Evolution of Technology

Endoscopic Sinus Irrigation System

Endoscopic sinus irrigation systems allow for directed, higher-powered irrigation of sinus contents directly where disease is located. Over the counter sinus irritations are often unable to reach diseased areas when there is advanced obstruction, and without articulating and curved instrumentation, would not be capable of dislodging mycetomas. These systems can replace more invasive surgical approaches to the paranasal sinuses, and also allow for the addition of topical medications in the saline irrigation solution, which can be directly applied in hard to reach areas.

Evolution of Procedure

Maxillary Sinus Debridement

Maxillary sinus debridement is aimed at mucosal preservation, while also removing obstructions in maxillary ostium outflow. After identification of the uncinate process, the opening to the maxillary can be located just posteriorly. The maxillary sinus is directly adjacent to the nasal cavity, and the near 90-degree angle of entry into the sinus can pose an issue for disease located at the far lateral and anterior aspect.

Specialized right angled and other curved instruments and irrigation systems, as well as more advanced surgical procedures to include Maxwell Luc and Maxillectomy, have been described to address difficult to reach areas of the maxillary sinus.

Evolution of Diagnosis

Fungal Sinusitis/Mycetoma

Fungal sinusitis is a disorder of the paranasal sinuses, caused by fungal colonization after inhalation of fungal spores in the environment. Individuals with impaired sinus clearance may be at increased risk of fungal colonization developing into outright infection. In the setting of impaired clearance, fungal hyphae may become intertwined, leading to the development of “fungus balls” or mycetoma.

Once a fungal ball develops, medical management is usually not sufficient, and surgical management is usually curative. Severe untreated cases can lead to meningitis, high fevers, vision problems, proptosis, cranial nerve deficits, or nosebleeds. Immunocompromised individuals are at risk of acute invasive fungal sinusitis, which can rapidly invade nearby structures such as the orbit and brain, and must be promptly address with surgical debridement.