[Heerman's principle in microsurgery of nasal cavity and paranasal sinuses].

Forty-year experience in surgical activity of an otorhinolaryngological department of A. Krupp's hospital in Essen, Germany, is reviewed. Main lines of Heerman's conception are shown in conduction of surgical interventions on the nasal cavity and paranasal sinuses, lacrimal tracts. Various endonasal interventions are performed with employment of endoscopes and surgical microscopes except malignant tumors, oroantral fistulas, malformations. The necessity of gain of surgical skill while operating corpses is emphasized.

[Influence of the anatomical structure of the uncinate process on bone patency of the maxillary sinus: a radiological and clinical evaluation]. / Wplyw typu budowy anatomicznej wyrostka haczykowatego na droznosc ujscia zatoki szczekowej--ocena radiologiczno-kliniczna.

The group of 185 patients with chronic and acute recurrent rhinosinusitis was analyzed radiologically with CT scans. The anatomical structure of the uncinate in its upper part, configuration and position of its low margin were evaluated. The results have been compared to the normal CT scans of paranasal sinuses of 50 persons without any sinus disease. The significant correlation was found between the shape and the development of pneumatization of the turbinate and the configuration of the uncinate process as well as to its type. The degree of the pneumatization and configuration or hypertrophy of the turbinate correlate also to the maxillary sinus disease.

[Microscopic endonasal sinus surgery (MESS) in nasal polyposis: long term results]. / Mikrochirurgia endonasalna zatok w leczeniu polipów nosa: wyniki odlegle.

The endonasal microscopic sinus surgery (EMSS) in polyposis nasi is a grateful and in most cases successful procedure with a relative low risk of complications. In 1988 and 1989 we operated on 302 patients with polyposis nasi following the "Heermann Concept of EMSS". In each case the total ethmoidectomy with maxillary, sphenoid and frontal sinus surgery was performed. After an average of 5.2 years we started a follow-up in 185 patients including a questionnaire and clinical examination with endoscopic control and olfactometry. We found recurrent polyposis in 17.3% and a reoperation was necessary only in 6.5%. The complaints in polyposis as nasal obstruction, frontal cephalgia and hyposmia could be improved in more than 80%. About 26.5% of our patients suffered from bronchial asthma. Every second of them (51%) saw an improvement of asthma complaints after the operation. It is remarkable, that the clinical and endoscopic findings do not correlate in all cases with the subjective judgement of the patients. We saw patients with manifest recurrent polyposis, who did not deplore any complaints and vice versa. At last 85.4% said, that they would undergo the operation again.

[Intranasal microsurgery in treatment of cerebrospinal rhinorrhea]. / Mikrochirurgia wewnatrznosowa w leczeniu plynotoku nosowego.

The authors describe two female patients with CSF-leakage. The first patient showed spontaneous CSF rhinorrhea from a leak in the posterior wall of the sphenoid sinus and the second one showed a traumatic fistula in "lamina cribrosa" area. The treatment of choice is closure of the CSF leakage by nasal surgeon (intranasal and with help of binocular microscope under hypotensive anaesthesia) using either intranasal-transseptal or intranasal-transethmoidal approach). This preserves olfaction and avoids the risk of a neurosurgical or paranasal methods. The diagnosis of CSF rhinorrhea can be established by beta-2 transferrin test, isotope scanning or fluorescence endoscopy. The high-resolutions CT is the best method for localization of the bone defect. The intranasal interposition of fascial or conchal grafts with use of fibrigen glue in cases of small defect (< 1-2 cm) is always successful.

[Pathogenesis of rhinosinusitis and endonasal microsurgery]. / Patogeneza schorzen zapalnych zatok przynosowych i mozliwosci leczenia wewnatrznosowa technika mikrochirurgiczna. Czesc I.

The functional microsurgery of the nose has been carried out with help of microscope since 1958 by H. Heermann. The authors described the importance of mucociliary system and lateral nasal wall for pathogenesis and diagnosis of recurring and chronic rhinosinusitis. By the means of nasal endoscopy and polytomography the infection foci can be exactly localised. The list of indications corresponds to our actual concept.

[Endonasal microsurgery by Heermann++. Part II]. / Mikrochirurgia wewnatrznosowa metoda Heermanna. Czesc II.

Endonasal sinus surgery in the case of inflammatory disease is of increasing importance. The maxillary, ethmoid, sphenoid and frontal sinus operations as well as the septumplasty are performed microsurgically. There are only few indications, when the intranasal procedure cannot be applied. We prefer all intranasal operations with the patient placed in semi-Fowler's position with hypotensive anaesthesia. Out of a total of 310 cases in which endonasal microsurgery was performed, 251 were submitted to a retrospective study 12-36 months after the operation. In our study there was an operative success rate of 92.8%. No complications such as: CSF leakage, persisting postoperative visual or ocular disturbance or vascular complications were observed. Compared with transfacial or external sinus surgery, the advantage of the transantral microsurgical technique are better functional results, fewer complications an a reduced duration of hospitalization.