Canine fossa approaches in endoscopic sinus surgery - our experience

Main Article



To define the role of canine fossa approach when standard endoscopic endonasal sinus surgery technique fails.

Study design

Retrospective review of all endoscopic sinus surgeries performed from 1992 to 2007.


Out of 1612 endoscopic sinus surgeries for various indications, CFA was used in 80 patients (4.96%) and among this 15 had bilateral procedure.The various diseases which required CFA were allergic fungal sinusitis (AFS), Fungal ball, Chronic invasive aspergillosis,antro choanal polyp, inflammatory polyp, Mucocoele and Maxillary cyst,inverted papilloma and Juvenile Nasopharyngeal Angiofibroma (JNA). Eight patients had minor complications (cheek swelling-6, facial pain-2 ) which resolved in 5 days.


Canine fossa approach offers an ancillary approach to failed standard endoscopic endonasal technique thereby avoiding other more invasive procedures.


CFA - canine fossa approach FESS - Functional Endoscopic Sinus Surgery CRS - Chronic rhinosinusitis ACP -Antro choanal Polyp IP-Inverted papilloma JNA- Juvenile Nasopharyngeal Angiofibroma 


  1. 1.
    Kennedy DW, Zinreich SJ, Rosenbaum A (1985) Functional Endoscopic sinus surgery theory and diagnostic evaluation. Arch Otolaryngol Head Neck Surg 11:576–582Google Scholar
  2. 2.
    Catalano PJ, Strouch M (2004) The minimally invasive sinus technique; theory and practice. Otolaryngol Clin N Am 37: 401–409CrossRefGoogle Scholar
  3. 3.
    Kennedy DW (2006) Technical innovations and the evolution of endoscopic sinus surgery. Ann Otol Rhinol Laryngol Suppl 196:3–12PubMedGoogle Scholar
  4. 4.
    Rajiniganth MG, Gupta AK, Gupta A et al (2003) Traumatic Optic neuropathy; Visual outcome following combined therapy protocol. Arch Otolaryngol Head Neck Surg 129(11):1203–1206PubMedCrossRefGoogle Scholar
  5. 5.
    El-Hinnawi Dm (1998) Combined functional endoscopic sinus surgery (FESS): a revisited approach. Rhinology 36(4): 196–201Google Scholar
  6. 6.
    Zacharek MA, Fong KJ, Hwang PH (2006) Image-guided frontal trephination: a minimally invasive approach for hardto-reach frontal sinus disease. Otolaryngol Head Neck Surg 135(4):518–522PubMedCrossRefGoogle Scholar
  7. 7.
    Har-El G (2005) Combined endoscopic trans-maxillary-transnasal approach to the ptergoid region, lateral sphenoid sinus and retrobulbar orbit. Ann Otol Rhinol Laryngol 114(6): 439–442PubMedGoogle Scholar
  8. 8.
    Batra PS, Citrdi MJ, Lanza DC (2005) Combined endoscopic trephination and endoscopic frontal sinusotomy for management of complex frontal sinus pathology AM J Rhinol. 19(5): 435–441PubMedGoogle Scholar
  9. 9.
    Ta-Jen-Lee MD and Shiang-Fu Huang MD (2006) Endoscopic surgery for antrochoanal polyps in children. Otolaryngol Head Neck Surg 688–692Google Scholar
  10. 10.
    Ernesto P, Vittorio S Giovanni F et al (2005) Inverted Papilloma: report of 89 cases. American Journal of Otolaryngology 178–185Google Scholar
  11. 11.
    Stephen G, Rodney JS, William EB et al 2004 Endoscopic and endoscope assisted resection of sinonasal inverted papilloma. Otolaryngol Head Neck Surg 174–179Google Scholar
  12. 12.
    Alfieri A, Jho H D, Schettino R et al (2001) Endoscopic Endonasal approach to the Pterygopalatine fossa: Antomic study. Neurosurgery 52:37378Google Scholar
  13. 13.
    Robinson SR, Baird R, Le T, Wormald PJ (2005) Incidence of complications after canine fossa puncture performed during endoscopic sinus surgery. Am J Rhinol 19(2):203–206PubMedGoogle Scholar
  14. 14.
    Albertien AC, Aukema, Paul GH, et al (2005) Treatment of nasal polypois and chronic rhinosi-nusitis with fluticasone propionate nasal drops reduces need for sinus surgery. Journal of Allergy and clinical Immunology 115:1017–1023CrossRefGoogle Scholar
  15. 15.
    Roee Landsberg, Yoram Segev, Ari DeRowe et al (2005) Systemic steroids for Allergic Fungal Sinusitis and Nasal Polyposis: A Comparative Study Otolaryngol Head Neck Surg 133:193–194Google Scholar
  16. 16.
    Kuhn F, Javer AR (2000) Allergic Fungal Rhinosinusitis Periopertive Management, Prevention of recurrence, and role of steroids and antifungal agents. Otolaryngol Clin N Am 33: 419–432CrossRefGoogle Scholar
  17. 17.
    Ferguson BJ (2000) Fungus balls of the paranasal sinuses. Otolaryngol Clin N Am 33:389–399Google Scholar
  18. 18.
    Kirtane M.V, Gautham K, Sharaddha R, et al (2005) Endoscopic CSF rhinorrhoea closure, Our experience in 267 cases. Otolaryngol Head Neck Surg 132 (2):208–212PubMedCrossRefGoogle Scholar
  19. 19.
    Wormald PJ, Van Hasselt A (2003) Endoscopic removal of juvenile angiofibromas. Otolaryngol Head Neck Surg 129: 684–691PubMedCrossRefGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2008

Authors and Affiliations

  1. 1.MCV Memorial ENT Trust HospitalPollachiIndia

Personalised recommendations