The agger nasi approach to the uncinate process: From top to bottom

TL;DR

This paper introduces a new endoscopic surgical approach to the Uncinate Process via the agger nasi region, showing it is safe and effective for treating chronic rhinosinusitis.

Contribution

A novel endoscopic approach to the Uncinate Process via the agger nasi region is introduced and validated clinically.

Findings

The agger nasi region provides a greater distance to the orbit, reducing the risk of injury.

The approach consistently identifies the maxillary sinus ostium and preserves key structures.

Patients showed significant improvement in SNOT-22 scores with no major complications.

Abstract

To describe a novel endoscopic approach to the Uncinate Process (UP) via the agger nasi region and evaluate its anatomical basis and clinical outcomes.

This study comprised two components. In the imaging study, 51 paranasal sinus CT scans were analyzed to measure the distance between the UP and the medial orbital wall at the agger nasi and ethmoid infundibulum regions, using standardized coronal and axial planes. In the clinical study, 53 patients with chronic rhinosinusitis underwent uncinectomy through the agger nasi approach. Pre- and postoperative SNOT-22 scores were compared after 6-months of follow-up, and complications were recorded.

The distance from the UP to the orbit was significantly greater at the agger nasi region compared to the ethmoid infundibulum on both sides (p < 0.001). Clinically, the agger nasi approach allowed consistent identification of the maxillary sinus ostium and preservation of key anatomical structures. There was a significant improvement in SNOT-22 scores postoperatively (p < 0.001), with no major complications observed.

The agger nasi approach to the UP is a safe, reproducible, and effective technique. The greater distance from the UP to the orbit in this region may reduce the risk of orbital injury and facilitate complete identification of the natural drainage pathway of the maxillary sinus.

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