Related Experiment Video
Updated: Sep 13, 2025
Management of the Uncinate Process in No-Touch Laparoscopic Pancreaticoduodenectomy
Published on: May 5, 2023
The agger nasi approach to the uncinate process: From top to bottom
Miguel Soares Tepedino1, Luziana de Lima Ramalho2, Leonardo Balsalobre3
1Universidade do Estado do Rio de Janeiro, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço e Base do Crânio, Rio de Janeiro, RJ, Brazil; Policlínica de Botafogo, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço e Base do Crânio, Rio de Janeiro, RJ, Brazil.
A new endoscopic technique accessing the uncinate process (UP) via the agger nasi region is safe and effective for chronic rhinosinusitis, improving patient outcomes and potentially reducing orbital injury risk.
Area of Science:
- Otolaryngology
- Endoscopic Sinus Surgery
- Anatomy
Background:
- The uncinate process (UP) is a key anatomical structure in the ethmoid infundibulum.
- Traditional approaches to the UP carry risks of orbital injury.
- A novel approach via the agger nasi region may offer anatomical advantages.
Purpose of the Study:
- To describe a new endoscopic technique for accessing the uncinate process (UP) through the agger nasi region.
- To evaluate the anatomical feasibility and clinical efficacy of this novel approach.
Main Methods:
- CT scans of 51 paranasal sinuses were analyzed to measure distances.
- 53 patients with chronic rhinosinusitis underwent uncinectomy using the agger nasi approach.
- Pre- and postoperative SNOT-22 scores were compared, and complications were recorded.
Main Results:
- The agger nasi region offered a significantly greater distance to the orbit compared to the ethmoid infundibulum.
- The approach facilitated consistent identification of the maxillary sinus ostium and preservation of structures.
- Significant improvement in SNOT-22 scores was observed, with no major complications.
Conclusions:
- The agger nasi approach to the UP is safe, reproducible, and effective.
- This technique may reduce the risk of orbital injury.
- It facilitates complete identification of the maxillary sinus drainage pathway.
