Microscopic Sinus Surgery, Transnasal Ethmoidectomy and Sphenoidectomy

Abstract

Intranasal ethmoid surgery has traditionally been a "blind procedure" using monocular vision, the delicate control of instruments being less than optimal. The addition of the operating microscope with a special self-retraining retractor speculum is presented in a series of 87 patients over 7 years, 49 of these having had transethmo-sphenoidectomy. Evaluation, anatomy, technique and results are discussed. Whereas the rate of serious complications is reported at 3% in large series, there were no complications in this series. The results of 181 microscopic antrostomies is also discussed. This technique offers considerable added safety to the patient, more self-confidence to the surgeon with binocular vision and much better control of instruments, and allows a more adequate procedure because of less fear of dreaded complications.

Otolaryngology–head and neck surgery at Johns Hopkins: The first 100 years (1914–2014)

“…Clinically, he was an early adopter of the Johns Hopkins telescope for endonasal diagnosis and as early as 1966 taught that “the ethmoid sinuses are usually the key to any problem involving infectious sinusitis. Infection generally begins there and persistent infection there is usually the reason for failure of therapy directed at any of the other paranasal sinuses.” In the mid‐1970s, a lecture at Johns Hopkins by Hamilton S. Dixon—the pioneer of microscopic ethmoidectomy—led to the broad introduction of the microscope for transnasal ethmoidectomy and for transnasal skull base surgery outside of the field of pituitary surgery at a time when other academic institutions were still using external or headlight approaches.…”

Endoskop-Mikroskop- Kombination (ENDO-OPMI) für die endonasale Nasennebenhöhlenchirurgie

“…Wesentlicher Bestandteil aller modernen endonasalen Operationsverfahren ist jedoch das jeweilige optische Hilfsmittel, das für eine verbesserte Sicht in der Tiefe des Operationssitus eingesetzt wird. Hierfür fanden Endoskop [4, 12, 17, 26-29, 34, 35] und Mikroskop [1,3,9,23] weite Verbreitung.…”

Microcirurgia na polipose nasal: análise evolutiva clínica e cirúrgica

“…Principalmente no pré-operatório essa terapêutica proporciona diminuição de processo inflamatório e infecções, facilitando as manobras cirúrgicas, notadamente pela diminuição do sangramento 9,10 . O controle ambiental é muito importante como suporte terapêutico profilático, assim como a imunoterapia hiposensibilizante específica 11,12 e o uso de cromoglicato de sódio 13 . Na evolução do tratamento cirúrgico dos pólipos nasais, o polipótomo criado por Fallopius e Fabricius no século XVI foi um dos primeiros instrumentos empregados para sua remoção.…”