Professor of Rhinology & Skull Base Surgery, Ain Shams University, Cairo, Egypt
Department of Oto-Rhino-Laryngology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Messerklinger advocated Functional Endoscopic Sinus Surgery (FESS) aiming at opening the diseased sinus at its natural ostium and possibly widen it to improve sinus drainage and ventilation. This functional concept entails reestablishing sinus drainage through its natural ostium and following the natural pathway of mucociliary drainage. The endoscopic surgery is a technique (possibly among others) to achieve this goal. The differentiation between the concept and the technique is important because endoscopic surgery could be radical as in tumor surgery for example and also with surgeon who radically removes turbinates or sinus mucosa unnecessarily. Regarding concepts, functional concept stands opposite to radical concept while endoscopic technique is differentiated from microscopic or headlight techniques. The same applies to powered techniques in contrast to cold instrument techniques.
Now, what is more important sinus drainage or ventilation?
Sinus Drainage is probably more important than ventilation because accessory ostia are common findings in chronic sinusitis providing ventilation but not drainage.
CT Scan of left chronic maxillary sinusitis illustrates natural ostial blockage and a large accessory ostium adequate to ventilate the sinus but not to drain it. This fact highlights the importance of including the natural ostium with the newly fashioned middle meatal antrostomy (MMA) in order to assure proper sinus drainage and prevent recirculation between the missed natural ostium and the newly made MMA (same like a large accessory ostium).
The second important point in the functional concept of FESS is to preserve as much as possible of the nasal mucosa in order to have rapid sound healing and preserve the important nasal functions.
Video1 illustrates recirculation of mucopus between the natural ostium hidden by the uncinate process and an accessory ostium in chronic maxillary sinusitis.
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Video2 demonstrates drainage of mucopus only from the natural maxillary ostium and not from the accessory ostium on left side of a patient with recurrent sinusitis.
Video3 demonstrates the same on the right side of the same previous patient.
Video 1 "Recirculation of mucus between Natural Ostium & Accessory O." Video 2 "Drainage through Natural O. only, Left side"
Video 3 "Drainage through Natural O. only, Right side"
