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Endoscopic Septoplasty with Limited Two-line Resection: Minimally Invasive Surgery for Septal Deviation

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Surgical instrument force exerted during endoscopic sinus surgery: differences within the ethmoid sinus complex.

Peter D Ross¹, Paul Joice, Ramez G Nassif

¹Department of Otolaryngology, Head and Neck Surgery, University of Dundee, Ninewells Hospital, Dundee, United Kingdom. pxross@dundee.ac.uk

American Journal of Rhinology & Allergy

|January 30, 2010

Summary

Surgeons exert less force on ethmoid sinus bone than on critical structures like the skull base during endoscopic sinus surgery (ESS). This finding suggests improved safety for ESS procedures, but requires further in-vivo validation.

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Area of Science:

Otolaryngology
Surgical Rhinology
Biomechanics

Background:

Endoscopic sinus surgery (ESS) is a key advancement in rhinology.
Limited data exists on forces applied during ESS.
Understanding these forces can enhance surgical training and patient safety.

Purpose of the Study:

To quantify forces during punch osteotomy in ESS.
To measure forces on paranasal sinus structures and critical surrounding bone.

Main Methods:

Simulated ESS performed on 15 cadaveric heads.
Peak axial forces measured using modified Blakesley forceps.
Forces recorded during osteotomy of ethmoid sinus complex, skull base, optic nerve, and internal carotid artery crests.

Main Results:

Mean force to breach ethmoid lamellae: 6.06 N.
Significantly higher forces needed for skull base (17.80 N), optic nerve crests (15.43 N), and internal carotid artery crests (13.15 N).
No significant difference in force between ethmoid lamella and lamina papyracea (6.13 N).

Conclusions:

Greater force is required for critical structures than for ethmoid sinus bone.
Results are reassuring for ESS safety.
In vivo studies are needed to confirm findings in live patients.