内視鏡下鼻内副鼻腔手術における前頭洞の開放 -当科における方法と術後成績-

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  • Endoscopic Frontal Sinus Surgery

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Endoscopic sinus surgery (ESS) has facilitated opening the frontal sinus, but, it still seems to be a tough procedure. This paper shows the safe and precise procedures for frontal sinus opening and its effectiveness. Our procedure is the anterior approach to attack the frontal sinus ostium while preserving the anterior-superior attachment of the uncinate process so that the middle turbinate is supported. In this method the key point is to identify the relation between the uncinate process attachment and the roof or medial wall of the ethomoidal bulla using a 70° endoscope. The wall of the ethmoidal bulla should then be removed from posterior to anterior, while keeping the anterior-superior attachment of the uncinate process intact, using giraffe forceps and a curved seeker.<br>From April 2004 until August 2005, 63 patients with chronic sinusitis were underwent frontal sinus opening with ESS at the department of Otolaryngology, Head and Neck Surgery, Ehime Prefectural Central Hospital. One hundred and fourteen sides of these patients were followed up after surgery for more than three months up to 792 days, with an average of 381 days, and the opening of frontal sinus was investigated using an electronic stroboscope at the time of final examination.<br>As for the result, open sinuses were observed in 99 sides (86.8%) and 26 sides of 39 sides (66.7%) with bronchial asthma were open. All of the closed frontal sinus were caused by polyp proliferation with no lateralization of the middle turbinate. This result suggested preserving the upper attachment of the uncinate process is helpful to keep the frontal sinus open.

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