Functional Endoscopic Sinus Surgery

Rhinology and sinus surgery have undergone a tremendous expansion since the discourses of Messerklinger and Wigand in the late 1970s. Imaging advances, increased understanding of the anatomy and the pathophysiology of chronic sinusitis, and image-guided surgery have allowed surgeons to perform more complex procedures with increased safety.

Outstanding short- and long-term results have been reported in the literature. Senior et al reported that symptoms improved in 66 of 72 (91.6%) patients following endoscopic sinus surgery, with a mean follow-up time of 7.8 years. In addition, endoscopic sinus surgery significantly influences quality of life; Damm et al reported an improvement in quality of life for 85% of their patient population, with a mean follow-up time of 31.7 months.

Although functional endoscopic sinus surgery is the primary approach used today for the surgical treatment of chronic sinusitis, the time-honored external approaches still play a role. Therefore, familiarity with endoscopic and external approaches, in conjunction with a precise understanding of the anatomy, ensures optimal patient care and outcome.

A recently developed alternative to functional endoscopic sinus surgery is balloon sinuplasty. This technique uses balloon catheters to dilate the maxillary, frontal, and sphenoid natural ostia without bone or soft-tissue removal. Reports show persistent patient symptom improvement and sinus ostia patency. Further study and long-term outcomes with this technology will determine its role in endoscopic sinus surgery.

• Chronic sinusitis refractory to medical treatment
• Orbital decompression (eg, Graves ophthalmopathy)
• Sinus mucoceles
• Excision of selected tumors