Background and evolution of endoscopic sinus surgery.
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Biomedical subjects
Publications and source records attributed to W Messerklinger.
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In the vast majority of cases infections of the paranasal sinus system are rhinogenic. Usually these spread via the middle nasal meatus and the anterior ethmoid to the dependent larger sinuses, especially to the frontal and/or maxillary sinus. If a sinusitis does not heal or is constantly recurring, a focus of infection has remained in a stenotic cleft of the lateral nasal wall, irritating nasal function and where from infection time and again may spread to the dependent sinuses. These Infection foci may be very circumscribed and limited, and not always must present with the typical triad of sinusitis symptoms: pathological secretion, nasal obstruction and cephalgia. Frequently only one of these symptoms prevails. By the means of nasal endoscopy and polytomography these foci can exactly be localized. After clearing the infection foci, which easily can be achieved under endoscopic guidance, mucosal function usually is restored and the dependent larger sinuses heal without having been touched.
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The so-called frontal recess (recessus frontalis) is a variable developed space of the anterior air cells, which is usually called "ductus" or "canalis naso-frontalis". As it leads into the frontal sinus, the state of the frontal sinus is entirely dependent on the conditions within the frontal recess. Its anatomical situation and transport of the secretion are described. The frontal recess may be influenced by narrow passes of the middle nasal meatus. All these facts are discussed in normal or abnormal states of nasal function. The clinical signs and sequelae of a diseased frontal recess are reported. For exact diagnosis nasal endoscopy, especially of the middle meatus, is recommended, apart from x-ray tomography or other clinical investigations. The various endoscopic findings are demonstrated. Finally, the indications are given for endoscopic operations, suggestions for endoscopic possibilities, and a detailed description of the technical procedure.
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If antral irrigation is impaired, there is in most cases also an impaired ventilation as a consequence of disturbances of the "ostio-meatal unit" of the maxillary sinus. This is therefore an important symptom showing the disposition or diseased region, which is the origin or cause of inflammations of the maxillary sinus, as the antrum is subordinate to the ethmoidal sinus. The reasons causing this symptom must be analysed carefully for adequate therapy. The various pathological conditions causing an impaired antral irrigation and their therapy are described in detail.
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The infundibulum ethmoidale is a cleft-like space situated like a funnel before the maxillary ostium. In this cleft inflammations occur very often. From here they may spread to the paranasal sinuses of the first series (frontal and maxillary sinus, anterior ethmoidal cells), especially to the antrum, and may cause recurrent or chronic inflammations. The walls of the infundibulum may be inspected endoscopically from the middle and inferior meatus, and also from the antrum. Sometimes a direct view in this cleft-like space may be obtained. On this way any inflammations of the infundibulum can be diagnosed exactly and treated endoscopically. This procedure leads not only to healing of the infundibulum, but also of the adjacent paranasal sinuses of the first series.
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