Wegener's Granulomatosis: The Role of Endoscopic Sinus Surgery

Conventional wisdom has dictated that the patient with Wegener's Granulomatosis may benefit from a Caldwell Luc or external ethmoidectomy in the treatment of sinusitis. No studies, however, have specifically evaluated the efficacy of such drainage procedures especially with respect to endoscopic sinus surgery (ESS). Nineteen patients diagnosed with Wegener's Granulomatosis were evaluated to assess the efficacy of medical and surgical treatment of their sinus disease. Four of these patients eventually required ESS after failure to treat their sinus disease medically. ESS was performed to drain the obstructed sinuses (three patients) or a mucocele (one patient). Initially, the sinuses were patent, but two patients developed persistent scarring and crusting associated with the chronicity and activity of their systemic disease. These results underscore the difficulty in treating these patients and the fact that despite adequate endoscopic drainage and meticulous postoperative care the underlying disease process may relentlessly cause scarring and sinus obstruction. These patients require continuous medical and intensive surgical therapy for the best chance for sinus disease control.