Sinus Endoscopic Surgery

Excerpt

Endoscopic sinus surgery (ESS) has significantly advanced since it was first applied. The introduction of endoscopic examination of the sinuses took place in 1902. However, for most of the last century and until the 1970s, ESS was not performed regularly. In fact, sinus pathologies were addressed using external approaches using a headlight. Since the 1970s, the techniques applied in endoscopic sinus surgery have been in a constant race with advances in technology with new surgical instrumentation, imaging, simulation, and navigation.

The concept behind sinus surgery stems from Messerklinger's studies on mucociliary clearance and its role in the pathogenesis of sinusitis. The goals of functional endoscopic sinus surgery (FESS) in the treatment of sinusitis are to enlarge sinus ostia, restore adequate aeration of sinuses, improve mucociliary transport, and provide a better route for topical therapies. The notion behind FESS may seem straightforward, but the anatomical variability and the broad range and severity of diseases addressed in every FESS remain challenges for the surgeon in every case. Pre-operative planning for sinus surgery is the crucial step to obtain optimal results and to avoid all possible complications.

Endoscopic sinus surgery targets sinus pathology and is the gold standard for treating chronic rhinosinusitis (CRS). The boundaries of ESS are continually expanding with technological advances. At this point, the indications of ESS have surpassed the field of rhinosinusitis. The application of this procedure marked its place in the management of sinus tumors and pathologies beyond the sinuses.