ENDOSCOPIC TRANSSEPTAL SPHENOTOMY WITH REMOVING SEPTAL CARTILAGE

Abstract

Sphenoiditis is an inflammatory disease of the mucous membrane of the sphenoid sinus. As a rule, changes in the main sinus are combined with other rhinological pathology, while its isolated lesion accounts for only 1-2% of cases among all inflammatory pathologies of the paranasal sinuses. Surgical approaches to the sphenoid sinus have recently undergone significant changes . Thanks to the development of endonasal transsphenoidal surgery of the skull base, approaches to the main sinus are distinguished by their .In the surgical treatment of isolated sphenoiditis, there are four main approaches to the sphenoid sinus: transnasal, transethmoidal, transpterygoidal and transseptal approaches. Before surgery, the patient’s data is analyzed and the optimal access to the main sinus is selected . This takes into account: preoperative diagnosis, location of the pathological process, degree of pneumatization of the sphenoid sinus, taking into account the spread of the lateral sinus recess, and so on . No less important in choosing an access is the equipment of the clinic, the availability of surgical equipment and the surgeon’s experience in performing endoscopic sinus surgery.In traditional functional endoscopic endonasal surgery (FESS), the sphenoid sinus is opened by identifying and expanding its natural anastomosis . In some cases, opening of the anastomosis is supplemented by lateropexy or partial resection of the middle and superior turbinates to improve the drainage function of the sinus . Depending on the area of removal of the anterior wall of the sphenoid sinus, the following types of opening of the main sinus are distinguished: 1, 2 and 3 types . Detection and expansion of the natural anastomosis of the sphenoid sinus with the nasal cavity is characterized as type 1 sphenotomy. However, when the anastomosis expands in the vertical direction, the sphenotomy is usually classified as type 2. Subtotal or total removal of the anterior wall of the sphenoid sinus, sometimes in combination with partial removal of the posterior wall of the ethmoidal labyrinth cells covering the entrance to the sinus, is classified as type 3 sphenotomy.The latter approach is part of the transsphenoidal approach to the base of the skull and consists of the widest possible removal of the anterior wall of the sphenoid sinus, uniting the sinuses on both sides into a single cavity .Transethmoidal access to the main sinus implies the presence of a pathological process in the cells of the ethmoidal labyrinth, mainly in the posterior sections. This approach requires opening from the anterior sections of the ethmoidal labyrinth to the posterior sections bordering the sphenoid sinus . It is critical to rely on four known anatomical landmarks during surgery to successfully approach the main sinus: the base of the skull (superior), the horizontal portion of the superior turbinate (inferior), the superior turbinate (medially), and the lamina paper (lateral) . In order to open the sphenoid sinus, it is always necessary to follow the inferior - medial direction after identifying the posterior cells of the ethmoidal labyrinth. This approach may be complicated by the presence of Onodi cells, in which case the main sinus will have a horizontal location.Thus, analyzing the available arsenal of surgical techniques for opening the sphenoid sinus, the method of choice in the treatment of isolated sphenoiditis is endoscopic transnasal and endoscopic transseptal approaches .A distinctive feature of the method is minimal invasiveness and functionality in the treatment of main sinus pathology.