Conventional and Powered Instrumentation for Endoscopic Sinus Surgery

Abstract

Maxillary sinus approaches are the basic interventions in endoscopic sinus surgery. Identification of the maxillary sinus ostium usually is a simple procedure depending on its localization and easily recognizable surrounding landmarks. Exposure of the ostium starts with uncinectomy under direct visualization with a 0^o endoscope. Angled endoscopes are more useful in identifying and widening the ostium and exploration or the surgical management of the maxillary sinus. Angled microdebriders can also be used for the widening of the ostium and the excision of the polyps localized in maxillary sinus. Ethmoidectomy is started with the resection of the ethmoid bulla under 0^o endoscopic visualization. Bulla resection is performed with straight and 45^o angled Blakesley forceps after perforating the inferomedial wall with a straight Frazier suction tube or a J curette. Through-cutting forceps is used to remove the osseous fragments along the medial orbital wall. Both transnasal and transethmoid approaches can be used for sphenoidotomy. The 0^o endoscopes are used until the natural ostium is identified. Once the superior turbinate is seen, the lower portion is truncated with a straight through-cutter to obtain a direct aspect to the sphenoid sinus ostium. In this step, a straight microdebrider is also helpful. Frontal sinusotomy procedures require specially designed instruments because of its hardly accessible localization. Angled endoscopes and giraffe-style instruments are crucial for successful surgery. A 70^o endoscope provides the best visualization to access frontal recess. Ball tip frontal sinus probes are helpful in exploring the frontal recess. Frontal sinus curette and curved suction tubes are used to dissect the skull base and identify the agger nasi cell. The 45^o and 90^o front to back and side to side through-cutting giraffe forceps is useful in removing the posterior and medial walls of agger nasi cell.