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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.
Objective:
To describe a novel endoscopic approach to the Uncinate Process (UP) via the agger nasi region and evaluate its anatomical basis and clinical outcomes.
Methods:
This study comprised two components. In the imaging study, 51 paranasal sinus CT scans were analyzed to measure the distance between the UP and the medial orbital wall at the agger nasi and ethmoid infundibulum regions, using standardized coronal and axial planes. In the clinical study, 53 patients with chronic rhinosinusitis underwent uncinectomy through the agger nasi approach. Pre- and postoperative SNOT-22 scores were compared after 6-months of follow-up, and complications were recorded.
Results:
The distance from the UP to the orbit was significantly greater at the agger nasi region compared to the ethmoid infundibulum on both sides (p < 0.001). Clinically, the agger nasi approach allowed consistent identification of the maxillary sinus ostium and preservation of key anatomical structures. There was a significant improvement in SNOT-22 scores postoperatively (p < 0.001), with no major complications observed.
Conclusion:
The agger nasi approach to the UP is a safe, reproducible, and effective technique. The greater distance from the UP to the orbit in this region may reduce the risk of orbital injury and facilitate complete identification of the natural drainage pathway of the maxillary sinus.
