Endoscopic surgery technique

Abstract

Several authors such as Stammberger and Kennedy have modified the original ideas about surgical techniques and endoscopic sinus procedures based on Dr. Messenklinger’s work on the mucociliary flow and nasosinusal pathology. They suggested modifications according to their personal experience and ability in a manner of “the way I do it”. Currently the trend is to do minimal surgery to remove the maximum amount of pathology. The problem with current surgical tendencies is that we have not been able to determine how much is “enough” and what the “limits” of our dissection should be to eliminate the pathology, maximize the patient’s benefits and minimize the damage. This has made an anatomical model necessary to determine the correct progression of the dissection so we don't interfere with the physiology of the structures. The objective is to protect the natural trajectories of the mucociliary flow, as is the case of the final common pathway, which will lead to adequate mucociliary transport from the natural ostium of the maxillary sinus. By doing this we guarantee the best functional results in each case. Marsupialization of the transitional spaces is also an important step in modern surgery to minimize the damage from the procedures. The final objective of all sinus surgeries is to create direct drainage from the paranasal sinuses into the nasal cavity, and to resolve obstructive processes of key sites without necessarily modifying each individual cavity affected by the disease as it has been established throughout history (Fig. 1).