INTRANASAL SPHENOETHMOIDECTOMY - AN EVOLUTION OF TECHNIQUE

Intranasal sphenoethmoidectomy was originally used primarily for the p rovision of adequate drainage of acute and subacute bacterial sinusiti s. However, the spectrum of inflammatory sinus disease has changed dra matically since the popularization of broad-spectrum antibiotics, and chronic hyperplastic rhinosinusitis has replaced acute sinusitis as th e primary indication for ethmoidectomy. In such cases fetal or almost fetal disease removal is crucial fo providing long-term drainage and v entilation. We describe several modifications of the Yankauer sphenoet hmoidectomy technique that enable the sinus surgeon to provide clearan ce of disease and excellent drainage for all sinuses by complete marsu pialization of the sphenoid, ethmoid, and maxillary sinuses. These mod ifications include (1) complete rather than partial removal of the mid dle turbinate, (2) extended middle meatal antrostomy with palatine bon e resection to the pterygoid process with delineation of the inferior and medial orbital wall, and (3) introduction of operative endoscopes as adjunctive tools in areas inaccessible to conventional visualizatio n. The current technique and results in nearly 2000 procedures are des cribed.