{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T21:59:56Z","timestamp":1791583196926,"version":"4.3.4"},"reference-count":49,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T00:00:00Z","timestamp":1768348800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T00:00:00Z","timestamp":1768348800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Surgical treatment represents an adjunct to medical therapy in the management of primary diffuse chronic rhinosinusitis (CRS). Despite advancement in endoscopic sinus surgery (ESS), there are currently no established guidelines delineating the appropriate surgical extent for defining adequate ESS in cases of primary diffuse CRS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Through a modified Delphi technique, 33 statements regarding the extent of surgery for each paranasal sinus were drafted following a literature review and submitted to an expert panel composed of 15 internationally recognized ESS experts. A consensus meeting was held to discuss the results for each iteration. An additional statement was added during the meeting, and a total of 34 statements were voted on during the last round.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Consensus was reached in 17 statements out of 34. Type 1 medial maxillary antrostomy, bilateral anteroposterior ethmoidectomy, and at least DRAF I frontal sinusotomy should be performed in all cases of primary diffuse CRS, with a particular focus on mucosal sparing, regardless of the likelihood of subsequently needing biologic therapy. DRAF III frontal sinusotomy should not be considered as a first\u2010line approach even in patients with risk factors for recurrence. Treatment of the sphenoid sinus might be avoided in cases where it is not involved by the pathology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This document outlines a consensus on the appropriate surgical approach for primary diffuse CRS, aiming to promote standardization while preserving individual clinical judgment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>5.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.70365","type":"journal-article","created":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T12:25:35Z","timestamp":1768393535000},"page":"2481-2490","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Surgical Adequacy in\n                    <scp>ESS<\/scp>\n                    for Primary Diffuse\n                    <scp>CRS<\/scp>\n                    : Expert Consensus Recommendations"],"prefix":"10.1002","volume":"136","author":[{"given":"Daniela","family":"Lucidi","sequence":"first","affiliation":[{"name":"Department of Otolaryngology Ospedale Santa Maria Delle Croci di Ravenna \u2010 Bologna University  Ravenna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlotta","family":"Pipolo","sequence":"additional","affiliation":[{"name":"Otolaryngology Unit, Department of Health Sciences Santi Paolo e Carlo Hospital, Universit\u00e0 Degli Studi di Milano  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Pagella","sequence":"additional","affiliation":[{"name":"Department of Clinical, Surgical, Diagnostic and Pediatric Sciences University of Pavia  Pavia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7023-6746","authenticated-orcid":false,"given":"Davide","family":"Mattavelli","sequence":"additional","affiliation":[{"name":"Unit of Otorhinolaryngology\u2010Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, ASST Spedali Civili of Brescia University of Brescia  Brescia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Battaglia","sequence":"additional","affiliation":[{"name":"Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences University of Insubria, ASST Lariana  Como Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5761-7018","authenticated-orcid":false,"given":"Eugenio","family":"De Corso","sequence":"additional","affiliation":[{"name":"Otorhinolaryngology Unit A. 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