Katsantonis G P, Friedman W H, Bruns M
Park Central Institute, St. Louis, MO 63139.
Otolaryngol Head Neck Surg. 1994 Dec;111(6):781-6. doi: 10.1177/019459989411100614.
Intranasal sphenoethmoidectomy was originally used primarily for the provision of adequate drainage of acute and subacute bacterial sinusitis. However, the spectrum of inflammatory sinus disease has changed dramatically since the popularization of broad-spectrum antibiotics, and chronic hyperplastic rhinosinusitis has replaced acute sinusitis as the primary indication for ethmoidectomy. In such cases total or almost total disease removal is crucial to providing long-term drainage and ventilation. We describe several modifications of the Yankauer sphenoethmoidectomy technique that enable the sinus surgeon to provide clearance of disease and excellent drainage for all sinuses by complete marsupialization of the sphenoid, ethmoid, and maxillary sinuses. These modifications include (1) complete rather than partial removal of the middle turbinate, (2) extended middle meatal antrostomy with palatine bone resection to the pterygoid process with delineation of the inferior and medial orbital wall, and (3) introduction of operative endoscopes as adjunctive tools in areas inaccessible to conventional visualization. The current technique and results in nearly 2000 procedures are described.
鼻内蝶筛窦切除术最初主要用于为急性和亚急性细菌性鼻窦炎提供充分引流。然而，自从广谱抗生素普及以来，炎性鼻窦疾病的范围发生了巨大变化，慢性增生性鼻-鼻窦炎已取代急性鼻窦炎成为筛窦切除术的主要适应证。在这些病例中，完全或几乎完全清除病变对于提供长期引流和通气至关重要。我们描述了扬卡尔蝶筛窦切除术技术的几种改良方法，这些方法使鼻窦外科医生能够通过蝶窦、筛窦和上颌窦的完全袋形化，清除所有鼻窦的病变并实现良好引流。这些改良包括：（1）完全而非部分切除中鼻甲；（2）扩大中鼻道上颌窦造瘘术，切除腭骨至翼突，同时勾勒出眶下壁和眶内侧壁；（3）引入手术内镜作为传统可视化无法到达区域的辅助工具。本文描述了当前的技术以及近2000例手术的结果。
