ethmoidectomy

Ethmoidectomy is a surgical procedure that removes part of the ethmoid sinus air cells to restore drainage and ventilation of the paranasal sinus system. It is commonly indicated for chronic rhinosinusitis with polyps or recurrent infections when medical therapy has failed, and may also be used for mucocele, fungal sinusitis, or benign tumors. It can be performed to improve sinus drainage, relieve orbital or skull base pressure, or enable access for other nasal procedures.

Anatomy and scope: The ethmoid sinuses form a delicate labyrinth of anterior and posterior air cells located between the nasal cavity and the orbits. They are bounded superiorly by the skull base and laterally by the lamina papyracea. The uncinate process and middle turbinate influence drainage pathways, and careful navigation is essential to avoid injury to surrounding structures such as the orbit and skull base.

Techniques: Today most ethmoidectomies are performed endoscopically via the nasal cavity as part of functional endoscopic sinus surgery (FESS). The procedure typically begins with uncinectomy and removal of ethmoid air cells. Anterior ethmoidectomy removes the anterior group of cells, while posterior ethmoidectomy targets the posterior group. A total ethmoidectomy removes all accessible ethmoid cells. External approaches, such as Caldwell-Luc procedures, are now rare and reserved for select complex cases or limited access needs.

Postoperative care and outcomes: Postoperative care commonly includes saline nasal irrigations and endoscopic debridement to manage crusting and synechiae. Outcomes are generally favorable for appropriately selected patients, with improved drainage and reduced symptoms in many cases.

Complications: Potential risks include cerebrospinal fluid leak, orbital injury, bleeding, infection, and adhesions. As with any sinus surgery, careful technique and postoperative follow-up are essential.