[Personal endoscopic operative technic for the lateral nasal wall--an endoscopic surgery concept in the treatment of inflammatory diseases of the paranasal sinuses]

Abstract

Many years of endoscopical investigation and observation have shown that most infections of the PNS are rhinogenic, spreading from the nose into the sinuses. Usually, a focus of infection in recurring sinusitis remains in stenotic areas of the anterior ethmoid, reinfecting the larger sinuses time and again. The anterior ethmoid, especially its infundibulum, thus holds a key position for reinfection or cure, and maxillary as well as frontal sinuses are fully dependent on the pathophysiological conditions obtaining in the anterior ethmoid. Endoscopic endonasal surgery under guidance of rigid endoscopes consequently aims at these primary focuses in the anterior ethmoid, clearing stenotic clefts and infected ethmoidal cells of diseased mucosa. For drainage and ventilation, the maxillary ostium is enlarged into the anterior nasal fontanelle. There is no need for any fenstration into the inferior nasal meatus. Once the ethmoidal focus is cleared, the dependent larger sinuses usually heal without having been touched themselves - even if their mucosal pathologies seemed almost irreversible. The endoscopic procedure, which is carried out in local and surface anaesthesia (excepting children) is described in detail. Excellent results with this method developed by Messerklinger, indicate that there is hardly any indication left for a Caldwell-Luc procedure in chronic recurring sinusitis.