A Comparative Study of Two Different Uncinectomy Techniques: Swing-Door and Classical

Introduction: The aim of this study was to determine which technique of uncinectomy, classical or swing door technique.  Materials and Methods: Four hundred eighty Cases of sinusitis were selected and operated for Functional Endoscopic Sinus Surgery (FESS). Out of these, in ۲۴۰ uncinectomies classical uncinectomy was done whereas in another ۲۴۰ uncinectomies swing door technique was used. Initially patients were medically managed treated according to their symptoms and prior management. Patients who had received previous adequate medical management were evaluated with CT scan of the sinuses. If disease still persists than they were operated for FESS. Results: The authors' experience indicates that Functional endoscopic sinus surgery can be performed under local or general anesthesia, as permitted or tolerated. In this review classical technique was used in ۲۴۰ uncinectomies. Out of this, ethmoidal complex injury was noted in ۴ cases, missed maxillary ostium syndrome (incomplete removal) was reported in ۱۲ patients and orbital fat exposure was encountered in ۵ patients. As compared to ۲۴۰ uncinectomies done with swing door technique, incomplete removal was evident in ۲ cases and lacrimal duct injury was reported in ۳ cases. 'Evidence that underscores how this 'swing door technique' successfully combines 'the conservation goals of the anterior-to-posterior approach and anatomic virtues of the posterior-to-anterior approach to ethmoidectomy of the total ۴۸۰ uncinectomies operated. Out of which ۲۴۰ uncinectomies have been performed using the 'swing-door' technique. The ۲۴۰ uncinectomies performed using classical technique were used as controls. The incidence of orbital penetration, incomplete removal, ethmoidal complex injury and ostium non-identification was significantly less with the new technique. Three lacrimal injuries occurred with the 'swing-door' technique compared to no injuries with classical technique. Conclusion: The authors recommend swing door technique as it is easy to learn, allows complete removal of the uncinate flush with the lateral nasal wall and allows easy identification of the natural ostium of the maxillary sinus without injuring the ethmoidal complex