Preface

This endoscopic sinus surgery (ESS) dissection manual illustrates a unique, anatomically based, and stepwise approach for learning to perform endoscopic sinus surgery. This approach has been used for years in teaching endoscopic surgical anatomy and technique to otolaryngology residents and fellows at the University of Miami School of Medicine. It combines all the best attributes of prior methodologies.

In this manual I illustrate how the bony ridge of the antrostomy and adjacent medial orbital floor can be very consistent and useful landmarks when performing ESS. By using the antrostomy ridge and medial orbital floor, in combination with columnellar measurements, even the most inexperienced surgeon can determine his or her approximate location within the ethmoid labyrinth and operate within a zone of confidence. Use of this approach also facilitates the determination of the correct anteroposterior trajectory into the posterior ethmoid and sphenoid sinuses. The methodical use of these landmarks keeps the surgeon oriented, especially when faced with significant anatomical distortion due to disease or prior surgery. That is, neither anatomical reference point appears to be significantly affected by inflammatory conditions or prior sinus surgery, and both are easy to find. Utilizing these consistent reference points minimizes the chance of inadvertent intracranial or intraorbital complications in the face of significant anatomical distortion.

The manual is divided into 20 dissections. Each of the dissections builds on the anatomical exposure and identification of key anatomical landmarks developed in the preceding dissection. In addition, an increasing degree of surgical skill and knowledge of the endoscopic paranasal sinus anatomy is required as the student progresses through all 20 dissections.

Therefore, one should complete each dissection before progressing to the next one in the manual. All the structures illustrated in each section should be completely identified. Remember that repetition is the key to developing an expertise in any surgical procedure. Finally, the endoscopic surgical skills acquired from this manual should be supplemented with additional reading from the references at the end of the manual to expand one's fund of knowledge in all the procedures discussed.