BIOSTATIC ENDOSCOPIC ETHMOID SURGERY A New Approach ...

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Biostatic Endoscopic Ethmoid Surgery – B.E.E.S. – A New Approach to
Functional Endoscopic Sinus Surgery for Acute Recurrent Rhinosinusitis
Surgical Concept
Ethmoid Infundibulotomy
The standard procedure for opening the ethmoid bone is an ethmoid
infundibulotomy that includes complete and atraumatic removal of the
uncinate process.
The uncinate process is sharply released at its poles with endoscopic
scissors. The lateral infundibular wall is removed, exposing the anterior
wall of the ethmoid bulla.
Ethmoid infundibulotomy:
1 Medial infundibular wall,
2 Sickle knife, 3 Ethmoid bulla,
4 Semilunar hiatus, 5 Nasolacrimal canal,
6 Middle turbinate, 7 Nasal septum,
8 Agger nasi.
Bullotomy
The anterior wall of the ethmoid bulla is trephined with a special instrument,
the bullotome, or with a straight blunt suction tip or sphenoid sinus
punch (small), for example. The portions of the anterior wall or bulla that
are removed will depend on the mucosal pathology.
a
b
Trephination of the anterior wall of the
ethmoid bulla is done with the bullotome
(a) or a small, circular sphenoid sinus
punch (b).
1 Nasal septum,
2 Middle turbinate,
3 Circular punch,
4 Ethmoid bulla,
5 Frontal recess,
6 Lateral nasal wall.
Bullotomy with the circular punch.