Open approaches

Abstract

Surgical intervention in diseases of the paranasal sinuses can change anatomy and drain infection. It does not intrinsically affect allergy, primary disease of the respiratory mucosa, the causes of nasal polyps, or other mucosal sensitivity to the environment. If one must operate on the paranasal sinuses, he or she should aim to accomplish the anatomic objectives and to do this in as safe a manner as possible. The underlying mucosal disease must then be addressed medically. It is critical that the surgeon understand the underlying pathophysiology, know the relevant anatomy, set realistic surgical objectives, and then accomplish those objectives in as safe a manner as possible while causing the least morbidity.Whether this is to be accomplished endoscopically or via an open approach depends on the surgeon's experience and skill, the availability of necessary technology, and the specific disease entity being treated. Historically the group of external sinus operations, e.g., external ethmoidectomy, Caldwell-Luc procedure, Lynch procedure, and osteoplastic frontal sinus obliteration have served as the basis for more complicated approaches to neoplasms, trauma, and other abnormalities of the craniofacial skeleton and skull base, and as a group of core operative skills from which to build. © Springer-Verlag Berlin Heidelberg 2005.