The rational of trans superior meatal posterior ethmoidectomy

Functional endoscopic sinus surgery has become the preferred surgery for a variety of sinonasal pathologies. Lesions confined to the posterior ethmoid sinuses or to the posterior sphenoethmoidal complex are usually treated by the conventional "anterior to posterior" approach. This procedure requires removal of the anterior ethmoids, which might impair the anatomical and functional integrity of the ostiomeatal complex (OMC). Here we describe our experience with an effective and minimally invasive surgical approach to treat these posterior lesions while preserving the OMC. Medical records of patients who underwent trans-superior meatal posterior ethmoidectomy or posterior sphenoethmoidectomy with OMC preservation during functional endoscopic sinus surgery between 2016 and 2021 were analyzed. Twelve patients were included in the study. Their diagnosis included sinusitis (5 patients), fungus ball (3), inverted papilloma (2), allergic fungal sinusitis (1) and mucocele (1). No intraoperative or postoperative complications occurred, and all patients recovered rapidly. Lesions confined to the posterior ethmoids or posterior sphenoethmoidal complex can be treated with trans-superior meatal posterior ethmoidectomy or posterior sphenoethmoidectomy.