Combined Fiberoptic Headlight and Endoscopic Sinus Surgery with Adjunct Use of Middle-Meatal Stenting

Abstract

The most substantial recent advance in rhinologic management has been the advent of functional endoscopic sinus surgery [1, 2, 4]. Its efficacy in the treatment of chronic obstructive rhinosinusitis has been well established in European centers for 20 years. Two distinct approaches evolved. The first technique is that espoused by Wigand et al. [10], which is rhinologic in style and advocates broad fenestration of the sphenoid, ethmoid, frontal, and maxillary sinuses, partial resection of middle turbinates and obligatory septal correction. In contrast is the technique of Messerklinger, who advocates a much more limited approach suggesting that opening the narrow anterior ethmoid sinuses and osteomeatal complex will physiologically reverse sinus disease. Despite technical divergence, these two approaches share the basic principle that most sinus mucosal disease will resolve if aeration and drainage are established (Fig. 24.1)