Mini-endoscopy of the frontal sinus to guide endonasal frontal sinus surgery

Abstract

Endoscopic frontal sinus surgery requires special attention to the numerous anatomical variations. Additionally, in situations of revision surgery, endonasal frontal sinus identification may be challenging. Numerous strategies have been described to access the frontal sinus in endonasal endoscopic frontal sinus surgery including an additional external approach. A pilot study is presented using a newly designed modular mini-endoscope (1.1 mm, 10.000 pixel, 2 working channels and 120° lens) to assist the frontal sinus surgery through a transcutaneous puncture of the frontal sinus. We used this mini-endoscope for primary frontal sinus surgery on 3 patients and for revision frontal sinus surgery on 4 patients. In all patients, the mini-endoscope could be placed in the frontal sinus without side effects. The visible illumination at the frontal sinus floor, caused by the mini-endoscope being in the frontal sinus, guided the surgeon endonasally directly to the frontal sinus floor. Frontal sinus drainage was achieved by the described guidance on all patients. In conclusion, mini-endoscopy of the frontal sinus might be an interesting option in endoscopic frontal sinus surgery to guide the surgeon by illumination in complex anatomical situations to the frontal sinus. This technique will contribute to further improvement in endonasal endoscopic frontal sinus surgery.

Aktueller Stand der endonasalen Nasennebenhöhlenchirurgie

“…Alternativ wurde bei schwieriger anatomischer Orientierung bei primärer Stirnhöhlenchirurgie oder bei Mukozelen nach externer Voroperation eine Punktion und Miniendoskopie über eine kleine Eröffnung der Stirnhöhlenvorderwand angegeben, um den optimalen endonasalen Eröffnungsbereich einer abgeschotteten Stirnhöhle bzw. den physiologischen Drainageweg zu identifizieren [413,414]. Der ergänzende Einsatz der intraoperativen Navigation ist insbesondere bei schwieriger anatomischer Situation bei Revisionsoperationen zu empfehlen [415,416].…”

Comprehensive review on endonasal endoscopic sinus surgery

“…Alternatively, a puncture and mini-endoscopy via a small opening of the anterior wall of the frontal sinus was described in cases of difficult anatomical orientation during primary frontal sinus surgery or during surgery for mucoceles after external previous surgery in order to identify the optimal endonasal area to open a completely obstructed frontal sinus or to demonstrate the physiological drainage [ 414 ], [ 415 ].…”

Maxillary sinus aeration analysis using computational fluid dynamics

“…Modern techniques (Endoscopic Sinus Surgery, ESS), Functional Endoscopic Sinus Surgery (FESS) aim to clear the nose and restore (re-create) the physiological sinonasal connection 4 – 6 . The main challenge and, at the same time, the difficulty of these procedures is the desire to minimize tissue injuries while at the same time individualizing the scope of the operation 7 – 9 . Preoperative, up-to-date radiological evaluation of the craniofacial cavity is used to accurately assess the surgical field and determine potentially hazardous sites 10 , 11 .…”