Endoscopic Maxillary Sinus Surgery Using the Microdebrider

ABSTRACT

In the treatment of chronic maxillary sinusitis, endoscopic sinus surgery, unlike the more radical Caldwell-Luc (C-L) operation, enables the preservation of mucosa. However, although a middle meatal antrostomy is superior in function and patency to an inferior meatal antrostomy, at times it is very difficult to remove diseased mucosa located at the antero-inferior or antero-medial side of the maxillary sinus to prevent recurrence, the C-L procedure is often chosen. In an effort to decrease the failure rate of endoscopic maxillary sinus surgery, we applied the microdebrider technique, a new approach of puncture and shaving. To evaluate the effectiveness of the microdebrider technique, we retrospectively reviewed the medical records of 33 patients (43 sinuses) who have been treated by this method. We analyzed the clinical courses of these patients during recovery and evaluated endoscopic findings made during follow-up examinations. Nasal symptoms were alleviated in every case except for two. Three cases required revision ESS or a C-L procedure at the puncture and shaving site. The maxillary sinuses of most patients (80%) were normalized, but five sinuses demonstrated polypoid or thickened mucosa. The ostiums of 36 maxillary sinuses remained patent but nine sinuses became stenotic. Complications, which included facial pain and facial paresthesia, were rare and disappeared shortly. We consider this new technique to be an effective method of eradicating maxillary sinus disease that is not otherwise accessible through the MMA window.