Mount Sinai sinus surgeons specialize in minimally invasive, functional endoscopic sinus surgery (FESS) for patients with chronic rhinosinusitis and sinusitis with or without nasal polyps. Sinus surgery for inflammatory disease allows medications such as nasal steroids, saline irrigations, and antihistamines to better reach their target areas. Polyp removal may also improve nasal congestion and nasal obstruction. This procedure is commonly performed along with septoplasty and inferior turbinate reduction to further open the nasal airways to improve breathing through the nose. Not all sinuses must be opened in order for surgery to be effective; surgeons will open a combination of the following sinuses: maxillary, ethmoid, frontal, and sphenoid on one or both sides. The extent of surgery is dependent on symptoms, anatomy, and the results of a CT scan. Sinus surgery is very effective in well-selected patients. For more information, go to: https://www.mountsinai.org/care/ent/services/nasal-sinus-allergy https://www.mountsinai.org/care/ent/services/general https://www.mountsinai.org/care/ent/services/pediatric
Satish Govindaraj, MD Chief of Rhinology; Vice Chair of Clinical Affairs, Department of Otolaryngology – Head and Neck Surgery Mount Sinai Health System Associate Professor, Otolaryngology, and Neurosurgery Icahn School of Medicine at Mount Sinai Daniel Alicea Delgado, MD Assistant Professor, Department of Otolaryngology-Head and Neck Surgery Mount Sinai Health System Anthony Del Signore, MD, PharmD Assistant Professor, Otolaryngology Mount Sinai Health System Director of Rhinology and Endoscopic Skull Base Surgery Mount Sinai Union Square Alfred M.C. Iloreta, Jr., MD Assistant Professor, Otolaryngology, Neurosurgery The Mount Sinai Hospital New York Eye and Ear Infirmary of Mount Sinai Mount Sinai Morningside and Mount Sinai West Madeleine R. Schaberg, MD Assistant Professor, Otolaryngology Mount Sinai Health System Director, Rhinology and Skull Base Surgery New York Eye and Ear Infirmary of Mount Sinai Calvin Wei, MD Assistant Professor, Department of Otolaryngology-Head and Neck Surgery Mount Sinai Health System Zan Mra, MD Assistant Professor, Otolaryngology Mount Sinai Brooklyn Noah B. Sands, MD Assistant Professor, Otolaryngology Mount Sinai West Edward J. Shin, MD Professor, Ear, Nose, Throat (ENT) / Otolaryngology - Head and Neck Surgery New York Eye and Ear Infirmary of Mount Sinai Benjamin C. Tweel, MD Medical Director, Department of Otolaryngology – Head and Neck Surgery Mount Sinai Health System Joshua Zeiger, MD Assistant Professor, Department of Otolaryngology - Head and Neck Surgery Mount Sinai Health System Zachary G. Schwam, MD Assistant Professor, Department of Otolaryngology-Head and Neck Surgery Division of Otology-Neurotology, Lateral Skull Base Surgery Mount Sinai Health System The Mount Sinai Oology Surgical video series presents functional endoscopic sinus surgery. This procedure is performed by members of our Rhinology and general OD oncology divisions for those patients with chronic Rhino cytic. This video was made by Kevin Wang along with series editor, Zachary Chung. Here you see on a kernel diagram on the left and sagittal diagram on the right of the paranasal sinuses. There are four sinuses in total. The maxillary hyoid sphenoid and frontal sinus. The goal of a pest procedure is to open up these sinus aero cells and widen natural drainage pathways. This helps improve ventilation, restore healthy mucosa and improve access for topical medications depending on patient specific disease factors, all or only some of these sinuses may need to be opened in a standard fest. We go through steps for a complete fest which includes a male andros toy, anti posture, pheno, doomy and frontal sinusotomy. The patient in this video has a history of chronic rhinosinusitis. Here we're looking in the left nasal cavity. You can see the inferior turbinate, middle turbinate septum and left septal spur max intros toy first, the curve of the un is visualized which often resembles a half moon, a ball tip probe is inserted poster to the unite and aimed inferiorly. It should fall into the natural maxillary os and the free edge is reflected anteriorly. The natural laws can also be approximated by the junction of the lower third and upper third of the maxillary line. Next, a back bitter is used to bring the unsin to its anterior limit. Care must be taken not to disrupt lacrimal bone or nasal lacrimal duct anteriorly. The reflected on is removed with an up biting kerosene and remaining portions removed with a microdebrider. When using the microdebrider, a tapping motion should be used in short intervals. Tissue should be allowed to come towards the instrument rather than digging in. This is safer and prevents inadvertent damage to underlying structures. The max and trusts me should be clearly visible at this point and if needed, the antrostomy is enlarged posteriorly using a straight through cutting instrument towards the posterior wall. Once again, the debrider is used to mop up hanging tissue. Next, the ethmoidectomy is addressed. Ethmoidectomy are classified as partial or total depending on whether the anterior or postema cells are removed. The first step in an anti ectomy is to identify and ect Ebola, we typically use AJ curet to enter the Bola starting in the retro bullet space and fracturing forward, we then remove remaining partitions using a combination of through cutting instruments and microdebrider. Once the Bola has been fractured, remove bony fragments with blakely forceps or a straight microdebrider is important to use mucosa sparing techniques through cutting instruments and blakely forceps can be used to cut and remove etno bony partitions but forceps should be used sparingly when removing mucosa to prevent stripping. The goal here is to identify the medial orbital wall and basil. The basal Lamela is the portion of the middle turbinate that curves laterally and attaches to the lateral nasal wall. On this axial C T scan of this patient, you can see the basal lamella highlighted in yellow which divides the anti etm cells shaded in red from the poster eide cells shaded in green. The next important point of reference is the root of the maxillary sinus which serves as both the point of entry of basil ella and height of the sphenoid. Once the basal lamelo is entered, this marks the start of our poster ethmoidectomy. The posterior portion of the middle turbinate is removed first in order to visualize the superior turbinate. So using the height of the max roof as a guide, one third of the lower superior turbinate is resected using through cutting instruments to reveal the natural sphenoid. A freer is then inserted into the natural laws to widen it. And the opening is further wide up to the skull base and laterally to lamina using a kerosene or mushroom punch with the pheno doomy complete and skull base defined. We now turn back death, myectomy of the superior most cells starting post yearly at the skull base. Ethmoid partitions are dissected off of skull base using a combination of kerosene through cutting instruments and microdebrider. The axle of the middle turbinate is also open to better visualize superiorly. Dissection continues from a post tier to anterior direction until the roof of the Ebola and super bola recess are reached. This marks the completion of the total ethmoidectomy. This is also the portion of the case when we use an angled endoscope to examine the max intros toy to incorporate the natural laws if it was not reached with zero degree instruments. The ideal shape of a completed antrostomy is pear shaped with the anterior portion dissected just post ear to the nasal arial duct, bone fragrances removed and mucosy is trimmed. Here, we see the open cavity with Max Troy on the right clear ethmoid air cells and sphenoid opening, poster frontal sinusotomy. The first step of frontal sinusotomy is to identify the anterior ETD artery which lies post here to the frontal recess. The natural drainage pathway of the frontal sinus is next identified. This is often described as a shadow recess known as the transition zone which is poster to ana many times the opening may be tiny or even hidden by redundant mucosa that requires general suctioning or probing to reveal. Once the frontal drainage pathway is found, remnant ana is removed using a combination of side to side and front to back through cutting instruments Homan punch curved microdebrider and frontal carsons. Finally, the post ear bony wall between the super orbital amo and the frontal recess is opened, enlarging the frontal recess in concluding this portion of the procedure.