The Bhoraskars' Web
| One of the most promising and newest surgical technique for treatment
of Chronic Sinusitis is Functional Endoscopic Sinus Surgery ( FESS )
Dr.Messerklinger and Dr.Stomberger from Graz, Austria, defined the basic techniques in the FESS. The term FESS was coined by Dr. Kennedy in 1985, the but concept was first introduced by Dr. Messerklinger. Principle : FESS works on the principle, that by restoration of ventilation and drainage of the sinus, the diseased sino-nasal mucosa reverts back to normal healthy state. Aim : The aim of FESS is to provide Re-aeration and Drainage to sinus's natural ostea (lining bone of sinus) by removing the infected and diseased ethmoidal air cells and polyps from Ostiomeatal complex. In FESS, the emphasis is on establishing normal mucociliary clearance, therefore the anatomical defects and the diseased mucosa which are likely to hamper mucociliary clearance is removed minimally. [ The term Ostiomeatal complex is used to include Ethmoid Infundibulum, Hiatus Semilunaris, Middle Meatus and Frontal recess. Anatomically this area comprises of very small channels that open into middle meatus. This area is very close to the major site of inhaled air particle impacting and hence susceptible to infection. Ostiomeatal complex plays a major role in the pathophysiology of recurring and chronic sinusitis and its clearance is very important. In chronic sinusitis the stenotic area is middle meatus. The persistence of the disease in Ostiomeatal complex is the commonest cause of failure of Caldwell Luc and Antrostomy operations. ] Technique : The middle turbinate is preserved and kept as a land-mark. The infundibulam is approached from front. This provides communication between anterior etmoid air cells, frontal sinus and maxillary sinus. |