This document discusses endoscopic sinus surgery (ESS) and the Messerklinger technique. It provides details on sinus anatomy and physiology, as well as factors that can lead to chronic sinusitis. Diagnostic nasal endoscopy is described as an accurate way to diagnose issues and determine appropriate treatment. True indications for ESS include chronic and recurrent acute sinusitis, nasal polyps, and fungal sinusitis. Advantages of ESS include a 3D view, good illumination, magnification, and the ability to visualize all areas of the sinuses. The conclusion states that ESS has clear advantages over conventional sinus surgeries in diagnosing and accurately treating patients.

1. DR.G.SUNDHAR
KRISHNAN M.S.,D.L.O.,
KRISHNA EYE & E.N.T.
HOSPITALS.

2. BASIS OF FESS
MESSERKLINGER TECHNIQUE
TARGETED AT THE PRECHAMBERS OF THE
LARGE SINUSES.
RESTORES THE BASIC PHYSIOLOGY [
MUCOCILIARY CLEARANCE ] OF ALL SINUSES BY
IMPROVING DRAINAGE & VENTILATION.

3. ANATOMY
3 PROMINENCES – TURBINATES
SPACES UNDERLYING – MEATUS
NLD - INFERIOR MEATUS
OSTIOMEATAL COMPLEX - MIDDLE MEATUS

4. PHYSIOLOGY
TWO CARDINAL FACTORS - DRAINAGE &
VENTILATION
MUCUS BLANKET - SUPERFICIAL GEL
LAYER,DEEP SOL LAYER
PATTERNS
MAXILLARY - STELLATE
FRONTAL - WHORL LIKE
ETHMOID - SPIRAL
SPHENOID - SPIRAL
GENENETICALLY PREDETERMINED

5. NORMAL PATHWAYS OF SECRETION

6. ABNORMAL PATHWAY OF
SECRETION TRANSPORT

7. CONTACT ZONE

8. VICIOUS CYCLE

9. FACTORS - DEVELOPMENT OF
CHRONIC RHINOSINUSITIS
ANATOMICAL VARIANTS
CONCHA BULLOSA
ENLARGED ETHMOIDAL BULLA
EVERTED UNCINATE PROCESS
PARADOXICAL MIDDLE TRURBINATE
SEPTAL DEFLECTION

10. PARADOXICAL MED UNCINATE
CONCHA SEPTAL SPURR

11. MUCOCILIARY ABNORMALITIES
PRIMARY
PRIMARY CILIARY DYSKINESIA
CYSTIC FIBROSIS
YOUNG’S SYNDROME
SECONDARY
ALLERGY
BACTERIAL INFECTION
IMMUNO DEFICIENCY
ALLERGY

12. DIAGNOSTIC NASAL
ENDOSCOPY
INDICATIONS
CHRONIC SINUSITIS
NASAL OBSTRUCTION
HEADACHE
ABNORMALITIES OF SMELL
EPISTAXIS
UNILATERAL NASAL DISCHARGE

13. DIAGNOSTIC NASAL
ENDOSCOPY
ADVANTAGES
ACCURATE DIAGNOSIS
RECOGNITION OF HIDDEN CHANGES
DECIDE THE MODALITY OF TREATMENT
FOLLOW-UP OF THE PATIENT

14. DIAGNOSTIC. . . .
PROCEDURE
LOCAL ANAESTHESIA
0 AND 30 DEGREES NASAL ENDOSCOPE
FIRST PASS - ALONG THE NASAL
FLOOR
SECOND PASS - ALONG
SPHENOETHMOIDAL RECESS
THIRD PASS - ALONG MIDDLE MEATUS

15. POLYP IN THE MIDDLE MEATUS

16. FUNGAL SINUSITIS

17. CT SCAN-GOLD STANDARD IN
ESS
CONFIRMATION OF THE DIAGNOSIS
EXACT DETAILS OF THE ANATOMY
IT IS A MUST IN CASES OF REVISION
SURGERY

19. INFUNDIBULAR & OMC PATTERN

20. EXTENSIVE NASAL POLYPOSIS

21. SPHENO - ETHMOIDAL RECESS
PATTERN

22. INDICATIONS -FESS
TRUE INDICATIONS
CHRONIC SINUSITIS
ACUTE RECURRENT SINUSITIS

23. OTHER INDICATIONS
NASAL POLYPOSIS
FUNGAL SINUSITIS
FRONTOETHMOIDAL MUCOCELE
REPAIR OF CSF LEAK
EPISTAXIS
CHOANAL ATRESIA
CIRCUMSCRIBED BENIGN TUMOURS

24. OTHER INDICATIOS
ORBITAL DECOMPRESSION
OPTIC NERVE DECOMPRESION
PERIORBITAL ABSCESS
BLOW OUT FRACTURE OF ORBIT
DACROCYSTORHINOSTOMY
HYPOPHYSECTOMY-TRANSPHENOIDAL

25. POSTOPERATVE PICTURE

26. CONTRAINDICATIONS
INTRACRANIAL COMPLICATIONS OF
SINUSITIS
LATERALLY LOCATED PATHOLOGY OF
FRONTAL SINUS

27. COMPLICATIONS
EARLY
 HAEMORRHAGE
 INJURY TO THE ORBIT
 CSF LEAK
LATE
 SYNECHIAE
 MENINGITIS

28. ADVANTAGES OF ESS
1. THREE DIMENSIONAL VIEW
2. GOOD ILLUMINATION
3. MAGNIFICATION
4. ANGLED ENDOSCOPE – NOOK & CORNERS
VISUALISED
5. ACADEMICALLY USEFUL FOR TEACHING
PURPOSES
6. PHOTOGRAPHIC AND VIDEO DOCUMENTATION

29. Microdebridder –
Recent Advancement
1. Cuts and Suction with same
instrument
2. Minimal bleeding
3. Minimal damage to normal mucosa
4. Reduced surgical time

30. CONCLUSION
ENDOSCOPIC SINUS SURGERY HAS CLEAR
ADVANTAGES OVER CONVENTIONAL SURGERIES
BY HELPING TO DIAGNOSE AND TREAT THE
PATIENT WITH ACCURACY