Preserving Function, Enhancing Precision: The Rise of Personalized Endonasal Sinus Surgery

Chronic rhinosinusitis (CRS) is a common disease with increasing global prevalence that significantly impacts patients' quality of life. Advances in surgical technology and a better understanding of mucosal pathophysiology have transformed its management landscape. However, a notable gap remains in the published literature. This article reviews the evolution of endonasal sinus surgery and presents a position on the emerging concept of "Thinvasive" surgery, a minimally invasive and function-preserving paradigm for the modern management of CRS. A comprehensive review of the historical development, current techniques, and novel approaches in endoscopic sinus surgery was conducted. The transition from traditional external procedures, such as Caldwell-Luc, to functional endoscopic sinus surgery (FESS) marked a pivotal shift toward mucosal preservation and restoration of physiological drainage. Further advancements, such as image-guided FESS, balloon sinuplasty, and other minimal-access modalities, have facilitated more precise and individualized interventions. The Thinvasive approach integrates these innovations with patient-specific assessment strategies, including radiologic and functional evaluation tools like the Sino-Nasal Outcome Test-22, quantum molecular resonance (Telea Medical, Sandrigo, Italy), and Ozilia-kinetic oscillation stimulation (Chordate Medical, Kista, Sweden). The future of endonasal sinus surgery lies in a flexible and personalized continuum. Thinvasive techniques offer a promising hybrid between medical and surgical treatment. Nonetheless, further research is needed to establish their long-term efficacy and to develop standardized patient selection frameworks.