This document describes the surgical technique of uncinectomy and maxillary sinusotomy. It discusses removing the uncinate process to expose the natural ostium of the maxillary sinus using various surgical tools like a sickle knife, backbiting forceps, and microdebrider. The uncinate process is identified by palpation and its posterior free edge. The technique involves incising the uncinate process with a sickle knife and dividing any remaining attachments with scissors or forceps. This exposes the natural maxillary ostium while leaving part of the uncinate process attached superiorly and inferiorly. The procedure finds application in cases of massive polyposis or revision sinus surgery.

1. •Dr. Mohammad Salah Mady
Lecturer of ORL,HNS .
Otorhinolaryngology Department,
Ain Shams University.
Uncinectomy & Maxillary
Sinusotomy

2. Messerlinger

3. The Wigand technique calls for a back-to-front
exenteration of disease from the paranasal sinuses
The Wigand technique finds application in cases of massive
polyposis or in revision surgery (where anatomical
landmarks are distorted

10. The uncinate process “guards” the natural maxillary
ostium to form a three-dimensional corridor to it, the infundibulum
ethmoidale

11. The entrance to this corridor is
the a two-dimensional semilunar-shaped gap hiatus semilunaris between the
free margin of the uncinate process
and the ethmoid bulla, called the hiatus semilunaris

17. Max. Os. before uncinectomy

18. Infundibulotomy
Partial removal of the uncinate process to expose the natural ostium
of the maxillary sinus

19. how to identify the UP :
1- palpation
2- posterior free edge

20. Palpating around the edge of the uncinate
process with a ball probe.

21. uncinectomy :
ant. post. : sickle knife, cottle, suction dissector
post. ant. : backbiting foreceps, kerrison, microdebrider

22. The backbiter is fed around the edge of the uncinate process and an inferior
horizontal bite is taken

24. uncinectomy + MMA (
backbiting + microdebrider)

25. The sickle knife is used with caution, incising
only 1 mm—which is all that is needed to go through the
uncinate process—and is kept in the sagittal plane as much as
possible

26. One method for doing an
uncinectomy is to initially incise
downward with a sickle knife
next turn the sickle knife
around and incise in the opposite
direction

27. The uncinate
process is then medialized to help
define its remaining superior
or inferior attachments.
right uncinectomy with the uncinate
process
medialized to reveal the natural
maxillary ostium

28. Zurich scissors or through-cutting forceps are used to divide any remaining
superior attachment of the uncinated process

29. Blakesley forceps can be used to grasp the uncinate and
rotate it laterally to free any remaining attachment

30. The natural maxillary ostium is exposed and a small part
of the uncinate process is left attached both superiorly
and inferiorly

31. uncinectomy & MMA (sickle knife)) + accessory ostium
uncinectomy by suction dissector

36. drsalahmady@gmail
Mohammad Salah Mady
00201006054993
Mohammad Salah Mady
Mohammad Salah Mady