Functional Endoscopic Sinus Surgery: University of Ottawa Experience and an Overview

Abstract

The treatment of chronic rhinosinusitis resistant to medical therapy has been historically managed by a variety of external and internal surgical procedures. The pathophysiology of chronic sinus disease has been elucidated through the work of Professor Messerklinger. He observed that chronic sinusitis is usually due to stenosis of the anterior ethmoid region. 1,2 Infection can spread from the anterior ethmoid and the middle meatal regions, to secondarily affect the maxillary and the frontal sinuses. 2 He noted that the mucosal changes that occur secondary to obstruction of the ostiomeatal unit (OMU), resolve when normal ventilation and mucociliary clearance is restored.1,3-6 This knowledge has led to the acceptance of endoscopic sinus surgery as a valuable modality in the surgical management of sinus disorders. The important components of the OMU include the middle turbinate and meatus, maxillary ostium, infundibulum, uncinate process, ethmoid bullae, and hiatus semilunaris. 7 Functional endoscopic sinus surgery (FESS) was introduced in the 1960s by Professors Messerklinger and Wigand. It was popularized in Europe by Stammberger and subsequently in North America by Kennedy. 1,2,6,8 The use of this approach has become more popular with improvement in the understanding of the anatomy of the lateral nasal wall and surgical training. The indications for endoscopic sinus surgery have expanded to include not only the management of sinus infection resistant to medical therapy , but also the treatment of nasal polyposis, nasolacrimal duct obstruction, thyroid orbitopathy, CSF leaks, drainage of orbital abscess and hematoma, decompression of the optic nerve and globe, and surgical management of circumscribed benign and well -localized malignant neoplasms.1,8-12 It also remains an excellent modality for nasal examination. The objective of this study is to review our