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
1a
2a
2b
Preoperative coronal CT scan.
Coronal CT scan 1 year after surgery.
1b
Coronal CT scans, preoperative (a) and
1 year postoperative (b).
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3b
Coronal CT scans, preoperative (a) and
1 year postoperative (b).
Clinical Cases
Woman 20 years of age with nasal airway obstruction and acute
recurrent bilateral rhinosinusitis predominantly affecting the maxillary
sinuses.
Preoperative CT (Fig. 1a) shows a deviated septum with spurring
toward the left side and large conchae bullosae on both sides. Slight
mucosal swelling is noted in the anterior ethmoid.
Operation: Surgery consists of partial bilateral middle turbinectomy,
preserving portions of the upper lateral curve and upper lamina. It
includes a bilateral infundibulotomy, bullotomy, supraturbinate antros -
tomy, and submucous septoplasty.
Postoperative CT, one year later (Fig. 1b) shows the lateral partial bilateral
turbinectomy preserving the turbinate trim, position, and sites of
attachment (see p. 16, removal of the frontal sinus floor with a punch).
Woman 53 years of age with nasal airway obstruction and recurrent
bouts of acute bilateral maxillary and frontal sinusitis.
Preoperative CT (Fig. 2a) shows a septal spur on the left side, bilateral
hyperplasia of the inferior turbinates, and minimal mucosal swelling in
the anterior ethmoid.
Operation: Surgery consists of an infundibulotomy, bullotomy, and
supraturbinate antrostomy on both sides. The frontal recess is
enlarged anteriorly to the bulla lamella, which is preserved. The procedure
also includes a septoplasty and bilateral strip turbinectomy.
Postoperative CT, one year later (Fig. 2b) documents broad, bila teral
supraturbinate antrostomies with medialization of the nasal septum.
The upper portion of the turbinate-bulla complex has been preserved,
and the middle turbinate has been stabilized in an optimum position.
Principle of stabilizing the turbinate position
Postoperative CT scan (b) illustrates the principle of stabilizing the
turbinate position by preserving the lamella or upper cap of the
ethmoid bulla as an essential maneuver for “trimming the turbinate.”