scholarly journals Endoscopic sinus surgery: evolution and technical innovations

2009 ◽  
Vol 124 (3) ◽  
pp. 242-250 ◽  
Author(s):  
S Govindaraj ◽  
N D Adappa ◽  
D W Kennedy
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Mucociliary Clearance ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Sinus Disease ◽  
Endoscopic Study ◽  
Technological Advances ◽  
Technical Innovations ◽  
The Impact ◽  
Nose And Sinuses

AbstractPrior to the introduction of functional endoscopic sinus surgery, several surgeons had begun to use telescopes to perform surgical procedures in the nose and sinuses. However, the central concepts of functional endoscopic sinus surgery evolved primarily from Messerklinger's endoscopic study of mucociliary clearance and endoscopic detailing of intranasal pathology. The popularity of a combination of endoscopic ethmoidectomy plus opening of secondarily involved sinuses grew rapidly during the latter part of the twentieth century, and endoscopic intranasal techniques began to expand to deal with pathology other than inflammation. We present a review of the evolution of knowledge regarding the pathogenesis of inflammatory sinus disease since that point in time, and of the impact that this has had on the management of inflammatory sinus disease. We also detail the technological advances that have allowed endoscopic intranasal techniques to expand and successfully treat other pathology, including skull base and orbital disease. In addition, we describe evolving technologies which may further influence development within this field.

Functional Endoscopic Sinus Surgery in Patients with Chronic Sinusitis and Asthma

1994 ◽  
Vol 110 (6) ◽  
pp. 494-500 ◽  
Author(s):  
Gary J. Nishoka ◽  
Paul R. Cook ◽  
William E. Davis ◽  
Joel P. McKinsey
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Hospital Admissions ◽  
Chronic Sinusitis ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Office Visits ◽  
Sinus Disease ◽  
Physician Office ◽  
Steroid Dependent ◽  
The Impact

Twenty asthma patients who underwent functional endoscopic sinus surgery for chronic sinusitis were studied. Medical records and questionnaire data for these 20 patients were studied regarding the Impact of sinus disease and functional endoscopic sinus surgery on their asthma. We found that 95% reported that their asthma was worsened by their sinus disease (95% confidence interval, 0.74 to 0.99+), and 85% reported that functional endoscopic sinus surgery improved their asthma (0.60 to 0.97). Of the 13 patients who used both inhalers and systemic medication, 53.8% were able to eliminate some of their medication (0.21 to 0.79). Furthermore, 61.5% of these patients had a concomitant reduction in their inhaler use (0.28 to 0.85). All patients (six) who used only inhalers experienced a reduction in their inhaler use (0.54 to 1.00), and two patients were able to eliminate their inhalers completely. One of two patients who were steroid dependent was able to discontinue steroids after surgery. Of patients who used steroids intermittently (13), 53.8% were able to eliminate the use of steroids after surgery (0.21 to 0.79). Patients who required preoperative hospital admissions (4) and emergency room or urgent physician office visits (18) had a 75.0% and 81.3% ( p < 0.001) reduction in visits, respectively, after surgery. Because 43% of the cost of asthma is the result of hospitalizations and emergency department/urgent physician office visits, a significant Impact on health care costs can be realized with functional endoscopic sinus surgery in this patient population.

Partial Endoscopic Middle Turbinectomy Augmenting Functional Endoscopic Sinus Surgery

1992 ◽  
Vol 107 (3) ◽  
pp. 382-389 ◽  
Author(s):  
William R. Lamear ◽  
William E. Davis ◽  
Jerry W. Templer ◽  
Joel P. Mckinsey ◽  
Herbierto Del Porto
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Underlying Disease ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Atrophic Rhinitis ◽  
Standard Component ◽  
Patients At Risk ◽  
Nasal Physiology ◽  
Middle Meatus Antrostomy ◽  
The Impact

Endoscopic sinus surgery has gained acceptance in the otolaryngologic community as an effective and safe method of treating inflammatory disease of the paranasal sinuses. At our institution, partial endoscopic middle turbinectomy has become a standard component of the procedure and our experience is reported. Middle turbinectomy enhances surgical exposure, specific anatomic anomalies are more completely corrected, and subpopulations of patients at risk for failure because of their underlying disease enjoy decreased rates of synechiae formation and closure of the middle meatus antrostomy when followed over time. Photodocumentation of the surgical technique and a discussion regarding the impact of middle turbinectomy on normal nasal physiology are presented. It is reported that the procedure is safe, and no complications directly attributable to middle turbinectomy (including atrophic rhinitis) are reported in a series of 298 patients.

Pre- and Postoperative Mucociliary Clearance in Functional Endoscopic Sinus Surgery

1997 ◽  
Vol 76 (12) ◽  
pp. 884-886 ◽  
Author(s):  
Shashikant K. Kaluskar
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Chronic Sinusitis ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Controlled Study ◽  
Symptom Profile ◽  
Before And After ◽  
Prospective Controlled Study ◽  
Results Of Surgery ◽  
Nose And Sinuses

The advent of functional endoscopic sinus surgery (FESS) has revolutionized the treatment of chronic sinusitis over the last decade. Although it has been well-established that FESS is more efficacious than conventional surgery, the lack of a quantifiable means of assessing results remains one of the major shortcomings of the technique, and hence a source of criticism. Since the pathophysiology of chronic sinusitis is intimately related to the mucociliary mechanism of the nose and sinuses, it seems logical to use this parameter as a yardstick of success. We undertook a prospective, controlled study of 40 patients and measured their “saccharin times” before and after surgery. The results show a marked reduction in clearance times postoperatively, corresponding well with improvement in symptom profile. We therefore propose this technique as a simple, safe and reliable method of assessing the results of surgery. Furthermore, the method could act as a preoperative indicator of ciliary motility disorders, as the prognosis in these patients is distinctly poor.

Functional Endoscopic Sinus Surgery in the Immunocompromised Child

1991 ◽  
Vol 105 (6) ◽  
pp. 818-825 ◽  
Author(s):  
Brian J. Wiatrak ◽  
Paul Willging ◽  
Charles M. Myer
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Fatal Outcome ◽  
Chemotherapeutic Agents ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Fungal Sinusitis ◽  
Sinus Disease ◽  
Immunocompromised Child ◽  
Surgical Modality ◽  
Sinonasal Disease

Fungal sinusitis in the immunocompromised child is an aggressive, invasive process that may result in a fatal outcome if not diagnosed early. As a result of increasing use of bone marrow transplantation and new cytotoxic chemotherapeutic agents resulting in severe agranulocytopenia, more patients have become susceptible to fungal sinus disease. Functional endoscopic sinus surgery has emerged recently as an important surgical modality in the treatment of sinus disease in adults and children. Use of this technique in immunosuppressed children has allowed early diagnosis of fungal sinonasal disease, resulting in earlier surgical intervention. The high-quality fiberoptic capability of nasal endoscopes allows very detailed visualization of the internal anatomy of the nose and detects early mucosal changes as a result of intranasal fungal disease. Our experience using functional endoscopic sinus surgery in immunocompromised children over an 18-month period is reviewed. Our philosophy for diagnosis and management of immunocompromised children with suspected fungal sinonasal disease is discussed.

Functional endoscopic sinus surgery for isolated sphenoid sinus disease

Head & Neck ◽  
1994 ◽  
Vol 16 (5) ◽  
pp. 433-437 ◽  
Author(s):  
Laurent Gilain ◽  
Didier Aidan ◽  
André Coste ◽  
Roger Peynegre
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Sphenoid Sinus ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Sinus Disease

Monitoring of intra-operative visual evoked potentials during functional endoscopic sinus surgery (FESS) under general anaesthesia

1996 ◽  
Vol 110 (1) ◽  
pp. 31-36 ◽  
Author(s):  
S. S. M. Hussain ◽  
H. C. K. Laljee ◽  
J. M. Horrocks ◽  
A. R. H. Grace
Keyword(s):  
Evoked Potentials ◽  
General Anaesthesia ◽  
Visual Evoked Potentials ◽  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Sinus Disease ◽  
Flash Visual Evoked Potentials ◽  
Preliminary Study ◽  
Visual Evoked

AbstractFunctional endoscopic sinus surgery (FESS) is an effective treatment for inflammatory sinus disease. The potential for major complications during FESS is high particularly under general anaesthesia. The most serious of these is injury to the eye leading to blindness. We looked at the feasibility of monitoring flash visual evoked potentials (VEP) simultaneously from both eyes during FESS. Five patients were included in this preliminary study. A haptic contact lens connected by fibreoptic cable to a photostimulator was placed on the eyes and stimulus of comparable intensity to a conventional strobe was delivered. We found that an increase in P100 latency to be an indicator of optic nerve compression. However, for this to be useful the diastolic blood pressure should not fall below 50 mmHg, the oxygen saturation should be maintained at 98 per cent and bleeding should be minimized during surgery. The changes in the amplitude of P100 was not found to be useful.While there is no substitute for learning endoscopic surgery by cadaveric dissection and supervised training we believe that in selected cases VEP monitoring can be employed with profit.

Functional Endoscopic Sinus Surgery in Patients with Normal Computed Tomography Scans

1994 ◽  
Vol 110 (6) ◽  
pp. 505-509 ◽  
Author(s):  
Paul R. Cook ◽  
Gary J. Nishioka ◽  
William E. Davis ◽  
Joel P. McKinsey
Keyword(s):  
Computed Tomography ◽  
Endoscopic Sinus Surgery ◽  
Facial Pain ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Select Group ◽  
Computed Tomography Scans ◽  
The Impact ◽  
Tomography Scan

Eighteen patients were operated on by functional endoscopic sinus surgery who had no ostiomeatal unit obstruction on computed tomography scan and had unremarkable paranasal sinuses. These patients also had no apparent ostiomeatal unit obstruction on diagnostic nasal endoscopy. Data were collected on these patients regarding the impact of very limited functional endoscopic sinus surgery on their principal complaint of recurrent sinusitis with facial pain/headache thought to be of sinogenic origin. Sixteen patients (88.9%) had a reduction in the number of sinus infections requiring antibiotic therapy. This reduction was significant at p < 0.0001. Twelve of 14 patients whose facial pain/headache was believed to be of sinogenic origin had a significant reduction in severity (95% confidence interval, 49.2% to 95.3%). We discuss the role of reversible nasal mucosal disease in the pathophysiology of recurrent rhinosinusifts in this patient population. This was a very small, select group of patients who had specific complaints and had had medical treatment failures. This therapy Is not recommended for every patient, but only a select few with classic complaints of sinus headaches or recurrent sinusitis and negative computed tomography scans.

The Impact of Screening Sinus CT on the Planning of Functional Endoscopic Sinus Surgery

1991 ◽  
Vol 105 (6) ◽  
pp. 802-813 ◽  
Author(s):  
Jerry W. Sonkens ◽  
H. Ric Harnsberger ◽  
G. Marsden Blanch ◽  
Robert W. Babbel ◽  
Steven Hunt
Keyword(s):  
Inflammatory Disease ◽  
Endoscopic Sinus Surgery ◽  
Patient Management ◽  
Individual Case ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Central Feature ◽  
The Individual ◽  
The Impact ◽  
Sinonasal Polyposis

The clinical and radiologic records of 500 sequential patients who underwent screening sinus CT as a prelude to possible functional endoscopic sinus surgery (FESS) were reviewed in order to answer three clinical-radiologic questions: (1) Can distinct radiologic patterns of inflammatory disease be identified on screening sinus CT (SSCT)? (2) If so, what are these radiologic patterns? (3) How do the findings seen on SSCT influence the endoscopic surgical plan? Five basic radiologic patterns of sinonasal inflammatory disease were identified among the 500-member patient population. These were based on known patterns of mucociliary drainage correlated with obstructive patterns observed on the CT scans. These radiologic batterns included: (1) Infundibular (129 of 500 or 26%), (2) ostiomeatal unit (126 of 500 or 25%), (3) sphenoethmoidal recess (32 of 500 or 6%), (4) sinonasal polyposis (49 of 500 or 10%), and (5) sporadia (unclassifiable) (121 of 500 or 24%) patterns. Normal SSCT was seen in 133 of the 500 patients (27%). Although the ostiomeatal unit is the central feature in sinonasal inflammatory disease, obstruction of the infundibulum alone or of the sphenoethmoidal recess can cause unique inflammatory patterns of disease that require tailored FESS. The identification of sinonasal polyposis raises a different set of FESS considerations. The sporadic pattern of inflammatory disease, when identified, creates unique FESS challenges, depending on the specific sinus or sinuses involved. Assignment of these patterns to the individual case also assists in patient management by grouping patients into nonsurgical (normal CT), routine (infundibular, ostiomeatal unit, and most sporadic patterns) and complex (sinonasal polyposis and sphenoethmoidal recess) surgical groups.

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