Powered Instrumentation in Rhinologic and Endoscopic Sinus Surgery

Abstract

Experience with the endoscopic approach to sinus and nasal disorders has led to the widespread recognition of the critical importance of mucosal preservation. The aim of functional endoscopic sinus surgery (FESS) should be to open diseased sinuses at the natural ostium and, wherever possible, to completely remove the underlying bony partitions in areas adjacent to chronic disease. At the same time, an intact mucoperiosteum-lined cavity should be left in the areas of the medial orbital wall, skull base and the frontal recess. While not always technically feasible at this time, this approach leads to more rapid healing with less crusting, reduced incidence of persistent disease and a more favorable postoperative course. Experience has shown that, when bone is exposed, healing is slowed and more intensive postoperative care is required. Scarring can be formidable in this setting. Indeed, it would appear that regenerated mucosa never re-develops normal ciliary density [22]. New bone growth may occur in areas of stripped mucosa and may provide a nidus for chronic infection.