[Preservation or reconstruction of uncinate process in endoscopic sinus surgery].

OBJECTIVE: To explore a new approach for paranasal sinus by using transnasal endoscope, which would be more coincided with the physiological characteristics of nasal cavity and nasal sinuses, and meet the requirement of structure reconstruction in functional nasal endoscopic surgery.

METHODS: Thirty patients with chronic rhinosinusitis (CRS) were selected as clinical subjects. For each patient, the left side was selected to preserve or reconstruct the shape of uncinate process by nasal sinus opening surgery, the right was received traditional functional endoscopic sinus surgery (FESS) as control. The curative effect after surgery was evaluated according to the restoration of symptoms and local state under endoscope. The most important was to observe whether the above structure could restore to normal after preserving or reconstructing the shape of uncinate process and affect the drainage of related sinuses, and whether diseased sinuses could gain the similar near prognosis to that after FESS.

RESULTS: The patients were followed up after 6 months since the performance of surgery. (1) Uncinate process maintained original or normal anatomical shape and did not affect the drainage of sinuses. (2) Opened nasal sinuses and rises were covered by uncinate process. (3) All sinuses drained well, and the restoration time and state of both sides of sinus mucosa were the same, and no local morphology was affected by preserving uncinate process.

CONCLUSIONS: (1) Sinus opening surgery by preserving or reconstructing uncinate process could maintain or reconstruct the original nasal cavity structure, and could protect the opened sinuses and avoid the attack of direct airflow. (2) 6-12 months after surgery, no difference was found as to the self sensation about the improvement of symptoms, and the shape of operational cavity in experimental group was similar to that in control group. (3) This surgical approach was under exploration, and it was only suitable for CRS patients with basic normal shape of uncinate process, and the surgical indications would be gained depending on the advancement of technology and accumulation of experience and the data obtained in future curative effect.