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Objectives/hypothesis: To investigate epidemiological features and symptoms of sialolithiasis and their implications for diagnosis and management., Study Design: Retrospective cohort study., Methods: Retrospective analysis on 2,322 patients with sialolithiasis, between 1987 and 2009. The statistical significance between two sample distributions was computed using analysis of variance Student t test for two-tailed distribution., Results: A total of 2,959 calculi were identified by means of ultrasound. Of those, 80.4% were located in the submandibular duct system (53% hilar/proximal, 37% distal, 10% intraparenchymal) and 19.6% were parotid stones (83% in Stensen's duct, 17% intraparenchymal). Sialoliths had been discovered beforehand in the submandibular gland (P = 0.00024; t test). Symptoms, measured from first visit, lasted on average 26 months (range: 1 day-30 years). The main group suffered from swelling (50.3%), followed by painful swelling (41.6%) and pain (3.1%). Multiple stones were found in 16.9% of patients (18.1% in the submandibular gland; 14.3% in the parotid). Average stone diameter in the submandibular gland was 8.3 mm (range 1-35 mm), and the stones were in Lustmann group II (46%). In the parotid gland, the average diameter was 6.4 mm (range 1-31 mm), and 51% were in Lustmann group I., Conclusion: Nowadays, epidemiologic features and clinical manifestations of sialolithiasis play an important role, assisting not only in diagnosis but also in determining appropriate treatment. Due to their location and smaller diameter, parotid stones in some cases can only be treated using a mini-invasive endoscopic technique. Submandibular stones more often require a combined approach., Level of Evidence: 4, (© 2015 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives/hypothesis: There are several therapeutic approaches to treat juvenile recurrent parotitis. The aim of this study was to compare sialendoscopy, including prophylactic cortisone irrigation, with observation and a conservative approach of antibiotic therapy alone., Study Design: Retrospective study, tertiary clinical center., Methods: The charts of patients treated for juvenile recurrent parotitis between November 2004 and June 2011 were reviewed. Initial acute flares were always treated with a course of antibiotics. Subsequent treatment consisted of either salivary gland endoscopy including cortisone irrigation or additional pure antibiotic therapy. Patients treated with salivary endoscopy were compared to patients treated with antibiotics alone with regard to the number of inflammatory episodes and pain intensity pre- and posttreatment., Results: Thirty-six patients were treated during the period of study, 15 with salivary endoscopy with cortisone irrigation and 21 with antibiotic therapy alone. A significant reduction in recurrent episodes and pain intensity following therapy was found in both groups. With respect to these two outcomes, the comparison showed two therapeutic options of equal merit., Conclusions: Salivary gland endoscopy is an option in the management of juvenile recurrent parotitis that helps in confirming the diagnosis and that also provides therapeutic intervention. However, although there are further advantages, the definitive value of salivary gland endoscopy requires ongoing evaluation in further prospective studies., Level of Evidence: 4., (Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.)

Sialendoscopy is established in the diagnostics and treatment of obstructive salivary gland diseases, but has not previously been reported in patients with injuries to Stensen's duct. Sialendoscopy assisted repair of a transected Stensen's duct in zone B is reported. The duct injury itself, its location, and its severity could be visualized and precisely assessed and allowed intraductal assessment of the ductal tissue. Rapid atraumatic dissection and also postoperative endoscopic follow-up examination with assessment of the anastomosis was provided by using the sialendoscope, which appears to be valuable for several reasons in the management of Stensen's duct trauma., (Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective was to assess the medium to long-term results and patients' perceive of success after combined sialoendoscopic and transcutaneous access in salivary gland diseases. A retrospective analysis was performed in a tertiary referral centre. A total of 19 patients have been treated with a combined sialoendoscopic and transcutaneous access. The main indication was sialolithiasis in 89.5 % of cases (n = 17), in 2 of these cases simultaneous complications were treated. Other indications included treatment-resistant stenosis and traumatic transection of the parotid duct. Intraductal stents were placed in 52.6 % of the cases. Patients were evaluated by clinical investigation, ultrasound examination and by a questionnaire to assess patients perceive of success. As a result the treatment was successful in 89.5 % of all cases, and in 94.1 % of the patients with sialolithiasis. Parotidectomy was required in two patients, as reconstruction of the ductal system was not possible intraoperatively (sialolithiasis, n = 1) or was unsuccessful (stenosis, n = 1). Prerequisites for successful treatment were the endoscopic access to the pathology, the possibility to reconstruct the duct and recovery of gland function postoperatively. A mean follow-up time for successfully treated patients was 40.67 months. All patients were satisfied with the results and reported a significant reduction in symptoms and improvement of their perceived quality of life (p = 0.001 each). As conclusion the combined access is a valuable alternative treatment in patients with sialolithiasis. Additional indications may include treatment-resistant stenosis and injuries to the parotid duct. However, the indication in stenosis needs to be carefully weighed up.

Conclusion: This study showed that elective neck dissection (ND) resulted in reduced regional recurrences in a selected group of surgically treated patients with pT1-2 carcinomas but did not show any benefit for disease-specific survival (DSS). Furthermore, the importance of pN classification was also verified for this patient group., Objectives: The aim of this study was to determine whether the use of elective ND in patients with early head and neck carcinomas and cN0 neck that have undergone a transoral removal of the primary tumor can reduce the incidence of regional recurrence and improve survival., Methods: Between 1980 and 2010, 224 patients that underwent transoral resection of a pT1-2 carcinoma and had a cN0 neck were included in the study; 101 patients received an elective ND and 123 did not., Results: The group that underwent elective ND showed a tendency toward better regional control (RC) (96.0% vs 90.3%, p = 0.07) but similar DSS (85.7% vs 85.4%, p = 0.984). Cases with pN0 classification had a better overall survival (74.6% vs 46.9%, p = 0.07), DSS (88.4% vs 53.6%, p = 0.44), and RC (98.6% vs 62.5%, p < 0.001) compared with pN+ patients.

This study aimed to evaluate the long-term outcomes of endonasal surgical treatment for choanal atresia (CA) and determine possible predictors of recurrence. A retrospective study of 50 cases of CA that were managed endonasally was conducted at an academic tertiary referral centre. Recurrence of disease was assessed with regard to the type and nature of atresia, presence of CHARGE association and stent usage. Bilateral CA cases (n = 76 sides) were operated at an early age and had an incidence of recurrence of 57%, while unilateral cases had a recurrence rate of 25% (3/12). Use of stents did not have a statistically significant effect on the rate of recurrence. However, a significantly higher recurrence rate was noted in patients with purely bony atretic plates (p < 0.001) or CHARGE association (p = 0.049). A tendency towards a higher recurrence rate in bilateral atresias was also found (p = 0.085). The transnasal approach is a safe and effective way to re-establish the nasal choanae. However, appropriate information on the likelihood of recurrence should be included in the preoperative counselling of patients and their parents, especially in cases with bilateral atresia or CHARGE association.

Objective: Sialendoscopy and other gland-preserving techniques such as extracorporeal shockwave lithotripsy (ESWL), transoral stone removal, and combinations of these methods have fundamentally changed the therapeutic approach to salivary stones. Since 2003, all patients presenting with sialolithiasis have been diagnosed and treated with the same algorithm and routine salivary gland endoscopy (SGE)., Study Design: Case series with chart review of patients with sialolithiasis treated between 2003 and 2008 using an algorithm for gland preservation., Setting: Tertiary referral academic medical center., Subjects and Methods: A total of 1154 patients with suspected sialolithiasis were identified and reviewed. Factors analyzed included stone location, size, surgical method, rate of stone clearance, complications, and rate of short- and long-term symptom resolution. Successful treatment was defined as freedom from symptoms at follow-up., Results: Diagnostic sialendoscopy confirmed 221 parotid stones and 812 submandibular stones, of which 206 and 736, respectively, were treated. Transoral stone removal was the most frequently used method to remove submandibular stones (92%), with a smaller percentage able to be removed by SGE alone (5%) with long-term success rates ≥90%. Only 4% (29/736) required submandibular gland removal. Parotid stones were removed by SGE (22%), combined SGE and incisional technique (26%), or ESWL (52%), with long-term success rates of 98%, 89%, and 79%, respectively. Only 8 of 206 (4%) patients eventually required parotidectomy., Conclusion: Salivary gland endoscopy is an important diagnostic and therapeutic tool in the management of sialolithiasis but must be combined with additional techniques to ensure a high rate of stone clearance, symptom resolution, and gland preservation.

Objective: To assess differences in minimally invasive treatment in various types of Stensen duct stenoses, because sparse data have been published concerning this., Design: Retrospective study., Setting: Tertiary reference center, level of evidence: 2b., Patients: Ninety-three patients with stenoses., Methods: Treatment of 111 parotid duct stenoses was evaluated with particular attention to which treatment strategies were successful in various types of stenoses (type 1, inflammatory; type 2, web-associated fibrous; and type 3, fibrous). Minimally invasive treatment consisted of sialendoscopy-guided rinsing with cortisone (all cases) and interventional sialendoscopy with instrumental dilation alone or combined with transoral ductal surgery., Results: Sialendoscopy-guided rinsing with cortisone was sufficient in 73.0% of cases of type 1 stenosis (21.5% of all cases). Interventional sialendoscopy with instrumental dilation was successful in 47.1% of cases of type 2 stenosis and 70.5% of cases of type 3 stenosis (59.2% of all patients). Interventional sialendoscopy combined with transoral duct surgery was successful in 72.7% of cases of type 3 stenosis (8.6% of all cases). Glands could be preserved in 96.4% of cases., Conclusions: Stenoses that can be differentiated using sialendoscopy seem to require different minimally invasive treatment. Sialendoscopy-guided rinsing with cortisone is an important basic anti-inflammatory treatment, particularly in inflammatory stenoses. Interventional sialendoscopy with instrumental dilation, transoral ductal surgery or a combination of both are the first choice in fibrous stenoses.

The aim of this study was to review the advantages, limitations, and international interdisciplinary expert perspectives and contrasts of salivary gland endoscopy and transoral techniques in the diagnosis and management of salivary gland calculi and their adaptation in North America. The transition from transcervical approaches to strictly sialendoscopic approaches is a broad chasm and often not feasible. Sialendoscopy, sialendoscopy-assisted, intraoral, and transcervical approaches all have surgical value. Diagnostic sialendoscopy, interventional sialendoscopy, sialendoscopy-assisted, and transoral techniques have been a major step forward, not only in providing an accurate means of diagnosing and locating intraductal obstructions, but also in permitting minimally invasive surgical treatment that can successfully manage blockages precluding sialoadenectomy in most cases. A flexible methodology is required. Multiple or combined measured may prove effective., (Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.)

Objectives/hypothesis: The management of stenoses of Wharton's duct has so far been little investigated or systematized. The development of minimally invasive treatment methods, including sialendoscopy, has made preservation of gland function possible., Study Design: Retrospective study in a tertiary referral center., Methods: A total of 153 stenoses of the submandibular duct were diagnosed and treated in 138 patients. Ultrasound and sialendoscopy were the first-choice diagnostic measures. A total of 62.7% of the stenoses were located in the distal, 11.1% in the middle segment, and 18.3% in the proximal to posthilar duct. Diffuse stenoses were observed in 7.8% of the cases. Sialendoscopy-assisted intraductal cortisone administration, interventional sialendoscopy, and transoral ductal surgery were the treatment options. The mean period between treatment and data collection was 52.5 months., Results: Fibrotic stenoses were diagnosed in 88.3% and bilateral involvement in 8.6% of the cases. Distal stenoses were treated predominantly by ductal incision (79.2%). Stenoses of the midsubmandibular duct were treated conservatively in 29.4% or with sialendoscopy or ductal incision in 35.3% of cases each. Proximal up to posthilar stenoses could be dilated by interventional sialendoscopy in 82.2%. In 25% of all diffuse stenoses, glandular resection was carried out, representing 2.6% of all stenoses. Glandular function was preserved in 97.8% of cases., Conclusions: Stenoses of the submandibular duct can be treated using minimally invasive procedures and with preservation of glandular function with a high success rate. Ductal incision procedures are the most important measure, but sialendoscopy becomes more important the more centrally the stenosis is located., (Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.)

Objectives/hypothesis: This study aimed to evaluate the results of endoscopic laser-assisted diverticulotomy and the transcervical approach in treating Zenker's diverticulum., Study Design: Retrospective clinical study., Methods: Results of 155 cases after endoscopic laser-assisted diverticulotomy and the transcervical approach were retrospectively compared., Results: Primary treatment consisted of endoscopic laser-assisted diverticulotomy in 65.2%, and 34.8% were treated by a transcervical approach. Average follow-up time was 61.8 months. Surgical time, duration of hospitalization, and occurrence of minor complications were significantly lower after endoscopic approach. Recurrence rate showed a statistically significant difference in favor of open approach. Including the recurrences, 38.7% could be cured only by transcervical techniques. Patient perception of success was found to be similar for the compared treatment modalities., Conclusions: Endoscopic approach proved to be the treatment of first choice. However, the fact that open techniques were necessary in nearly 40% of our cases suggests that this operative technique retains a substantial role in treatment of this disease., (Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.)

Objective: To determine whether unique patterns of care are evolving in the United States compared with Germany in endoscopic management of chronic sialadenitis., Design: Comparison of consecutive series of patients., Setting: Academic tertiary salivary referral centers in Germany and the United States., Patients: A total of 446 patients having chronic sialadenitis treated with salivary endoscopy., Main Outcome Measures: To compare practice patterns and outcomes at each location, databases tracking patients having chronic sialadenitis treated with salivary endoscopy were searched for the following variables: age, sex, involved gland, radiographic studies, endoscopic findings, endoscopic-related complications, gland preservation rate, patient symptom control, and techniques for managing salivary stones and intraductal scar tissue., Results: Significantly more patients in the US cohort had chronic sialadenitis of the parotid gland (P = .03) and multiple gland involvement (P < .001). Salivary endoscopy was regularly performed using local anesthesia in Germany and using general anesthesia in the United States (P < .001). Endoscopic-related complication rates were higher (10.9% vs 1.6%) and gland preservation rates lower (85.9% vs 98.4%) among US patients; however, patients with intact glands demonstrated similar rates of symptom control at both centers (92.7% in the United States vs 85.3% in Germany) at the last follow-up visit. The lower rate of gland preservation in the United States is largely because of lack of access to lithotripsy for larger salivary stones., Conclusions: Different patterns of care are emerging in the endoscopic management of chronic sialadenitis in the United States compared with Germany, where these techniques were largely developed. Nevertheless, patients with chronic sialadenitis at both locations who undergo endoscopic gland-preserving therapy have high rates of gland preservation and symptom control.

Background: Transoral laser microsurgery (TLM) has led to an expansion of the therapeutic modalities for malignomas of head and neck. This study aims to assess the oncologic results and functional outcomes of TLM in early carcinomas., Patients and Methods: This is a retrospective study of 947 cases with T1-2 carcinomas primarily managed with laser surgery between 1979 and 2007. All cases were assessed for survival, with respect to location, T and N classification and status of surgical margins. Cases were additionally evaluated for incidence of major complications and retention of laryngeal and pharyngeal function., Results: Disease specific survival was 78.6% for oropharyngeal, 68.9% for hypopharyngeal, 82.3% for supraglottic und 95.2% for glottis carcinomas. Survival estimates were found to be significantly better for cases without cervical metastasis and with negative surgical margins. A low rate of major complications (4.7%) were noted. 1% of the patients had a permanent dysfunction of swallowing and 1.1 % needed a permanent tracheostomy., Conclusion: Laser surgery appears to be a very effective management modality for small carcinomas of the head and neck as long as clear surgical margins can be achieved. This technique offers acceptable oncologic results with a low incidence of complications and satisfactory retention of function.

Minimally invasive, in particular endoscopic treatment modalities are an important topic in medicine today. Over the last 15 years mini-endoscopy (ME) has been introduced and established in different fields of the head and neck region. ME includes endoscopy of the Eustachian tube, middle ear, lacrimal duct system and duct system of the major salivary glands. Direct visualization by endoscopy enables rapid, efficient and accurate diagnosis and treatment planning according to the findings. In the majority of cases simultaneous interventional therapy is possible. This has lead to a fundamental change in treatment regimes which now aim to preserve the anatomic structure and function. In specialized centers the frequency of external dacryocystostomy could be reduced to less than 10% by means of endoscopic surgery of the lacrimal system, while the frequency of parotidectomy was reduced to below 5%. This development allows not only for medical advances, but also for the desired cost reduction on the part of the administrative organs responsible for providing medical care.

Many patients with advanced head and neck cancer are already in a poor nutritional status and need supportive nutritional therapy at the time of initial diagnosis. Malnutrition is associated with delayed recovery, prolonged hospital stay and unfavorable prognosis. By using percutaneous endoscopic gastrostomy (PEG), the social stigmatization for the patient resulting from the conspicuous nasal feeding tube is avoided. The PEG can be easily implemented at the time of diagnosis by head and neck surgeons in patients suffering from massive tumor-associated weight loss, when definitive or adjuvant radiochemotherapy is anticipated, or prior to tumor surgery likely to be followed by prolonged significant dysphagia and protracted swallowing rehabilitation. Analgesics can be administered via the PEG tube, thus simplifying adequate pain management, which plays a central role in the care of head and neck cancer patients.

The treatment of stenoses and non-stone-related obstructive diseases of the major salivary glands has undergone significant changes due to the development of minimally invasive treatment modalities. Correct diagnosis can often not be established in detail with all diagnostic tools except sialendoscopy, which is necessary for gland-preserving therapy. Over the last 10 years a range of minimally invasive treatment approaches aimed at preserving gland function have been developed. In addition to sialography-controlled therapy, interventional sialendoscopy plays a central role, representing the treatment of first choice in all stenoses and non-stone-related obstructions of the salivary duct system and with a success rate of about 85%-90%. By combining sialendoscopy with other minimally invasive surgical procedures, the function of the gland can be preserved in more than 95%. Thus sialendoscopy plays a crucial role in the treatment of non-stone-related obstructive diseases of the major salivary glands. In stenoses of the salivary gland ducts extirpation of the gland should be considered only as a last step.

Sialoliths are the underlying cause of salivary gland obstructive disease in 60%-70% of cases. Modern minimally invasive techniques have enabled accurate diagnosis and findings-specific therapy with the aim of full gland-function preservation. This article provides an overview of the current diagnostic measures for and therapy of sialolithaisis. Ultrasound is the investigation of first choice and is able to recognize stones in well over 90% of cases. Sialendoscopy is a directly visualizing technique which is superior to all other diagnostic measures for the assessment of pathologic changes in the salivary duct system and the detection of stones. Treatment was significantly improved with the introduction of extracorporal shock wave lithotripsy (ESWL), sialographic-controlled techniques, surgical procedures of the duct system and in particular by interventional sialendoscopy. Interventional sialendoscopy, especially when combined with other treatment modalities, has a success rate of 85%-95%. Cases which respond poorly to therapy can be treated successfully with the endoscopic transcutaneous approach in about 90% of cases. When sialendoscopy is performed in combination with other minimally invasive treatment options the gland can be preserved in 95%-98% of all cases.

Objective: Despite all the advances of minimally invasive surgery, refractory stones remain in 10 to 20 percent of all cases of parotid gland sialolithiasis, and persistence of the symptoms makes removal of the gland inevitable. In some of these cases, however, it may be possible to conserve the gland using a combination of endoscopic and transcutaneous procedures., Study Design: Case series with chart review., Setting: Tertiary referral center., Subjects and Methods: Nine patients treated with a combined endoscopic transcutaneous operation were evaluated. During this procedure, the stone is removed through a skin incision under endoscopic guidance. Indications were sialolithiasis refractory to treatment (n = 5), sialolithiasis with complications (n = 2), contraindications to primary minimally invasive surgery (n = 1), and primary treatment (n = 1). In seven cases, the stones were extracted. Simultaneous resection of a sialocele was carried out in one case, and simultaneous resection of a saliva-cutaneous fistula was carried out in another. A stent was inserted in 66.7 percent of the cases., Results: Treatment was successful in 88.9 percent of the patients. All of these patients were free of stones and symptoms, and glandular function was maintained both clinically and on ultrasound assessment. Complete parotidectomy had to be carried out in one case because it was not possible to reconstruct the duct system., Conclusion: The combined operation offers a further option for gland-conserving treatment in cases with obstructive salivary gland disease, especially sialolithiasis. At present, it is indicated for cases that are resistant to treatment after sialendoscopy or extracorporeal shock wave lithotripsy. The gland resection rate can thus be further reduced.

The aim of this study is to review the long-term results of endonasal endoscopic dacryocystorhinostomy (DCR) according to our experience as well as to evaluate potential prognostic factors for long-term outcomes. The files of 165 patients who underwent endonasal DCR at a tertiary referral centre between 1991 and 2001 were retrospectively assessed. Furthermore, these cases were clinically evaluated at least 5 years after surgery and completed a subjective result evaluation questionnaire. A cure was reported by a total of 112 (67.9%) subjects and significant improvement without need for further treatment was noted in 23 cases (13.9%). Thirty (18.2%) cases were considered as failures. The overall successful outcome according to the subjective symptom evaluation was 81.8%. Poor correlation between clinical findings and subjective report of symptoms was found. None of the prognostic factors that were assessed affected outcomes significantly. In conclusion, long-term success rates for endonasal DCR seem to be comparable to previously published short-term results.

Objectives: The origin of strictures of Stensen's duct often remains unclear, but chronic recurrent parotitis may be one associated disease. Failure of conservative therapy leads to a recommendation of parotidectomy in a high percentage of cases. Nowadays, development of new, minimally invasive methods may lead to a fundamental change in the treatment regimen., Methods: We retrospectively evaluated 39 patients who presented with symptomatic strictures of Stensen's duct from 2002 to 2005. Sialoscopy was performed with semirigid endoscopes. Therapy consisted of irrigation and intraductal infusion of cortisone. If possible, interventional sialoscopy was carried out as the first-line procedure. If indicated, operative procedures of the duct were performed., Results: After irrigation and intraductal medication, 17.9% of the patients were free of symptoms. Interventional sialoscopy was carried out in 74.4%, with a success rate of 75.9%. Operative duct procedures (extended papillotomy or resection of papilla stricture with duct reinsertion) were carried out in 23% of cases. In 5.1% of the total cases, parotidectomy was unavoidable., Conclusions: Sialoscopy-based methods play a central role in gland-preserving treatment of strictures of Stensen's duct. Sialoscopy has proven to be a fast, useful, and relatively safe therapeutic tool with a high success rate. Parotidectomy is the last choice in symptomatic cases.

Background: In 5-10% of all cases with an obstructive disease of the major salivary glands, a diagnosis cannot be established by conventional radiological imaging or ultrasound. Using sialendoscopes, intraductal pathology can made visible to the surgeon, aiding in diagnosis and adequate treatment., Material and Methods: Between 2001 and 2005, 369 sialoscopies were performed on 318 patients in the ENT department of the University of Erlangen-Nuremberg. Semi-rigid sialoscopes with an external diameter of between 0.7 and 1.7 mm were used., Results: In 34.9% of cases conservative treatment was necessary. In 65.1%, based on the sialoscopic findings, further therapeutic procedures such as extracorporeal shock wave lithotripsy, interventional sialoscopy or duct slitting were required and planned. Of 133 performed interventional sialoscopies, 83.5% were successful., Conclusions: Sialoscopy is a useful diagnostic and therapeutic tool in obstructive salivary gland disease. Interventional sialoscopy has been performed with high success rates and has proven to be an important part in our concept of a gland preserving therapeutic regime.

Objective: Sialoscopy has developed into an important diagnostic and therapeutic tool for diseases of the major salivary glands., Study Design and Setting: We evaluated 103 patients with chronic swelling of the major salivary glands. Routine diagnostic measures revealed no clear diagnosis. The findings of 109 sialoscopies are described. A semi-rigid endoscope (with a diameter of 1.1 mm and 2 integrated working channels) was used for sialoscopy, 51.5% of the cases in Warthon's duct and 48.5% in Stensen's duct., Results: Pathologic findings resulted in 83.0% of the submandibular and in 96% of the parotid ducts. Obstruction neither due to sialolithiasis nor stenosis was observed in 56.3%, whereas sialolithiasis was observed in 20.3% of the patients. In 36 (35%) patients, an interventional sialoscopy was performed., Conclusions: In cases of invisible salivary duct obstruction, especially in those with low mineralized calculi, strictures, stenoses, or postinflammatory changes, sialoscopy gives immediate and direct information about causal pathologies. Moreover, further therapy can be planned within the same procedure.

Background: Minimally invasive endoscopic and microscopic procedures represent state of the art paranasal sinus surgery techniques in both diagnostic and surgical fields. To combine favorable aspects of both techniques, we evaluated the clinical applicability and effectiveness of multifunctional microendoscopes, providing multiple features to ensure highest accuracy and surveillance when performing crucial steps in paranasal sinus surgery., Methods: The study included both anatomic experiments on cadaveric heads and clinical tests on patients undergoing routine paranasal surgery. The systems applicability was evaluated in procedures approaching the frontal and sphenoid sinus. Three different endoscopes, 2 straight and the other 1 with a 90 degrees angle, were tested. They integrate canals for flushing and suction and a working canal for either drilling or obtaining biopsies with a miniaturized forceps. For stereotactic feedback, the applicability in combination with a computer-navigation system was evaluated., Results: Anatomic tests were performed to optimize illumination and to test drilling features and forceps biopsies. In all cases, the frontal sinus ostium and the sphenoid sinus anterior wall was easily identified and enlarged by drilling under visual and stereotactic control. Continuous suction and irrigation ensured a constant visual surveillance by removing drilling debris and blood. Best suited for multifunctional endoscopic surgery were drill heads with a cylinder shape, for placing bore holes along the Z axis, and spherical drill heads, for furbishing and enlarging drill holes., Conclusion: These new instruments have proven their applicability in paranasal sinus surgery. Multifunctional endoscopic procedures were deemed best suited for maneuvers requiring highest precision, such as the surgery of the frontal and sphenoid sinus.

Objective: Endoscopically or microscopically controlled paranasal sinus surgery currently represents the state of the art. For anatomic reasons the ostium of the frontal sinus and the frontal sinus itself are difficult to observe. Flexible endoscopes are often difficult to implement and do not provide enough light intensity to visualize all parts of the frontal sinus., Materials and Methods: A specially curved rigid endoscope with a working channel of 1.5 mm that allows passage into the frontal sinus has been developed to manage this problem. The system was used on 15 patients during paranasal sinus surgery to evaluate possible indications and its clinical usefulness., Results: The endoscope could be introduced into the frontal sinus after an ethmoidectomy had been performed in all of the patients. The anatomy of the sinus could be visualized with sufficient light intensity in 14 patients. The shadowing of the frontal sinus seen in CT was not due to polyps of the mucosa of the frontal sinus in all cases, but rather due to secretion with otherwise normal mucosa. In the cases with polyps, it was necessary to irrigate with saline solution to prevent the buoyant polyps from collapsing over the endoscope. The following specific indications for this endoscopic version were established during this first test: intraoperative and postoperative control of the frontal sinus, clinical evaluation of tumor growth into the frontal sinus, biopsies within the frontal sinus, and evaluation of fractures., Conclusion: The new device provides further insight within the field.