History of sinus surgery

From Otolaryngology Online

The earliest description of maxillary sinus surgery dates back to 17th century, when the maxillary sinus was accessed through the alveolar margin. Nathaniel Highmore an English surgeon and anatomist described in 1651 a method to open the antrum of Highmori through maxillary alveolus after having removed a tooth.

In the 18th century, a French surgeon Louis Lamoier, presented a method of opening the maxillary antrum without the need for tooth extraction. He showed antrum can be opened through the space between molar tuberosity and the third molar tooth.

John Hunter and Anselme-Louis-Bernard-Berchillet Jourdain independently introduced a method of entering the maxillary sinus via the middle meatus. The lack of proper visualization of the middle meatus created problems for this approach and this technique was abandoned after bleeding problems and damage to orbital contents.

Develpment of modern rhinology began in the early 1880's when a trocar for the puncturing the maxillary antrum via the inferior meatus was introduced independently by Johan von Mickulicz-Radecki in 1886 and Herman Krause in 1887.

At the end of 19th century three surgeons i.e. George Walter Caldwell, Robert Henry Scanes, Spicer and Henry Paul Luc independently described the method of enlarged canine fossa opening, complete removal of sinus mucosa and an intranasal antrostomy in the inferior meatus. This radical sinus surgery was later called the Caldwell-Luc operation was the most common surgical treatment modality for chronic maxillary sinus disease at the begining of the 20th century. But, its popularity began to wane due to the complications associated with this procedure, the introduction of antibiotics and the evolution of endonasal sinus surgery.

An inferior meatal antrostomy was used without addressing the maxillary sinus mucosa. It was Mikuliz who first described this method in 1887. It has since been used in treating maxillary sinus infections. In this method, the purpose of the inferior antrostomy is to create a route for passive drainage and the mechanical cleansing of the infected maxillary sinus. Inferior meatal antrostomy has been known for their low patency rates. There is always the danger of injury to the nasolacrimal duct or canine teeth. This procedure has also been critisized for creating a deviation from the normal sinus function. Development of endoscopic sinus surgery and the characterization of mucociliary clearance towards the natural maxillary sinus ostium have decreased the popularity of inferior meatal antrostomy.