Endoscopic endonasal sinus surgery. Approaches and post-operative evaluation.

Recently, by using a rigid endoscope and a VIDEO system (CCD camera and TV monitor) for endonasal sinus surgery, surgical complications have been prevented. This is because a decrease in the dead angles achieves wide and clear visualisation of the site of manipulation of the paranasal sinuses, which have a delicate and complicated structure. Our endonasal sinus procedures under local anaesthesia consist of removal of pathologic mucosa within the anterior and posterior ethmoid sinuses, opening of the cellulae and establishment of sufficient communication between the ethmoid sinus and the maxillary and frontal sinuses. Even if pathologic mucosa is present in the maxillary sinus, we leave it intact and attempt to heal it by achieving good ventilation. The surgical technique often includes correction of septal deviations and conchotomy. In patients with moderate to severe sinusitis (62 cases, 102 examples) who underwent endoscopic endonasal sinusectomy by the same surgeon, X-ray studies of post-operative changes of the maxillary sinus were performed. Fifteen cases showed excellent results, 47 good results, 30 fair results and 10 were unchanged. Clinical symptoms exhibited an overall improvement rate of 73%. Improvement of nasal discharge and nasal obstruction was more easily achieved than improvement of post-nasal discharge.