Nasal Centripetal Endoscopic Sinus Surgery

Objectives: My aim in this article is to report 26 years of experience in order to evaluate the applicability and efficiency of centripetal dissection in intranasal ethmoid sinus surgery. Methods: I performed a retrospective review of 2,500 patients treated in the Felippu Institute, Sao Paulo, over the 26-year period from 1984 to July 2010. All of the patients underwent intranasal ethmoid sinus surgery with the centripetal technique. Before surgery, an otolaryngological examination, nasal endoscopy, and computed tomographic scans with axial, coronal, and sagittal projections were performed. All surgeries were carried out under general anesthesia and with the help of a surgical microscope or (after 1997) a rigid 30 endoscope. The surgical technique required a standard endoscopic sinus surgery set. The complications of intranasal ethmoid sinus surgery were recorded and classified as intraoperative, short-term, or long-term. Results: I observed an intraoperative complication (cerebrospinal fluid leak) in 4 patients. There were no cases of peri-orbital damage. I recorded no short-term or long-term complications. All of the intraoperative complications were resolved during surgery. Conclusions: With the use of this technique, the surgeon can precisely identify the position of the surgical instrument without losing his or her orientation, and thereby significantly reduce the risk of complications.