Study On The Difference And Complementarity In Visual Field Of Four Kinds Of Endoscopic Maxillary Sinus Operations

ObjectiveWith the appearance and wide application of endoscope, which makes it more convenient and diverse to deal with maxillary sinus disease. Many classical minimally invasive surgical approaches come into being, such as several endoscopic intranasal approaches or associated with external nasal approach. However, the controllable range of endoscopic surgical field is often limited by the narrow surgical approach, there are also adverse effects of maxillary sinus special anatomy. The controllable surgical field of endoscopic maxillary sinus operation under different approaches directly affects the effective range of some surgical approaches to treating diseases. To explore the difference and complementarity in visual field of four different kinds of endoscopic maxillary sinus operations, we inspected every maxillary sinus cavity by using endoscope through four different surgical approaches on two cadaveric head specimens.MethodsDissected the selected four maxillary sinus, simulated surgical approach on every maxillary sinus,anterior wall antrostomy,middle meatus antrostomy,inferior meatus antrostomy and endoscopic nasal lateral wall dissection in turn.After fenestration of each approach, we inspect the maxillary sinus cavity by using different endoscope through every windowing, adjust the direction and position of endoscope, detect the largest field of vision, Using nasal endoscopic video recording system, record microscopic observation. The endoscopic vision of every surgical approach is confirmed by three otolaryngologists together. Then study the difference and complementarity in visual field of four kinds of endoscopic maxillary sinus operations. ResultsThe 0°endoscope that is combined with 30°,70°endoscope can allow optical control of the total anatomic areas of the maxillary sinus via AWA or ENLWD on every one of the four maxillary sinus specimens; the three endoscopes via MMA can allow optical control of the following anatomic areas of the maxillary sinus:posterior half of the roof, posterior small part of the medial wall, superior half of the posterior wall, then extend to superior two-thirds the lateral wall when the maxillary sinus with 4-sided pyramidal shape; the three endoscopes via IMA can allow optical control of the following anatomic areas of the maxillary sinus:posterior and lateral wall, superior wall, maxillary sinus floor, posterior half of the medial wall, part of the medial wall below window, inferior two-thirds of anterior, then extend to anterior wall when the maxillary sinus with 4-sided pyramidal shape.The 0°endoscope via AWA did not allow optical control of the following anatomic areas of the maxillary sinus:superior and lateral part of the medial wall around window; especially prelacrimal recess, when the gasification level of the maxillary sinus is good.The 0°and 30°endoscope via IWA can't allow optical control of the floor the maxillary sinus with good gasification and a well-built alveolar recess.But the 30°endoscope via IWA can allow optical control of lateral part of the anterior wall of the maxillary sinus with 4-sided pyramidal shape, the typical 4-sided pyramidal shape can facilitate the 70°endoscope to inspect the maxillary sinus via MMA.The gasification level of sinus has no effect on the inspection of the maxillary sinus via ENLWD by using every endoscope we selected In the experiment.ConclusionsThere is a certain difference in visual field among four kinds of endoscopic maxillary sinus operations. When using three kinds of endoscopes, the examination of the maxillary sinus through AWA or ENLWD is better than the other two approaches, throughout all corners, then the visual field through MMA or IMA is incomplete. There are some additional field of vision, when add IMA on the base of MMA, It did not allow optical control of the frontal parts of the maxillary sinus (anterior half of the medial wall, the junction of the anterior wall and the medial wall, especially the prelacrimal recess). The gasification and shape of the maxillary sinus has different effect on every endoscope via different approaches.