Precision infundibulotomy

The infundibulotomy incision is generally the initial step in endoscopic sinus surgery. During this procedure, inadvertent penetration of the lateral wall of the infundibulum above the maxillary sinus ostium may occur, resulting in orbital trauma due to violation of the medial orbital wall (lamina papyracea). To decrease the potential for this type of complication, a curved dental elevator has been modified in angle and length to permit surgical precision during the infundibulotomy. The design allows for simultaneous medial displacement of the uncinate process with its attached mucosa, creating an initial wide antrostomy. The curvature of this instrument's tip enables it to be directed inferiorly and away from the medial orbital wall. Mucosal trauma involving the superior edge of the inferior turbinate just below the infundibulotomy is minimized by the semisharp angled tip and round handle of the instrument. This angled elevator has been used successfully in more than 500 patients who underwent endoscopic sinus surgery at New York University Medical Center. We discuss the relevant anatomy and review the details of our technique.