Endoscopic view of the ethmoid strut.

The importance of the infundibulum of the ethmoid, a so-called prechamber to the dependent sinuses, has been stressed by Stammberger. (1) Any narrowing or obstruction of the infundibulum middle meatus or ostiomeatal complex can cause inflammatory disease in the sinuses. Endoscopic sinus surgery can relieve narrowing or obstruction in these prechambers so that the ventilation and drainage pathway from the sinuses will improve.

One of the complications of this type of surgery is postoperative lateralization of the middle turbinate, which results in the narrowing of the middle meatus and obstruction of the ostiomeatal complex--the very problems surgery was meant to correct. (2) Many attempts have been made to develop techniques to prevent middle turbinate lateralization.

We have found that preservation of an "ethmoid strut" helps prevent middle turbinate lateralization. (3) Our technique involves performing endoscopic ethmoid surgery through the anterior wall of the bulla after resection of the uncinate process (figure, A). A circumferential dissection is carried out through the eth moid sinus from the anterior to posterior aspect, leaving an inferior bony strut on the ethmoid floor (figure, B). (3) The presence of the strut leaves less room for the middle turbinate to be displaced laterally (figure, C). The presence of the strut also prevents obstruction of the middle meatal antrostomy if one has been performed. At the end of the procedure, a rolled-up Gelfilm splint can be inserted into the surgically widened middle meatus to help keep the space open (figure, D).

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References

(1.) Stammberger HR. Functional Endoscopic Sinus Surgery: The Messerkliuger Technique. Philadelphia: B.C. Decker; 1991.

(2.) Krouse JH, Christmas DA Jr. Powered instrumentation in functional endoscopic sinus surgery. II: A comparative study. Ear Nose Throat J 1996;75:42-4.

(3.) Christmas DA, Yanagisawa E, Mirante JP. Powered endoscopic ethmoid sinusotomy. In: Yanagisawa E, Christmas DA, Mirante JP, eds. Powered Instrumentation in Otolaryngology--Head and Neck Surgery. San Diego: Singular; 2001:55-76.

Dewey A. Christmas, MD; Joseph P. Mirante, MD; Eiji Yanagisawa, MD

From the Department of Otolaryngology, University of South Florida College of Medicine, Tampa, and the Halifax Medical Center, Daytona Beach, Fla. (Dr. Christmas and Dr. Mirante); and the Southern New England Ear, Nose, Throat, and Facial Plastic Surgery Group; the Section of Otolaryngology, Hospital of St. Raphael; and the Section of Otolaryngology, Yale University School of Medicine, New Haven, Conn. (Dr. Yanagisawa).