FESSDRRAJINI

Functional Endoscopic Sinus Surgery – Concepts of Surgery

Significant controversy reigned throughout the 20th century with regard to the extent of surgery that should be performed in chronic sinusitis. Debate is sure to continue until the pathogenesis of chronic sinusitis is better understood. The concept of “irreversibly diseased” mucosa that needs to be surgically removed has now largely been eliminated. Indeed, the problems associated with exposure of bone from mucosal stripping during surgery have been increasingly appreciated. Moriyama and colleagues have shown that denuded bone results in extremely delayed healing. The bone may remain exposed for 6 months or more, and ciliary density may never return to normal at these sites. Greater emphasis thus should be placed on mucosal preservation within the ethmoid sinus during surgery. The initial understanding of functional endoscopic sinus surgery (FESS), namely, that drainage of the involved sinuses is sufficient to induce disease resolution, currently has been modified somewhat, based on continued improvement of the understanding of the disease process.

BALOON SINOPLASTY

Balloon sinuplasty was developed in 2006 and this new iteration of it is considered different from prior french biliary catether in that the new technique can fracture bones. Kennedy concluded in a recent study that this technique may lead to bacterial introduction and subsequent osteitis, mucositis, and mucoceles.

Conclusions

Functional endoscopic surgery is a complex and constantly evolving field with new techniques, instruments and approaches continually described. The most important aspect to remember when performing sinus surgery is that one must be safe and the best way to assure one is safe is to have an excellent understanding of the anatomy of the paranasal sinuses. Even in the advent of image guidance, it is paramount to have a good understanding of the proximity of structures to avoid damage to them. The second most important aspect of sinus surgery, as in all other surgery, is understanding the indications and knowing what type of surgery is best fitted for each individual patient.