HISTORY OF ENDOSCOPIC SINUS SURGERY M.Nourollahian MD1St Endoscopic sinus surgery Seminar 21-22 Jan 2010
Introduction:History of EndoscopyWhen did people start to have a look into human bodies? The first description dates to Hippocates in Greece (460–375 BC)
1806 Philip Bozzini developed an instrument called ‘Lichtleiter‘
1867 Desormeaux used an open tube to examine the genitourinary tract
Maximilian Nitze modified Edison`s light bulb and created the first electrical light bulb for using it for urological procedures
1880 Zaufal was using an endoscope for examination of the eustachian tube orifices with modified Cystoscope.
1903 Hirschman precursor to the endoscope used a 4.0-mm diameter endoscope to examine the middle meatus and maxillary antrum.
However, the utility of endoscopic examination of the nose fell into a dark age (1903-1950)
1950 Von Riccabona and Nehls utilized new endoscopes developed by Hopkins cold light with improved resolution, a large field of vision, and accurate color.
1970 This ultimately led to a renewal of interest in endoscopy of the upper airways.
1980 Dr. Walter Messerklinger, Professor and Chairman of the ENT university Hospital, Graz.
controversial questions, 1:The choice of an operative approach, either external or intranasal, has been one source of controversy. Many early rhinologists advocated external approaches to the frontal and ethmoid sinuses, including Lynch who in 1921 claimed a 100% cure rate with fronto-ethmoidectomy. However, few, if any, surgeons were able to duplicate these results.
Mosher pointed out the difficultyof opening the frontal sinus through an external approach, remarking that the duct "tends to slant inward and to come into relationship with the inner surface on the anterior end of the middle turbinate.Therefore, The duct is easier to approach from the nose than from the orbit.“
controversial questions, 2:The extentof surgery has been another source of controversy. The early rhinologists were not concerned about the preservation of functioning structures.
Van Alyea, advocating conservative surgery of the sinuses in 1951 wroteHis comments serve as an example of the controversy between "physiologic" surgery and radical surgery even at that time.
controversial questions, 3:Use of the rigid intranasal endoscope, while providing answers for many controversial questions, has raised many new areas of discussion. Its use over the last 15 years has had a profound impact on our knowledge of nasal and sinus anatomy and physiology .Acceptance of the techniques, however, has not been without criticism.
Although the general techniques of endoscopic sinus surgery for inflammatory disease are now widely accepted.Healthy discussion within the field continues
New questions: • How should the surgeon manage the middle turbinate or the frontal sinus? • How much emphasis should be placed on the ostiomeatal complex in the surgical management of sinus disease? • What is the true meaning of functional endoscopic sinus surgery (FESS)? • Is nasal endoscopy a necessary cost-effective technique for all patients with a rhinologic complaint?
New indications: For endoscopic techniques continue to become established in the fields of cranial base repair,hypophysectomy, dysthyroidorbitopathy, inverted papilloma, tumors of the anterior skull base, discussion with regard to the role of endoscopic techniques will continue.Such controversy will ultimately result in greater knowledge and improved care for patients.
It is hoped that such discussion will eventually move to a new plane as we improve our knowledge of basic physiology and pathophysiology.
The term (FESS) functional endoscopic sinus surgery was originally coined by Kennedy in 1985To draw attention to the potential for reestablishing sinus drainage and mucosal recovery, principles understood because, of the use of the endoscope.
However, this terminology (FESS) does not imply "minimalistic" treatment of sinus disease with incomplete operations. It is essential that the operations performed address all areas of disease. The thin membranous bony partitions found in areas adjacent to chronic disease may become devitalized and should be removed while mucosa should be preserved wherever possible.