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.

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.

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 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.

scholarly journals Uncinate Preserving Procedures: A Leading Step toward Conservation in Functional Endoscopic Sinus Surgery

2015 ◽  
Vol 8 (1) ◽  
pp. 12-14
Author(s):  
Sourabha K Patro
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Uncinate Process ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Nasal Physiology

ABSTRACT Uncinate process is thought to be having role in controlling airflow dynamics at the osteo meatal complex. Excision of uncinate process during traditional functional endoscopic sinus surgery (FESS) affects these airflow patterns increasing the flow in the sinuses in inspiration and decreasing it during expiration. Conventional way of performing a FESS always includes uncinectomy. However, preservation of uncinate process during surgery leads to the protection of the opened sinuses and avoid the attack of direct airflow to the sinus along with maintaining the normal nasal drainage from the sinus cavities. There is no clear evidence or consensus in the issue and regarding the feasibility of successful access in the ethmoids and sphenoids and beyond by preserving this immensely important land mark. In this study, we have tried to see that whether it is feasible to conserve uncinate as a future eland mark and preserve more normal nasal physiology compared with the resection of uncinate process. How to cite this article Gupta AK, Patro SK. Uncinate Preserving Procedures: A Leading Step toward Conservation in Functional Endoscopic Sinus Surgery. Clin Rhinol An Int J 2015;8(1):12-14.

scholarly journals Effectiveness of Functional Endoscopic Sinus Surgery in Surgical Management of Ethmoid Polyps

2022 ◽  
Vol 8 (1) ◽  
pp. 38-42
Author(s):  
Kumari Radha M. N ◽  
Anju Unnikrishnan ◽  
Manju N
Keyword(s):  
Ct Scan ◽  
Surgical Management ◽  
Paranasal Sinuses ◽  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Middle Meatus ◽  
Frontal Recess ◽  
Extent Of Surgery ◽  
Middle Meatus Antrostomy

Background: Aim: To assess efficacy of functional endoscopic sinus surgery in surgical management of ethmoid polyps.Methods:One hundred twelve adult patients age ranged 18- 38 years of either gender with ethmoid polyps underwent FESS under general anesthesia. The extent of surgery was decided based on the findings in pre-operative CT scan of paranasal sinuses. Anterior ethmoidectomy, posterior ethmoidectomy, middle meatus antrostomy and clearance of frontal recess were performed in all the patients. Five functional criteria were evaluated as nasalobstruction , anosmia, rhinorrhea, post nasal drip, head ache and facial pain.Results:Pre- operative nasal obstruction percentage was 3.42 and post- operative ercentage was 2.10, Anosmia percentage was 2.14 and 1.15, Rhinorrhea percentage was 3.56 and 2.08 and ocular problem in 1 and synechia in 4 cases.Conclusions:Functional endoscopic sinus surgery found to be effective in management of ethmoid polyps and hence can be the treatment of choice.

Indications, Evaluation, Complications, and Results of Functional Endoscopic Sinus Surgery in 200 Patients

1993 ◽  
Vol 108 (6) ◽  
pp. 688-696 ◽  
Author(s):  
Lane F. Smith ◽  
Paul C. Brindley
Keyword(s):  
Medical Therapy ◽  
Endoscopic Sinus Surgery ◽  
Complex Disease ◽  
Major Complication ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Atrophic Rhinitis ◽  
Outpatient Basis ◽  
Sinus Disease ◽  
Preoperative Symptom

Functional endoscopic sinus surgery (FESS) is a new and exciting treatment for chronic sinus disease. Our knowledge of the surgery continues to expand. A retrospective and prospective review of 200 patients undergoing FESS was undertaken at the Houston Ear, Nose, and Throat Clinic. Parameters studied included patient symptoms, medical history, medical therapy, and radiologic findings. Also reviewed were length of hospitalization, complications, and postoperative symptoms. Nasal obstruction was the most common preoperative symptom. Anterior ethmoid and ostiomeatal complex disease were the most common preoperative CT scan findings. More than 84% of the surgeries were performed on an outpatient basis. Minor complications developed in 8% of the patients, and only one major complication occurred (0.05%). With a mean followup of 17 months, 88% of the patients were symptom-free or Improved; however, 41.5% still required some medical therapy. FESS can safely be performed while the patient is under general anesthesia. Partial middle turblnectomy is a safe and recommended procedure; no cases of atrophic rhinitis occurred. We conclude that FESS is a highly successful treatment for chronic sinus disease ( p < 0.01) and that a strong patient history for sinus symptoms is the most Important Indication for FESS.

Utility of Second-Look Endoscopy with Debridement After Pediatric Functional Endoscopic Sinus Surgery in Patients with Cystic Fibrosis

2020 ◽  
Vol 129 (12) ◽  
pp. 1153-1162
Author(s):  
Zachary M. Helmen ◽  
Ryan E. Little ◽  
Thomas Robey
Keyword(s):  
Cystic Fibrosis ◽  
Endoscopic Sinus Surgery ◽  
Tertiary Care ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
P Value ◽  
Second Look ◽  
Significant Difference ◽  
Pulmonary Exacerbations ◽  
The Impact

Objectives: To determine the utility of Second-look endoscopy with debridement (SLED) after functional endoscopic sinus surgery (ESS) in pediatric cystic fibrosis (CF) patients. To compare outcomes in pediatric CF patients undergoing sinus surgery for chronic sinusitis with or without SLED. To describe findings present at the time of SLED. Methods: Retrospective chart review of 61 ESS procedures performed at a tertiary care pediatric center from 2013 to 2016. Data collected included demographics, SLED findings, and 6-month pre-/postoperative disease specific outcomes including incidence of sinonasal and pulmonary exacerbations and revisions. Results: Sixty-one cases were reviewed. SLED was performed in 38 cases on average 22.4 days postoperatively. Average preoperative Lund-Mackay score was 14.9 and 14.8 among patients undergoing ESS with and without SLED, respectively. Pre-/postoperative intranasal steroid use and extent of surgery performed was similar among all patients. At the time of SLED, rates of synechiae, polyps and maxillary antrostomy obstruction were 26.3%, 23.7%, and 7.9%, respectively. The incidence and number of days to onset of postoperative sinonasal exacerbations requiring antibiotic therapy within 6 months of ESS were 1.0 (SD 1.0) and 85 days (SD 45.7); and 1.3 (SD 1.0) and 80.4 days (SD 40.5) for patients undergoing ESS with and without SLED, respectively ( P value .33). The number of days to first pulmonary exacerbation was 113.9 (SD 45.5) and 47.4 (SD 34.1) among SLED and non-SLED patients, respectively ( P value .01). No significant difference was observed in revision rates and time to revision ESS (30% and overall average 1.4 years, respectively). Conclusion: The utility of SLED among pediatric CF patients remains unclear. While debridement did not have a significant impact on sinonasal exacerbations or revision rates, pulmonary exacerbations for patients undergoing SLED were delayed. Further studies are needed to clarify the impact of SLED.

Recovery of Nasal Physiology after Functional Endoscopic Sinus Surgery: Olfaction and Mucociliary Transport

ORL ◽  
1995 ◽  
Vol 57 (5) ◽  
pp. 264-268 ◽  
Author(s):  
Yang-Gi Min ◽  
Yeong-Seok Yun ◽  
Byeong Ho Song ◽  
Yang Sun Cho ◽  
Kang Soo Lee
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Mucociliary Transport ◽  
Nasal Physiology

scholarly journals ENT Residents Benefit from a Structured Operation Planning Approach in the Training of Functional Endoscopic Sinus Surgery

Medicina ◽  
2021 ◽  
Vol 57 (10) ◽  
pp. 1062
Author(s):  
Sven Becker ◽  
Phillipp Gonser ◽  
Magnus Haas ◽  
Martin Sailer ◽  
Matthias F. Froelich ◽  
...  
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Free Text ◽  
Operation Planning ◽  
Course Materials ◽  
Report Quality ◽  
Time Requirements ◽  
Conventional Manner ◽  
The Impact

Background and Objectives: Preoperative planning utilizing computed tomographies (CT) is of utmost importance in functional endoscopic sinus surgery (FESS). Frequently, no uniform documentation and planning structures are available to residents in training. Consequently, overall completeness and quality of operation planning may vary greatly. The objective of the present study was to evaluate the impact of a structured operation planning (SOP) approach on the report quality and user convenience during a 4-day sinus surgery course. Materials and Methods: Fifteen participant were requested to plan a FESS procedure based on a CT scan of the paranasal sinuses that exhibited common pathological features, in a conventional manner, using a free text. Afterwards, the participants reevaluated the same scans by means of a specifically designed structured reporting template. Two experienced ENT surgeons assessed the collected conventional operation planning (COP) and SOP methods independently with regard to time requirements, overall quality, and legibility. User convenience data were collected by utilizing visual analogue scales. Results: A significantly greater time expenditure was associated with SOPs (183 s vs. 297 s, p = 0.0003). Yet, legibility (100% vs. 72%, p < 0.0001) and overall completeness (61.3% vs. 22.7%, p < 0.0001) of SOPs was significantly superior to COPs. Additionally, description of highly relevant variants in anatomy and pathologies were outlined in greater detail. User convenience data delineated a significant preference for SOPs (VAS 7.9 vs. 6.9, p = 0.0185). Conclusions: CT-based planning of FESS procedures by residents in training using a structured approach is more time-consuming while producing a superior report quality in terms of detailedness and readability. Consequently, SOP can be considered as a valuable tool in the process of preoperative evaluations, especially within residency.

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