Hydraulic dissection technique during endoscopic sinus surgery using a novel balloon sinus dilation device.

IntroductionChronic rhinosinusitis with nasal polyposis is a common chronic disease that often affects maxillary sinus. Endoscopic sinus surgery is the most common procedure for treating the majority of maxillary sinus lesions. ObjectiveTo demonstrate the role of canine fossa puncture during endoscopic sinus surgery procedure in patients with severe maxillary sinus disease. MethodsWe present 2 cases where canine fossa puncture has been performed as method to obtain a complete access to the maxillary antrum. ResultsAccording our experience, 2 cases on 296 endoscopic sinus surgery (0.6%) where antrostomy and used of angled microdebrider were not sufficient, canine fossa puncture has been performed as an alternative method to obtain a complete access to the maxillary antrum. ConclusionAlthough the advent of endoscopic sinus surgery, our cases support the fact that actually canine fossa puncture is a minimally invasive technique useful in selected cases.

The purpose of this level 4, retrospective cohort study was to detail the outcomes of primary, revision, and endoscopic modified Lothrop procedure (EMLP) (Draf III) frontal sinus surgery and evaluate whether risk factors would help determine which patients would benefit from which procedures. The study used a retrospective chart review. Endoscopic assessment of frontal ostium patency and patient reported symptoms were prospectively collected on patients who underwent frontal sinusotomy between January 2003 and December 2009. High-risk cohorts were studied to assess their response to standard endoscopic sinus surgery (ESS) compared with EMLP. A total of 339 patients who met the inclusion and exclusion criteria underwent either primary or revision endoscopic frontal sinus surgery. The average ± standard deviation (SD) length of follow-up was 20.8 ± 18.7 (95% confidence interval [CI], 18.0-22.9) months. Postsurgical recurrence of disease with persistence of symptoms requiring an EMLP occurred in 9 patients in the primary group and 38 in the revision group. The highest risk groups for failure of standard frontal sinusotomy were patients with nasal polyps, asthma, Lund-Mackay score >16, and frontal ostium size <4 mm (relative risk = 9.9, p < 0.0001). Patients with underlying asthma and polyposis as well as narrow frontal ostia and extensive radiological disease have a high failure rate from standard endoscopic frontal sinusotomy. In this patient group consideration should be given to offering the patient a primary EMLP procedure, which has excellent success rates with low risks and low morbidity.

Endoscopic sinus surgery with and without computer assisted navigation: A retrospective study

Objective To investigate the causes, clinical features, treatment and prognosis of chronic sinusitis and nasal polyps with endoscopic sinus surgery. Methods A total of 10 patients (10 eyes) from clinic of Xi’an No.4 Hospital between January 2001 and December 2016 due to vision loss caused by endoscopic sinus surgery were prospectively examined. All patients were enrolled and administered visual acuity testing, ophthalmic examinations, color photography, and other clinical observations. Results Ten cases of ocular complications occurred, including central retinal artery occlusion in 1 case, optic nerve injury in 6 cases, orbital hemorrhage in 2 cases, and orbital infection in 1 case. Conclusions The complications of endoscopic sinus surgery in patients with chronic rhinosinusitis and nasal polyps are complex, and the preparation, familiarity with nasal endoscopic resection and skilled operation can reduce the occurrence of complications. Timely detection of eye complications can reduce the risk of serious consequences. Visual impairment caused by endoscopic sinus surgery is difficult to treat and result in poor prognosis. Key words: Nasosinusitis; Nasal polyp; Endoscopic surgery; Eye; Complication

This systematic review consolidates current evidence on the efficacy, safety, and tolerability of awake, office-based procedures for chronic rhinosinusitis (CRS). It aims to evaluate whether these minimally invasive interventions performed under local anesthesia are viable alternatives to conventional sinus surgery under general anesthesia. A systematic search of PubMed/MEDLINE, Google Scholar, and Scopus databases was performed through November 2025, following PRISMA guidelines. Studies were selected using the PICOS framework, including adult patients undergoing in-office procedures (e.g., balloon sinus dilation, endoscopic sinus surgery, polypectomy, steroid-eluting implant placement) for CRS. Data were extracted and narratively synthesized due to heterogeneity. Eleven studies involving 1,283 patients were included. The procedures demonstrated significant and sustained improvements in patient-reported (SNOT-22, SNOT-20, NOSE, VAS) and objective (Lund-Mackay, Nasal Polyp Score) outcomes. Complication rates were low, with minor adverse events. Intraoperative pain was generally mild, tolerability was high (82-95%), and patients reported rapid recovery (often within 48h) and high satisfaction (72-95% willing to repeat the procedure). Awake sinus procedures are an effective, safe, and well-tolerated treatment option for selected CRS patients. They offer significant symptom relief, high patient satisfaction, and rapid recovery while avoiding general anesthesia. These techniques represent a transformative, patient-centered, and resource-efficient component of modern rhinology.

Complete versus Limited Endoscopic Sinus Surgery for Chronic Rhinosinusitis in Adults with Cystic Fibrosis.

We evaluated the effectiveness of two navigation systems with optical tracking in endoscopic sinus surgery (ESS). The Signa SP/i Intraoperative navigation system (General Electric Co., Intraoperative NS) is advantageous in acquiring both real time and high-resolution images during surgery, compared to conventional image-guided navigation (Stealth Station TREON, Medtronic Inc., IGNS) that rely entirely on preoperative three-dimensional images. We studied the following in 14 patients treated with intraoperative NS and 19 treated with IGNS: 1) additional time for navigation system implementation, 2) available instrumentations in ESS, and 3) navigation system accuracy. Navigation systems required additional time to prepare ESS. The time lapse from admittance to the operating room to ESS onset was measured in patients under both systems and controls undergoing ESS without any image guidance. Preparation of the intraoperative NS required an additional 52 min and IGNS required 17 min compared to the control group. Based on operative instruments, the intraoperative NS has some limitations arising from the application of a high magnetic field. Surgical instruments must not be attracted by the magnetic field in the operating room. So those used in our study were thoroughly examined and some remanufactured using MR safe materials. All instruments in ESS could be used in surgical guidance during surgery in the IGNS. Anatomic landmarks were accurately visualized using intraoperative NS and IGNS. Intraoperative NS renews the image during surgery, so surgeons could confirm the surgical outcome during ESS. Since the average distant error in both systems was between 1 mm and 2.5 mm, we confirmed that accuracy obtained with both navigation system was suitable for ESS completion. The intraoperative NS renewed the image during navigation. In conclusion, both navigation systems are sufficient for accurate image navigation in ESS, but navigation systems must be selected based on the individual case.

Endoscopic sinus surgery in cystic fibrosis: do patients benefit from surgery?

Background: People with chronic rhinosinusitis may be referred for endoscopic sinus surgery (ESS), a procedure commonly performed under general anaesthesia, once maximal medical therapy has failed. A new pathway of care is emerging: Local Anaesthetic Nose &amp; Sinus Surgery (LANSS). With LANSS the patient is not placed under general anaesthesia, but instead the procedure is performed under a local anaesthetic. Methodology: A decision analytic model was developed from the perspective of the UK National Health Service (NHS) to assess the potential cost impact of LANSS versus current standard care pathway for ESS. Results: Modelling indicated that the introduction of LANSS would generate substantial savings of around £84,500 per year if introduced to a typical NHS trust with a large otolaryngology department undertaking 300 ESS procedures per year. These savings are generated as a proportion of the ESS procedures no longer need to be completed in an operating theatre, which reduces operational costs (saving around £64,500 per year), plus the use of local anaesthetic instead of general anaesthetic and a reduction in the time a patient spends as an inpatient. Conclusions: The uptake of LANSS could generate cost-savings of around £84,500 per year to a typical NHS trust in the UK.

Cerebrospinal fluid (CSF) leak remains one of the most serious complications of endoscopic sinus surgery (ESS). Although rare, its consequences may include meningitis, pneumocephalus, intracranial abscess, and long-term neurological morbidity. This expanded manuscript presents a comprehensive academic review of preventive strategies, surgical techniques, anatomical considerations, and postoperative management regarding CSF leaks in ESS. Among the critical intraoperative hazards, catastrophic orbital hemorrhage and CSF leak represent the two complications most universally dreaded by rhinologic surgeons. Both events underscore the necessity of meticulous preoperative planning, high-resolution CT evaluation, and disciplined intranasal dissection that respects natural boundaries. Although the majority of ESS procedures proceed uneventfully, even small breaches in the skull base may lead to CSF rhinorrhea, with potential sequelae including meningitis, intracranial abscess, pneumocephalus, prolonged hospitalization, and the need for revision surgery. Early intraoperative recognition—such as identifying clear pulsatile fluid, the reservoir sign, or sudden visualization of dura—is essential, as timely repair can prevent both acute morbidity and delayed complications.The purpose of this work is to provide surgeons with a clear, structured framework to minimize risk and to optimize outcomes through evidence-based repair protocols.

The surgical treatment of frontal sinus fractures is foreshadowed by fears of late complications. Complications such as meningitis and mucoceles should be prevented by cranialization or obliteration of the frontal sinus. These procedures are still standard treatment despite of recent developments over the last two decades in endoscopic sinus surgery, in medical imaging and surgical instrumentation. Nowadays the role of cranialization and obliteration is challenged by refined endoscopic frontal sinus surgery techniques, the widely-used image-guided systems and the multiplanar high-resolution computed tomography along with new data about postoperative complications. This overview summarizes the current literature, taking into account the existing evidence in the treatment of frontal sinus fractures.

Background/Objectives: Odontogenic sinusitis (ODS) is the most common cause of unilateral maxillary sinus opacification. Initial treatment consists of intranasal steroids and antimicrobial therapy. In case of persistence of the disease, endoscopic sinus surgery (ESS) is advised. It is still not clear what extension of ESS is required and whether frontal sinusotomy or ethmoidectomy is justified in ODS with frontal sinus involvement. Methods: Adult patients presented with uncomplicated recalcitrant bacterial ODS due to endodontic-related dental pathology were evaluated by an otolaryngologist and a dentist and scheduled for ESS. Sinus CT scan demonstrated opacification of maxillary sinus and partial or complete opacification of extramaxillary sinuses ipsilateral to the side of ODS. Patients were undergoing either maxillary antrostomy, antroethmoidectomy, or antroethmofrontostomy. Preoperative and postoperative evaluations were done with nasal endoscopy, dental examination, subjective and radiological symptoms. Results: The study group consisted of 30 patients. Statistically significant decreases in values after surgery were found for SNOT-22, OHIP-14, Lund-Mackay, Lund-Kennedy, and Zinreich scale. Tooth pain was present in 40% cases during the first visit and in 10% during the follow-up visit. Foul smell was initially reported by 73.3% and by one patient during follow-up visit (3.3%). Significantly longer total recovery time and more crusting was marked for antroethmofrontostomy when compared to maxillary antrostomy. Conclusions: ESS resolved ODS with ethmoid and frontal involvement in almost every case. Minimal surgery led to improved overall clinical success in the same way as antroethmofrontostomy without risking the frontal recess scarring and stenosis.

Cerebrospinal fluid leakage is always the primary complication during the endoscopic endonasal skull base surgery. Dural suturing technique may supply a rescue method. However, suturing and knotting in such a deep and narrow space are difficult. Training in the model can improve skills and setting a stepwise curriculum can increase trainers' interest and confidence. We constructed an easy model using silicone and acrylic as sphenoid sinus and using the egg-shell membrane as skull base dura. The training is divided into three steps: Step 1: extracorporeal knot-tying suture on the silicone of sphenoid sinus, Step 2: intra-nasal knot-tying suture on the same silicone, and Step 3: intra-nasal egg-shell membrane knot-tying suture. Fifteen experienced microneurosurgical neurosurgeons (Group A) and ten inexperienced PGY residents (Group B) were recruited to perform the tasks. Performance measures were time, suturing and knotting errors, and needle and thread manipulations. The third step was assessed through the injection of full water into the other side of the egg to verify the watertight suture. The results were compared between two groups. Group A finishes the first and second tasks in significantly less time (total time, 125.1 ± 10.8 vs 195.8 ± 15.9min) and fewer error points (2.4 ± 1.3 vs 5.3 ± 1.0) than group B. There are five trainers in group A who passed the third step, this number in group B was only one. This low cost and stepwise training model improved the suture and knot skills for skull base repair during endoscopic endonasal surgery. Experienced microneurosurgical neurosurgeons perform this technique more competent.

Endoscopic endonasal anterior skull base surgery is currently applied for the treatment of olfactory neuroblastoma, and other skull base lesions. In the surgical approach to the anterior skull base, one of the important step is extended frontal sinus surgery, including modified endoscopic Lothrop procedure (MELP). Surgical simulation using artificial three dimensional (3D) models is known to a useful training method to learn the surgical steps and to gain the surgical skills. In this study, we investigated the usefulness of a 3D head model with the detailed CT information in the surgical simulation for extended frontal sinus surgeries and anterior skull base resections. 3D head models (KEZLEX, Ohno, Japan) were used as a surgical simulator. This model is exactly reconstructed and made as a human head including sinonasal structure and anterior/posterior skull base by 3D printer. In this model, we made the first olfactory nerve with a steel wire at the skull base as the posterior limit of the frontal sinus flour to the skull base. In addition, the head model was examined for surgical anatomy by using the cone-beam CT (Accuitomo, Morita, Japan). Then, endoscopic endonasal surgery was performed using a high speed bur (M5, Medtronic, Japan) for the bone resection guided with a navigation system (Fusion, Medtronic, Japan). MELP was performed according to the surgical steps of the outside-in frontal drill-out technique. In results, MELP and the anterior skull base resection including crista galli were successfully performed for 3D model with CT and the navigation. These findings suggest that surgical simulation using artificial 3D head model and cone beam CT combined with a navigation system is useful in the surgical training for endoscopic endonasal anterior skull base surgery.

Chronic rhinosinusitis continues to present diagnostic and therapeutic challenges for clinicians. Recently, attention has been focused on reliable and valid measures of outcomes for many sinonasal diseases. As a significant fraction of patients with chronic rhinosinusitis will come to endoscopic sinus surgery, there has been a dedicated focus on determining objective clinical outcomes after medical and surgical treatment for CRS. This has been aided by validated instruments for measuring both symptom outcomes and quality of life after endoscopic sinus surgery. Recent studies have demonstrated that endoscopic sinus surgery provides statistically and clinically significant improvements in most sinonasal symptoms. These benefits are maintained more than 1 year after surgery. In addition, the significant adverse effects of chronic rhinosinusitis on quality of life can be reversed with appropriate endoscopic sinus surgery. Certain sub-populations do not fare as well with endoscopic sinus surgery, however; adjunctive medical management is required to maintain symptomatic and quality-of-life improvements for patients with nasal polyposis. Unfortunately, paranasal sinus computed tomography scan findings do not predict symptomatic or quality-of-life improvements after endoscopic sinus surgery. With reliable objective evidence of the health benefits of endoscopic sinus surgery, patients should be considered for such surgery after failure of medical management. Further work is required to characterize outcomes for sub-populations, and to stage and select patients who will derive appropriate benefit from endoscopic sinus surgery.