Microscopic Endonasal Surgery: Clinical Update for Treatment of Chronic Sinusitis with Polyps

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Abstract
Microscopic endonasal surgery has been routinely used over the past 5 years in treating over 450 patients with various paranasal sinus pathologic conditions. The main advantages of this technique are wide-field stereoscopic vision, bimanual dissection, and simplified resident instruction. Disadvantages include the need for specialized instrumentation, general anesthesia, and sometimes difficult visualization of angular views. Despite these shortcomings, the precision offered allows for decreased operative morbidity with enhanced preservation of normal tissues. Operative hemorrhage, which often presents a formidable problem during telescopic sinus surgery, is easily controlled by selective bipolar cautery, hypotensive anesthesia, and use of the semi-Fowler's position, which allows blood and mucus to flow out of the operative field. The aim of this manuscript is to detail our operative experience in a group of 325 patients who were treated for chronic sinusitis with polyposis nasi using microscopic endonasal surgery.