A Systematic Classification on Surgical Approaches for the Sphenoid Sinus: Establishing a Standardized Nomenclature on Endoscopic Sphenoid Sinus Surgery.

Abstract

The sphenoid sinus can pose significant challenges during endoscopic sinus surgery. It is crucial for surgeons to adopt surgical strategies that adequately address sphenoid pathology while minimizing surgical risks and optimizing outcomes. Unlike the well-established surgical approach nomenclature for the maxillary and frontal sinuses, a standardized nomenclature for sphenoid sinus surgery has yet to be established. Hence, we provide a comprehensive review of the various techniques to approach the sphenoid sinus and propose a common surgical classification system to better identify and categorize these surgical approaches. Each surgical technique has been classified based on the extent of surgery, anticipated operation time, level of surgical complexity, potential complications, and expected wound healing time, ensuring alignment with established standards in the literature. The proposed sphenoidotomy types are Type I: sphenoid ostial dilation; Type IIa: transnasal sphenoidotomy (sphenoidotomy without ethmoidectomy); Type IIb: transethmoidal sphenoidotomy (sphenoidotomy with ethmoidectomy); Type III: bilateral, common cavity sphenoidotomy, or "sphenoid drill-out", Type IV: transpterygoid approach, to expose the lateral sphenoid sinus recess, and Type V: sphenoid nasalization, completely removing the sphenoid sinus floor. By standardizing the nomenclature of various sphenoid sinus approach techniques, we aim to promote consistent terminology for teaching, surgical planning, clinical research, and interdisciplinary communication with regards to sphenoid sinus surgery.