Surgical management of chronic paranasal sinusitis

An attempt is being made to try to standardize an approach to surgical problems involving the paranasal sinuses, excluding malignancies. This is being done in conformity with a definition proposed by Ferris Smith in 1934 along with certain up‐to‐date modifications. There are five basic surgical operations commonly and effectively utilized in approaching these sinus problems. Three of these procedures, namely, the nasal antral window, the Caldwell‐Luc, and the intranasal ethmoidectomy, are felt to be best utilized in the primary approach to the majority of inflammatory problems. The remaining two procedures, the fronto‐ethmo‐sphenoid sinusotomy and the osteoplastic frontal flap, are advocated primarily in approaching space occupying lesions, excluding polyps, and secondarily where attempts to manage the problem by the first three lesser surgical procedures have been unsuccessful. The merits, goals, and indications of all five procedures are discussed. In many instances two procedures may have equal effectiveness in handling a patient's particular problem, and the procedure of choice rests with the personal preference of the individual surgeon. At other times an inappropriate procedure may not benefit the patient while a properly selected operation could readily enable a cure. It is in this latter area of selecting the appropriate surgical procedure to attack a particular problem that a serious deficit now exists in the practice of otolaryngology. It is the further contention of this presentation that these five basic procedures can effectively handle the majority of chronically diseased paranasal sinusitis problems. It is unfortunate that the one procedure that is the most effective and the most physiological in handling the majority of the more difficult problems, namely, the intranasal ethmoidectomy, was allowed to fall into near disrepute by a historical misunderstanding. 0