Nasal and Paranasal Sinus Anatomy for the Endoscopic Sinus Surgeon

To functionally investigate the distribution of the olfactory epithelium in humans by means of the electro-olfactogram (EOG) and anatomically located biopsy specimens. Prospective, nonrandomized, investigational. Supra-threshold EOG recordings were made on 12 healthy, trained volunteers (6 women, 6 men; age range, 21-48 y). Vanillin was used as the stimulus, since it exclusively excites olfactory receptor neurons. The EOG was recorded with tubular electrodes that were placed using thin-fiber endoscopic guidance. Biopsy specimens were obtained of anterosuperior nasal cavity mucosa in the same regions as the positive EOGs in 15 smell-tested patients (7 women, 8 men; age range, 22-60 y) during routine nasal and sinus surgery. This biopsied tissue was histologically processed and stained for olfactory and neural proteins. Viable responses to EOG testing were obtained in 7 of 12 subjects. In these seven subjects it was possible to identify nine sites above or below the anterior middle turbinate insertion where EOGs were obtained. The biopsy results showed mature olfactory receptor neurons in this same area. Human olfactory epithelium appears to be distributed more anteriorly than previously assumed.

The radical operations of the paranasal sinuses with total removal of the diseased mucosa very often produced postoperative disability due to scar formation and nerve irritation. A new concept of endonasal sinus surgery is based on the reestablishment of paranasal draining, reventilation, and preservation of the lining mucosa. This became possible by a strictly endonasal approach using angle-optic endoscopes for the optical control of manipulations. The principles of endonasal antrostomy, ethmoidectomy, and infundibulotomy are outlined, and their preliminary results are given. The importance of long-range postoperative local treatment is emphasized.