Combined Open and Endoscopic Approaches to the Paranasal Sinus

  • A. Volkan Sünter
  • Ozgur Yigit
  • Neven Skitarelic


Various surgical routes are defined to access the paranasal sinuses. Frontal, ethmoid, and maxillary sinus pathologies have been approached externally using trephination, osteoplastic flap, external frontoethmoidectomy, and Caldwell-Luc procedures. These traditional techniques often resulted in undesirable perioperative and postoperative morbidity. In addition these external techniques are insufficient for the pathologies that invade the sphenoid sinus. Over the last 30 years, due to technological advancements the endoscopic surgical approaches to the paranasal sinuses and surrounding structures have gained popularity. These technological advancements are improved telescopes, angled powered instrumentations, and navigation systems. Endoscopic approach with angled telescopes provides a better vision of the relevant surgical anatomy and operation field when compared to external approaches. Besides, even though open techniques are being done less than endoscopic approaches, they still maintain their importance for some indications. For a safe and successful surgery, the surgical anatomy of the paranasal sinus is the most important point. Anatomical development of the paranasal sinuses continues until adulthood. Various anatomical variations of paranasal sinuses also exist. The relationship of the paranasal sinuses with the adjacent anatomic structures which are important vessels and cranial nerves must be considered. Orbit, skull base, cranial nerves, internal carotid artery, and some of the structures are the most important ones. The paranasal sinuses are distinguished with the walls of the anatomical structure of the bone environment. In some areas these walls are relatively thin and subjected to surgical trauma and this can lead to serious problems in environmental structures. Anatomical landmarks of the paranasal sinuses may show structural changes depending on the previous surgery, trauma, or underlying disease. In view of all these circumstances to know the surgical anatomy in a good way is the most important factor to reduce the risk of complications.


Combined Open Endoscopic Paranasal sinus Approaches Surgical anatomy Reducing the risk 


  1. 1.
    Eibling DE, Myers EN. Anterior antrostomy: the Caldwell-Luc operation. In: Operative otolaryngology: head and neck surgery. Philadelphia, PA: Saunders; 2008.Google Scholar
  2. 2.
    Hoffman S. Osteoplastic operation on the frontal sinus for chronic suppuration. Ann Otol Rhinol Laryngol. 1904;13:594–8.CrossRefGoogle Scholar
  3. 3.
    Lynch RC. The techniques of a radical frontal sinus operation, which has given me the best results. Laryngoscope. 1921;31:1–5.CrossRefGoogle Scholar
  4. 4.
    Patel AM, Vaughan WC. “Above and below” FESS: simple trephine with endoscopic sinus surgery. In: Kountakis SE, Senior B, Draf W, editors. Frontal sinus. Berlin: Springer; 2005.Google Scholar
  5. 5.
    Woodworth BA, Bhargave GA, Palmer JN, et al. Clinical outcomes of endoscopic and endoscopic-assisted resection of inverted papillomas: a 15-year experience. Am J Rhinol. 2007;21:591–600.CrossRefGoogle Scholar
  6. 6.
    Duque CS, Casino RR. Surgical anatomy and embryology of the frontal sinus. In: Kountakis SE, Senior B, Draf W, editors. Frontal sinus. Berlin: Springer; 2005.Google Scholar
  7. 7.
    Batra PS, Citardi MJ, Lanza DC. Combined endoscopic trephination and endoscopic frontal sinusotomy for management of complex frontal sinus pathology. Am J Rhinol. 2005;9:435–41.CrossRefGoogle Scholar
  8. 8.
    Lombardi D, Tomenzoli D, Butta L, et al. Limitations and complications of endoscopic surgery for treatment for sinonasal inverted papilloma: a reassessment after 212 cases. Head Neck. 2011;33:1154–61.CrossRefGoogle Scholar
  9. 9.
    Bent JP, Spears RA, Kuhn FA, Stewart SM. Combined endoscopic intranasal and external frontal sinusotomy (the above and below approach to chronic frontal sinusitis: alternatives to obliteration). Am J Rhinol. 1997;11:349–54.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • A. Volkan Sünter
    • 1
  • Ozgur Yigit
    • 1
  • Neven Skitarelic
    • 2
    • 3
  1. 1.Department of OtorhinolaryngologyUniversity of Health Sciences, Istanbul Training and Research HospitalIstanbulTurkey
  2. 2.Department of Health StudiesUniversity of ZadarZadarCroatia
  3. 3.Faculty of MedicineUniversity of RijekaRijekaCroatia

Personalised recommendations