Functional Endoscopic Sinus Surgery [antikvár]

Maxillary sinusitis is a common disorder causing repeated visits to doctors, large expenses for medicines and many lost workdays. In Finland, with a population of approx. 5 millión, doctors issue 1.1 millión prescriptions annually for maxillary sinus diseases. The symptoms of chronic maxillary sinusitis are variable, but the most common are nasal obstruction, facial pain and various forms of rhinitis. When medical treatment fails to cure the disease, surgery is considered. Surgical procedures for the sinuses have always been fairly common among ENT operations but have increased in frequency during recent years. Functional endoscopic surgery (FES) is nowadays established as minimally invasive modality among sinus procedures. FES is largely based on research made by Messerklinger, whose work - published in English in 1978 under the title "Endoscopy of the Nose" - is still a cornerstone in endoscopic diagnosis of the lateral nasal wall. The principles of FES have been discussed in many monographs (Rice and Schaefer 1988, Wigand 1990, Stammberger 1991, Lusk 1992). FES is based on precise diagnostics with the aid of endoscopes and CT scans. According to FES philosophy, the key area in the pathogenesis of sinusitis is the ostiomeatal unit (OMU), where even minor disorders may cause sinusitis as sequelae. By treating underlying obstructions in the areas of the ethmoids, the larger sinuses, like maxillary antra, could be cured without direct intervention. FES can be done transnasally with endoscopes, rendering open surgery very often unnecessary. When the ideas of FES began to gain favour among rhinologists in the mid 1980's, an old controversy arose between this concept and the more radical Caldwell-Luc (C-L) approach in treating patients with maxillary sinusitis. For at least a century, the main controversies in surgical management of patients with maxillary sinus disease have been: 1. The approach to the maxillary sinus: sublabial or transnasal? 2. Should antral mucosa be removed and how radically? 3. The ventilation and drainage route of the antrum: via the inferior or the middle nasal meatus? The classic C-L operation includes the sublabial opening of the antrum with removal of the diseased antral mucosa and creation of an inferior meatal fenestration representing open surgical modality. In the past, it has been a widely used technique, but today it is rarely used. When this study began eight years ago, the C-L procedure was almost the only surgical procedure offered for pa-