Calibrated Approach to Endoscopico Sinus Surgery

Abstract

Endoscopic sinus surgery, in which the surgeon views the nose and paranasal sinuses through a telescope, can potentially lead to loss of perspective of the patient's entire head. Preoperative computed tomographs are also taken at angles different from those encountered in the surgical setting. As a result, the appropriate angle and depth of instrument insertion can fail to be appreciated. In order to study those angles and depths in a setting that more closely resembles the clinical situation in the operating room, we have performed 15 cadaver dissections and measured 14 dimensions relevant to the endoscopic approach. We recommend that cadaver dissection be an important part of continued training in sinus surgery. We also recommend that a reference probe be placed along the floor of the nose and that endoscopic instruments be calibrated at 1-cm intervals so that the depth of insertion can be monitored by an observer or instructor.