Functional anatomy of the uncinate process and its role in endoscopic sinus surgery
Tóm tắt
A basic step of Functional Endoscopic sinus surgery—the most modern and revolutionary surgical treatment for chronic and recurring sinusitis, is removal of uncinate process to expose the infundibulum. The purpose of this study is to explore the functional role of uncinate process with special reference to endoscopic sinus surgery. A fixed dose of sterile methylene blue was sprayed into the nasal cavities of post endoscopic sinus surgery cases, 20 without uncinate process preservation and 20 with uncinate process preservation. The area of staining/deposition of the stain in the ethmoidal cavity and the maxillary sinuses was endoscopically observed. Deposition of methylene blue was consistently found to be occurring in a larger area of the ethmoidal cavity including the maxillary sinus in post endoscopic sinus surgery cases without uncinate process preservation. Uncinate proces probably acts as a protective wall by directing the allergen bearing and contuminated inspired air away from the sinuses and facilitating ventilation of the sinuses in the mucocilliary pretreated expiratory phase. Injudictious removal of the uncinate process especially in cases with allergic rhinosinusitis should thus expose the sinus mucosa to contaminated air.
Tài liệu tham khảo
Arrendondode Arreola G., Lopez Serna N., De Hoyos Parra R., Arreola Salinas M.A., (1996) Morphogenesis of the lateral nasal wall from 6 to 36 weeks. Otolaryngol Head Neck Surg 114:54–60.
Bingham B., Wang R.G., Hawke M., Kwok P. [1991]: The embryonic development of the lateral nasal wall from 8 to 24 weeks. Laryngoscope 101: 992–997.
Bolger W.E., Wooddruff W.W. Jr., Morehead J., Parsons D.S., [1990]: Maxillary sinus hypoplasia: Classification and description of associated uncinate process hypoplasia. Otolaryngol Head Neck Surg. 103: 759–65.
Caliot P., Midy D., Plessis J.L. [1990]: The surgical anatomy of the middle meatus. Surgg Radiol Anat 12: 97–101.
Davis W.E., Templer J.W., Lamear W.R., [1991]: Patency rate of endoscopic middle meatal antrostomy. Laryngoscope 101: 416–421.
Groves J. and Gray R.F. [1995]: Applied physiology of the nose and paranasal sinuses. In a Synopsis of otolaryngology. 4th edition [Grooves J., Gray R.F., eds.] John Wright and Sons, Bristol, pp 167–168.
Kennedy D.W., Zenreich S.J., Rosenbaum A.E. and Johns M.E., Functional endoscopic sinus surgery. [1985]. Theory and diagnostic evaluation. Archives of otorhinolaryngology 111: 576–582.
Kosko J.R., Hall B.E., Tunkel D.E. [1996]: Acquired maxillary sinus hypoplasia: A consequence of endoscopic sinus surgery? Laryngoscope 106: 1210–1213.
Levine H.L. [1990]: Functional endoscopic sinus surgery. Evaluation, surgery and follow-up of 250 patients. Laryngoscope 100: 79–84.
Nayak Dr, Balakrishnan R., Murthy K.D.: An endoscopic physiological approach to nasosinus allergy, [unpublished data]
Nishioka G.J., Cook P.R., Davis W.E., Mckinsey J.P. [1994] Immunotherapy in patients undergoing functional endoscopic sinus surgery. Otolaryngol Head Neck Surg 110: 406–412.
Prades J.M., Veyret C., Martin C. [1993]: Microsurgical anatomy of the ethmoid. Surg Radiol Anat 15: 9–14.
Rice D.H. [1989]: Basic surgical techniques and variations of endoscopic sinus surgery. OCNA 22: 713–726.
Shambaugh G.E. Jr. [1995]: Allergy in otolaryngology the experience of an expert. ENT Journal 74: 798–799.
Stammberger H. and Posawetz W. [1990]: Functional endoscopic sinus surgery, concept, indications and results of the Messerklinger's technique. Eur Arch Otorhinolaryngol. 247: 63–76.
Wake M., Shanker L., Hawke M., Takeno [1993]: Maxillary sinus hypoplasia. Embryology and Radiology. Arch Otolaryngol Head Neck Surg 119: 1353–1357.