PubMed · 13640968
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J O GOODSELL. 1959-04-25. Debridement is paramount.. https://doi.org/10.1001/jama.1959.03000340064017
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PURPOSE OF REVIEW: The technologic cornerstones of endoscopic sinus surgery initially rested on the endoscope and CT scanning. In the mid-1990s, the advent of powered instrumentation, in particular the microdebrider, advanced the surgeon's ability to treat polypoid disease, sinus and nasal disease in a bleeding field, choanal atresia, antral choanal polyps, and inferior turbinate hypertrophy. This review evaluates both positive and negative tissue effects secondary to powered instrumentation. RECENT FINDINGS: Recent reports of deleterious outcomes with powered instrumentation require a reevaluation of the role of powered instrumentation and consideration of factors that lead to injury. The rapidity of injury makes the powered instrument especially dangerous in inexperienced hands. One third of participants in a recent survey were unaware that powered instruments could be involved in orbital injury and half were unaware that cranial injuries could be secondary to powered instrumentation. SUMMARY: Microdebriders will continue to advance the field of endoscopic surgery, providing clearer operative fields and causing less tissue trauma in experienced hands. However, the severity of complications, including the potential for rapidly aspirating orbital and cerebral contents when laminae are violated, must be appreciated and respected.
PURPOSE OF REVIEW: Improved understanding of sinonasal mucociliary function as well as technological advancements have led to a renaissance in the management of sinonasal disease. The current techniques, and adjunctive intraoperative technologies, have allowed for a more precise and safer surgical dissection, extending this surgical application to include the routine endoscopic management of skull base lesions and sinonasal malignancies. The anatomic boundaries of the nasal endoscope continue to be redefined. This paper will review the recent advances in the field of surgical rhinology as well as discuss directions for the future. RECENT FINDINGS: Advancements in imaging technology including image acquisition, three-dimensional reconstruction, stereotactic navigation, and CT-MRI fusion have aided in more thorough preoperative planning, enabling safer and more precise endoscopic surgical dissection. Refinement of endonasal powered instrumentation including microdebriders and high-speed suction irrigation drills have minimized trauma to normal tissues and accelerated postoperative healing. Increased experience with the endoscope has broadened the endoscopic ventral skull base exposure from the odontoid process to foramen ovale to the olfactory bulb. SUMMARY: Endoscopic sinus surgery is no longer exclusively for the management of chronic rhinosinusitis and nasal polyposis. Sinonasal malignancies, as well as anterior skull base lesions have become part of the rhinologist's responsibility. Furthermore, selective lesions managed through traditional craniotomies may now be accessed via trans-sinonasal transcranial endoscopic routes.