The State of the Art in Transnasal Endoscopic Sinus

							Functional Endoscopic Sinus Surgery:
Theory & Basic Technique
 Reda Kamel
 Professor of Rhinology
 Endoscopy, Allergy & Sleep Disordered Breathing
 Center
 Cairo University – Egypt



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Ostiomeatal complex: OMC




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           Ostiomeatal complex: OMC

                     Suprabullar recess

                                                     Frontal ostium

    Lateral sinus                                        Frontal recess
                                                     HSS
Retrobullar recess
                                                         HSI


                Maxillary ostium          Infundibulum

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Ostiomeatal complex : OMC




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Ostiomeatal complex : OMC




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Functional Endoscopic Sinus Surgery:
Theory
• OMC blockage




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Functional Endoscopic Sinus Surgery:
Theory
• OMC clearance




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 Functional Endoscopic Sinus Surgery:
 Theory
•Sinus recovery




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Functional Endoscopic Sinus
          Surgery
           Chronic Sinusitis

            Aim of surgery:
1- Good drainage
2- Proper aeration

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Endoscpic Sinus Surgery:
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 1. Uncinate process
 2. Bulla ethmoidalis          6

 3. Maxillary ostium           5
 4. Basal lamella
                               4
 5. Posterior ethmoids         3

 6. Sphenoid sinus             1

 7. Frontal recess                     R
1- Uncinectomy:




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2- Middle meatal antrostomy:




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3- Anterior ethmoidectomy:

   Mucous membrane preservation
    of lamina papyracea and skull
    base.




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4-Penetration of basal lamella &
5-Posterior Ethmoidectomy:




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6- Sphenoidotomy:

Approach:
1. Transnasal
2. Transethmoid
3. Transethmoid Transnasal



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6- Sphenoidotomy:

Approach:
1. Transnasal
2. Transethmoid
3. Transethmoid Transnasal



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Operative Strategy:




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7- Frontal recess clearance:   Strategy




 -Bulla ethmoidalis
 -Basal lamella
 -Posterior ethmoids
 -Sphenoid
 -Frontal recess


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7- Frontal recess clearance:


 Uncapping of the egg




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Frontal recess clearance:


 Uncapping of the egg




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Frontal recess clearance:


 Uncapping of the egg




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Frontal recess clearance:


 Uncapping of the egg




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FESS: [safe & effective]

1.    CT guided endoscopic surgery
2.    Anatomical landmarks
3.    Nature of disease
                                        Learning
4.    Quality tools                      Curve
5.    Hypotensive anesthesia
6.    Comfortable field and position

7.    Tailored surgery
8.    Preservation of middle turbinate
9.    Preservation of mucous membrane
10.   Sharp cut edge of bone and mucous membrane
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Knowledge is power




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