Intranasal Transethmoid Approach to the Sphenoid Sinus Ostium in Endoscopic Sinus Surgery: A Safe Technique Using the Superior Turbinate As a Key Landmark

Hong, Soon Kwan

Abstract

BACKGROUND AND OBJECTIVES
Identification of the natural ostium verifies the safest entry to the sphenoid sinus (SS) in endoscopic sinus surgery (ESS). In order not to destabilize the middle turbinate (MT), new techniques have recently been introduced on transethmoid approaches to the SS ostium after ethmoidectomy. The aims of this study are to introduce an intranasal transethmoid approach to the SS ostium for sphenoidotomy using the superior turbinate (ST) as a key landmark without destabilization of the MT in ESS for chronic sinusitis with concurrent sphenoiditis and to determine its efficacy by evaluating the outcome of the patients.
MATERIALS AND METHODS
Fifty-three chronic sinusitis patients (37 males and 16 females, aged 14 to 63 years) with concurrent sphenoiditis in one or both SSs and their 75 SSs were included in this study. Sphenoidotomy was performed in all patients. The SS ostium was identified just medial to the ST remnant. Number of SSs where the ostium was identified was determined, and surgical complications were evaluated. To assess olfactory changes, a butanol threshold test was performed before and after the surgery.
RESULTS
The SS ostium was identified in 73 (97.3%) of the 75 SSs. The preoperative threshold (3.9+/-3.0) in the butanol test significantly improved to 5.1+/-2.5 after the operation in the 75 nasal sides. Olfactory function of only 3 (4.0%) sides worsened after surgery. There were no major complications in all patients. Conclusion: This technique may be an effective and safe approach to the SS ostium in ESS for chronic sinusitis with concurrent sphenoiditis without destabilization of the MT.