THE SWING-DOOR TECHNIQUE FOR UNCINECTOMY IN ENDOSCOPIC SINUS SURGERY

Uncinectomy is an important step in endoscopic sinus surgery. The trad itional method of performing uncinectomy has the risk of penetration o f the lamina papyracea with orbital fat exposure. If the orbital penet ration is not recognized, major complications may follow. In this stud y the authors used historical consecutive controls to compare the inci dence of orbital penetration, identification of the natural ostium and lacrimal apparatus injury by the traditional surgical technique and a new technique of uncinectomy. Six hundred and thirty-six uncinectomie s have been performed using the 'swing-door' technique. The 636 uncine ctomies performed prior to changing techniques were used as historical controls. The incidence of orbital penetration (six compared to 0; p< 0.05) and ostium non-identification (42 not identified as compared to 0; p<0.001) was significantly less with the new technique. One lacrima l injury occurred with the 'swing-door' technique compared to zero wit h the standard technique (p>0.05). The techniques are described and th e complications discussed. The authors recommend this technique as it is easy to learn, allows removal of the uncinate flush with the latera l nasal wall and allows easy identification of the natural ostium of t he maxillary sinus.