Uncinectomy through the anterior nasal fontanelle in endoscopic sinus surgery.

In functional endoscopic sinus surgery, the resection of the uncinate process is an important step. The traditional method of performing uncinectomy is associated with the risk of penetrating the lamina papyracea and orbital fat exposure. Without timely detection and appropriate treatment, uncinectomy may lead to serious consequences such as blindness. In our study, we used the novel approach of performing uncinectomy through the anterior nasal fontanelle. Orbital complications were observed in 4 of the 112 patients who underwent the traditional method; however, no complication was observed in patients who underwent surgeries with the new approach (P < 0.01). No nasolacrimal duct injury or eye movement disorder was observed in the 2 groups. The percentage of opening of the maxillary sinus ostia by using the new method was significantly greater than that achieved by using the traditional method (97.93% and 70.53%, respectively). The mean score in the visual analog scale, which is used to measure the efficacy of the procedure, for the new method was lower than that for the traditional method, and the difference was statically significant (t = 4.17, P < 0.01). Six and 12 months after the operations, the Lund-Kennedy endoscopy scores obtained when the new method was used were lower than those obtained when the traditional method was used (t = 3.27 and t = 4.40, respectively; P < 0.05). Therefore, uncinectomy through the anterior nasal fontanelle was a convenient and safe procedure and ensured good exposure of the maxillary sinus ostia. This procedure effectively improved the efficacy of endoscopic sinus surgery.