The technique of dermoplasty to treat recurrent nasal polyps: preoperative evaluation, surgical details, postoperative endoscopic appearance and histopathologic analysis

BACKGROUND. The tendency of the nasal polyps for recurrence is well established and recognized. A potentially effective measure to reduce this tendency seems to be the replacement of the mucosa responsible for polyp growth.

MATERIAL AND METHODS. Since February 2012, we have used this method in fifteen patients with intractable polyposis. After a short course of preoperative medication, we performed a detailed computed scan analysis to study the anatomy of the ethmoidal complex and calculate the area and contour of the graft. Under general anaesthesia, we removed the mucosa of the nasal roof and replaced it with a split-thickness skin graft. For maintenance, only a short course of nasal drops every three months seems to suffice.

RESULTS. Excluding the first two cases due to a poor surgical technique, the rest of the cases may be considered successful. All patients experience a functional nose with restored nasal breathing and occasionally olfactory function with only a minimal pharmaceutical aid. Polyps still grow, but they show a much more benign course and are readily responsive to medical treatment. Interestingly, polyps present squamous metaplasia postoperatively. This feature needs further investigation.

CONCLUSION. The method of dermoplasty presents a high potential for control of polyp growth. With only an hour prolongation of surgical time, a minor increase in complication rate and a small increase in morbidity rate, the technique deserves further attention from the rhinological society.