Minimally invasive therapy in otorhinolaryngology and head and neck surgery

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Abstract
Summary Minimally invasive surgery in ENT means replacement of the traditional, partially destructive, approaches to the area with new surgical techniques using the natural openings of the body. Such techniques require special instruments, optical aids such as the endoscope and microscope, specialized knowledge of surgical anatomy, and particularly in the region of the paranasal sinuses, a new concept of mucous membrane treatment. CO2 laser surgery has become valuable for the treatment of inborn and acquired benign lesions of the upper aero-digestive tract in infants and adults. Laser surgery is especially useful for the management of vascularized tumours such as haemangiomas and papillomas and for stenosis since function can be preserved and tracheotomy avoided. In recent years great advances have been made in curative and palliative laser treatment of malignant tumours of the oral cavity, oropharynx, hypo-pharynx and the larynx. Early malignant lesions can be treated by micro-endoscopically controlled laser surgery with excellent oncological results. Swallowing and vocal function can be preserved. Radical mutilating surgery for advanced stage tumours does not result in improved survival rates. Minimally invasive laser surgery is advocated where possible to avoid en bloc resection and subsequent defect repair while allowing similar survival rates with a better quality of life. Principles of minimally invasive surgery in the upper aero-digestive tract, in the paranasal sinuses and in the region of the medial orbital wall and optical nerve are presented.