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Combined Open and Endoscopic Approach to the Paranasal Sinus

Various surgical routes are defined to access the paranasal sinuses. Frontal, ethmoid, and maxillary sinus pathologies have been approached externally using trephination, osteoplastic flap, external frontoethmoidectomy, and Caldwell-Luc procedures. These traditional techniques often resulted in undesirable perioperative and postoperative morbidity. In addition these external techniques are insufficient for the pathologies that invade the sphenoid sinus. Over the last 30 years, due to technological advancements the endoscopic surgical approaches to the paranasal sinuses and surrounding structures have gained popularity. These technological advancements are improved telescopes, angled powered instrumentations, and navigation systems. Endoscopic approach with angled telescopes provides a better vision of the relevant surgical anatomy and operation field when compared to external approaches. Besides, even though open techniques are being done less than endoscopic approaches, they still maintain their importance for some indications. For a safe and successful surgery, the surgical anatomy of the paranasal sinus is the most important point. Anatomical development of the paranasal sinuses continues until adulthood. Various anatomical variations of paranasal sinuses also exist. The relationship of the paranasal sinuses with the adjacent anatomic structures which are important vessels and cranial nerves must be considered. Orbit, skull base, cranial nerves, internal carotid artery, and some of the structures are the most important ones. The paranasal sinuses are distinguished with the walls of the anatomical structure of the bone environment. In some areas these walls are relatively thin and subjected to surgical trauma and this can lead to serious problems in environmental structures. Anatomical landmarks of the paranasal sinuses may show structural changes depending on the previous surgery, trauma, or underlying disease. In view of all these circumstances to know the surgical anatomy in a good way is the most important factor to reduce the risk of complications.

combined ; open ; endoscopic ; paranasal sinus ; approaches

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