POWERED INSTRUMENTS IN FESS

Fuctional endoscopic sinus surgery is the treatment for sinusitis, which aims at preserving the functional anatomy of the nose. There are two approaches:

1. Meserrklinger and
2. Wigand

The steps of functional endiscopic sinus surgery include:

1. Uncinectomy and infundibulectomy
2. Anterior ethmoidectomy
3. Middle meatal antrostomy
4. Perforation of basal lamella
5. Posterior ethmoidectomy
6. Sphenoid sinus exploration
7. Skull base disease clearance
8. Frontal recess exploration

Powered endoscopic sinus surgery refers to use of microdebrider. It is the most common instrument used nowadays for surgical treatment of chronic rhinosinusitis. The microdebrider is tge powered rotatory shaving device that provides atraumatic dissection by resecting tissue precisely and minimizing mucosal trauma and stripping.

The advantage of microdebrider over the traditional surgical technique are:

1. Minimal bleeding
2. Decreased surgical time
3. Faster postoperative healing
4. Minimal crust formation
5. Low incidence of synaechiae formation
6. Easy to learn and use
7. Easier to use in children who have narrower anatomical spaces
8. Better precision

The disadvantages include:

1. Orbital complications: especially medial rectus injury. It can be prevented by directing the cuttingvwindow away from the orbit and directing it upward or downward and not towards the lamina papyrecea or periorbita.
2. CNS complications: due to injury to the skull vase causing CSF leak, subarachnoid haemorrhage.

Powered devices are helpful as an alternate to remove the antral portion of the antochoanal polyp with minimal morbidity. The openings of maxillary and sphenoid sinuses and revision of frontal and sphenoidal recess is also easier and safer with minimal complications.

Powered