Endoscopic Sphenoethmoidotomy is a minimally invasive surgical procedure performed via an endonasal approach. It consists of opening and draining the sphenoid sinus under endoscopic guidance. This procedure is used in the treatment of chronic inflammatory pathologies, as well as in cases of tumoral formations or fungal conditions localized in the sphenoid sinus.

Procedure Components and Details:

• The sphenoid sinus is one of the four types of paranasal sinuses, located deep within the sphenoid bone, behind the nose and close to vital structures such as the optic nerve and the pituitary gland.
• The intervention is performed using high-precision endoscopic technology, with cameras and fine instruments introduced through the nostrils.
• A controlled opening (sphenoethmoidotomy) is performed to allow drainage, ventilation, and therapeutic access to the sinus.
• The procedure allows for the removal of inflammatory tissue, chronic secretions, polyps, or tumoral formations (e.g., mucoceles, cysts).

Purpose and Goals of the Procedure

The main objective is to ensure proper drainage and ventilation of the sphenoid sinus, as well as the removal of pathological contents (purulent secretions, polyps, fungi, or tumors). The procedure helps relieve symptoms such as retro-orbital headache, deep nasal pressure, or visual disturbances secondary to chronic sphenoidal sinusitis.

Medical Indications

• Chronic sphenoidal sinusitis unresponsive to conservative treatment
• Sphenoidal mucocele
• Nasosinusal polyposis involving the sphenoid sinus
• Benign or malignant tumors of the sphenoid sinus
• Aspergilloma or other localized fungal infections

Patient Preparation

• Preoperative ENT consultation and imaging (CT of sinuses/paranasal region ± MRI)
• Standard preoperative blood tests (CBC, coagulation panel, blood glucose, etc.)
• Anesthesia risk assessment
• Discontinuation of anticoagulants, as per professional medical advice

Procedure

Under endoscopic guidance, the surgeon performs a posterior transmeatal approach to the sphenoidal recess. The natural ostium of the sinus is identified and widened to allow for proper drainage and aeration. Any pathological content is removed while preserving vital surrounding anatomical structures (internal carotid artery, optic nerve).

Type of anesthesia: General
Duration of the procedure: Approximately 30–60 minutes

Recovery:

• Hospital stay: 0–1 day (depending on the medical context)
• Postoperative medication: Antibiotics, anti-inflammatory drugs, nasal saline irrigation
• Precautions: Avoid physical exertion and exposure to respiratory infections
• ENT follow-up: At 7–10 days for crust aspiration and reevaluation
• Complete healing: Within a few weeks, depending on the underlying condition

Endoscopic sphenoethmoidotomy is an effective and safe procedure that enables treatment of deep sphenoidal sinus pathologies through a minimally invasive approach, with reduced risks and rapid recovery.

Sources:

https://pubmed.ncbi.nlm.nih.gov/20599088/

https://www.optecoto.com/article/S1043-1810(14)00017-7/fulltext

https://www.sciencedirect.com/science/article/abs/pii/S0194599896700955

https://my.clevelandclinic.org/health/treatments/17478-functional-endoscopic-sinus-surgery

https://medicine.uiowa.edu/iowaprotocols/endoscopic-sinus-surgery