Evolving Materials and Techniques for Endoscopic Sinus Surgery - 05/08/11

Doi : 10.1016/j.otc.2010.02.018

Frank W. Virgin, MD ^a, Benjamin S. Bleier, MD ^b, Bradford A. Woodworth, MD ^a,^c,^⁎
^a Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alabama at Birmingham, BDB 563, 1530 3rd Avenue South, Birmingham, AL 35294, USA
^b Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
^c Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, 790 McCallum Building, 1918 University Boulevard, Birmingham, AL 35294, USA

Corresponding author. Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alabama at Birmingham, BDB 563, 1530 3rd Avenue South, Birmingham, AL 35294.

Résumé

Functional endoscopic sinus surgery was initially introduced as a minimally invasive procedure to treat chronic rhinosinusitis (CRS) in patients for whom medical management failed. Sinus surgery has been deemed an extremely effective part of the overall management of chronic sinus disease with symptomatic improvement in the vast majority of patients. At the forefront, technologic advances have been critical in advancing endoscopic sinus surgical procedures. With the introduction of improved optics and lighting, advanced instrumentation, and image-guided surgical navigation, the limitations of endoscopic procedures have been significantly reduced. Endoscopic techniques have evolved to include the management of both malignant and benign neoplasms of the sinuses and anterior skull base. This article highlights some of the newest advances in technology, materials, and medical/surgical techniques used in endoscopic sinus and skull base procedures and illustrates how they advance overall patient care to help minimize morbidity and complications.

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Keywords : Endoscopic sinus surgery, Skull base surgery, Cerebrospinal fluid leak, Coblator, Hydrodebrider, Hemostasis, Robotic surgery, Nasoseptal flap, Nasal septal flap, Intracranial hypertension, Laser tissue welding

Plan

Hemostatic agents

Topical Epinephrine

Other Topical Hemostatic Agents

Management of Elevated Intracranial Pressure

Locating Skull Base Defect Site

Laser Tissue Welding

Nasal Septal Flaps and Bone Grafts

Intraoperative computed tomography and image guidance system

Robotic skull base surgery

Implications for research

Implications for clinical practice

Disclosures: Frank W. Virgin, MD has no financial disclosures or conflicts of interest. Bradford A. Woodworth, MD is a consultant for ArthroCare ENT and Gyrus ENT, and serves on the Speaker’s Bureau for GlaxoSmithKline. Benjamin S. Bleir, MD is a co-inventor on LTW solder (09/18/09), Solder Formulation, and use in Tissue Welding U.S. Pat. Non-Provisional Filing (Docket V4914, PCT/US2009/057419, University of Pennsylvania).