Endoscopic Ethmoidectomy (FESS) Surgical Technique

Monteiro, Pedro; Lubbe, Darlene

Endoscopic Ethmoidectomy (FESS) Surgical Technique

Open Education Resource

2025-03-08

Abstract

Endoscopic ethmoidectomy refers to exenteration of the anterior +/- posterior ethmoid cells. The ethmoids are in close proximity to the orbit and its contents, the optic nerve, the sphenoid sinus, the paper-thin cribriform plate with meninges above, the ethmoidal arteries and the olfactory nerves. Like all endoscopic sinus surgery, the anatomy and surgical technique are best learned on a cadaver, followed by surgery under direct supervision of an experienced endoscopic sinus surgeon. Ethmoidectomy done by a surgeon unfamiliar with the detailed anatomy of the nose and paranasal sinuses, especially in the absence of a CT scan or when unable to properly interpret a CT scan, or by a surgeon untrained in endoscopic sinus surgery, is high-risk. This chapter presents the relevant anatomy, indications for surgery, preoperative work-up, surgical instrumentation, anaesthesia, surgical technique, postoperative care and pitfalls of endoscopic ethmoidectomy.