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

Abstract

The sphenoid sinus presents significant challenges during endoscopic sinus surgery. It is essential that surgeons employ strategies that effectively address sphenoid pathology while minimizing surgical risks and optimizing outcomes. Although nomenclature for maxillary and frontal sinus surgery is well established, there is currently no standardized nomenclature for sphenoid sinus surgery. We present a comprehensive review of techniques for accessing the sphenoid sinus and propose a common surgical classification system to better define and categorize these approaches. Each technique is classified based on surgical extent, anticipated operation time, complexity, potential complications, and expected wound healing, aligning with established standards in the literature. The proposed sphenoidotomy types are as follows: 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 for these techniques, we aim to enhance consistency in terminology for teaching, surgical planning, clinical research, and interdisciplinary communication in sphenoid sinus surgery.