Beruflich Dokumente
Kultur Dokumente
Endoscopic
Sinus Surgery
Introduction
Functional endoscopic sinus surgery
(FESS) is a surgical modality for some
diseases of the nose and paranasal sinuses.
It is the mainstay in the surgical treatment
of sinusitis and nasal polyposis, including
fungal sinusitis.
Indications
Chronic sinusitis refractory to medical
treatment
Recurrent sinusitis
Nasal polyposis
Antrochoanal polyps
Sinus mucoceles
Excision of selected tumors
Relevant Anatomy
Immediately upon entering the nasal cavity,
the first structures encountered are the nasal
septum and the inferior turbinate.
The nasal septum consists of the quadrangular cartilage
anteriorly, extending to the perpendicular plate of the
ethmoid bone posterosuperiorly and the vomer
posteroinferiorly. Recognizing deflections of the nasal
septum preoperatively is important because they may
significantly contribute to nasal obstruction and limit
endoscopic visualization during surgery.
08/31/15
Abou-Elhamd
Septal
cartilage
Perp. Plate
of Ethmoid
Vomer
Maxilla
08/31/15
Palatine B
Abou-Elhamd
Sphenoid
S
ET
Ostio-Meatal
Complex
08/31/15
Abou-Elhamd
maxillary sinus
The uncinate process is the next key
structure to be identified in endoscopic sinus
surgery. This L-shaped bone of the lateral
nasal wall forms the anterior border of the
hiatus semilunaris, or the infundibulum. The
infundibulum is the location of the
ostiomeatal complex, where the natural
ostium of the maxillary sinus opens.
sphenoid sinus.
The internal carotid artery is typically the
most posterior and medial impression seen
within the sphenoid sinus. In approximately
7% of cases, the bone is dehiscent. The
optic nerve and its bony encasement
produce an anterosuperior indentation
within the roof of the sphenoid sinus.
frontal sinus
The frontal recess, or the frontal outflow tract,
is the tract that leads from the frontal sinus
into the nasal cavity
Often, the ethmoid bulla is the posterior
border of the frontal sinus outflow tract.
Anteriorly, the frontal sinus outflow tract is
bordered by the uncinate process or the agger
nasi cells (frontal anterior ethmoid air cells).
Contraindications
Certain conditions may require an external
approach for complete treatment of disease;
these include:
intraorbital complications of acute sinusitis,
such as orbital abscess or frontal osteomyelitis
with Potts puffy tumor. An open approach in
these instances, with or without additional
endoscopic assistance, may be preferable.
Complications
Bleeding
Synechiae formation
Orbital injury
Diplopia
Orbital hematoma
Blindness
CSF leak
Direct brain injury
Nasolacrimal duct injury/epiphora (watering of the eye)
Thank you