Secure endoscopic sinus surgery with partial middle turbinate modification: a 16-year long-term outcome report and literature review

Abstract

The efficacy of functional endoscopic sinus surgery for the treatment of chronic sinusitis is well established. Two contrasting European techniques were introduced to North America in the 1980s: that espoused by Wigand, which included endoscopic isthmus modification of all sinus ostia and cavities with modification of the middle turbinates, and that developed by Messerklinger, who practiced only minimal opening of the narrow osteomeatal tract at the anterior ethmoid sinus to achieve physiologic reversal of sinus disease. These techniques were additionally modified recently by the introduction of power resection techniques by Setliff and Christmas and stereotactic computer navigation by Anon and Fried. In 1986, after exposure to both original techniques, I developed a middle-ground approach that lies between the extremes of the two European schools. The benefits of this middle-ground multimodal secure technique include a high success rate, maximal safety, and the ability to be performed as an adjunct to any other indicated functional nasal surgery. Since its inception, a key feature of this technique has included partial modification of the bulky inferior portion of the middle turbinates. This has contributed markedly to successful long-term outcome and safety rates.