaryngology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Sanjuan de Moreta
authors.forename: Isabel
authors.initials: I
authors.lastname: Cardoso-López
authors.forename: Daniel
authors.initials: D
authors.lastname: Poletti-Serafini
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010256:Paranasal Sinuses / Q000601:surgery*; D012189:Retrospective Studies; D012220:Rhinitis / Q000601:surgery*; D012852:Sinusitis / Q000601:surgery*