Singhania Ankit A, Bansal Chetan, Chauhan Nirali, Soni Saurav
Department of otorhinolaryngology, SBKS Medical College, Sumandeep University, Waghodia, Vadodara, Gujarat, India.
Iran J Otorhinolaryngol. 2012 Spring;24(67):63-7.
The aim of this study was to determine which technique of uncinectomy, classical or swing door technique.
Four hundred eighty Cases of sinusitis were selected and operated for Functional Endoscopic Sinus Surgery (FESS). Out of these, in 240 uncinectomies classical uncinectomy was done whereas in another 240 uncinectomies swing door technique was used. Initially patients were medically managed treated according to their symptoms and prior management. Patients who had received previous adequate medical management were evaluated with CT scan of the sinuses. If disease still persists than they were operated for FESS.
The authors' experience indicates that Functional endoscopic sinus surgery can be performed under local or general anesthesia, as permitted or tolerated. In this review classical technique was used in 240 uncinectomies. Out of this, ethmoidal complex injury was noted in 4 cases, missed maxillary ostium syndrome (incomplete removal) was reported in 12 patients and orbital fat exposure was encountered in 5 patients. As compared to 240 uncinectomies done with swing door technique, incomplete removal was evident in 2 cases and lacrimal duct injury was reported in 3 cases. 'Evidence that underscores how this 'swing door technique' successfully combines 'the conservation goals of the anterior-to-posterior approach and anatomic virtues of the posterior-to-anterior approach to ethmoidectomy of the total 480 uncinectomies operated. Out of which 240 uncinectomies have been performed using the 'swing-door' technique. The 240 uncinectomies performed using classical technique were used as controls. The incidence of orbital penetration, incomplete removal, ethmoidal complex injury and ostium non-identification was significantly less with the new technique. Three lacrimal injuries occurred with the 'swing-door' technique compared to no injuries with classical technique.
The authors recommend swing door technique as it is easy to learn, allows complete removal of the uncinate flush with the lateral nasal wall and allows easy identification of the natural ostium of the maxillary sinus without injuring the ethmoidal complex.
本研究的目的是确定哪种筛窦切除术技术，即传统技术还是摆动门技术。
选取480例鼻窦炎患者行功能性鼻内镜鼻窦手术（FESS）。其中，240例筛窦切除术采用传统筛窦切除术，另外240例筛窦切除术采用摆动门技术。最初，患者根据其症状和先前的治疗情况接受药物治疗。曾接受过充分药物治疗的患者接受鼻窦CT扫描评估。如果疾病仍然存在，则对其进行FESS手术。
作者的经验表明，功能性鼻内镜鼻窦手术可在局部或全身麻醉下进行，视情况允许或患者耐受程度而定。在本综述中，240例筛窦切除术采用传统技术。其中，4例出现筛窦复合体损伤，12例报告有上颌窦口漏诊综合征（切除不完全），5例出现眶脂肪暴露。与采用摆动门技术的240例筛窦切除术相比，2例切除不完全，3例报告有泪道损伤。“有证据强调了这种‘摆动门技术’如何成功地结合了‘从前向后入路的保留目标和从后向前入路的解剖学优点’，在总共480例进行的筛窦切除术中。其中240例筛窦切除术采用了‘摆动门’技术。采用传统技术进行的240例筛窦切除术用作对照。新技术导致的眶穿透、切除不完全、筛窦复合体损伤和窦口未识别的发生率显著降低。‘摆动门’技术出现3例泪道损伤，而传统技术无损伤。
作者推荐摆动门技术，因为它易于学习，能完整切除与鼻外侧壁齐平的钩突，便于识别上颌窦自然开口且不损伤筛窦复合体。
