Advances in Endoscopic Sinus Surgery Technique: The Impact of Technological Breakthroughs

Messerklinger initially characterized sinonasal mucociliary clearance patterns in the 1950’s using India ink particles and hypothesized that inflammatory disease within the sinuses, as well as anatomic variants, could obstruct mucus outflow. He introduced use of the endoscope for diagnostic evaluation, as well as surgical principles known as the Messerklinger technique [1]. In the following 70 years his technique, known as Endoscopic Sinus Surgery (ESS), was refined and popularized by Stammberger, Kennedy, and others [2,3]. Both emphasized the preservation of normal anatomic structures and re-establishment of natural mucociliary clearance patterns. Towards that end, Kennedy viewed the surgery as a functional and minimally invasive procedure, adding the term “functional” to ESS, with the procedure now widely known as Functional Endoscopic Surgery (FESS) [4]. Since then, minimally invasive endoscopic techniques have been further refined by a multitude of talented multi-disciplinary physicians, too numerous to name here [5].