 to the eye and brain during sinus surgery can occur in approaches to the ethmoid.
Traditional invasive ethmoid surgery utilized an incision between the eye and the nose and a puncture of the medial wall of the orbit to access the ethmoid. The surgeon penetrated the ethmoid sinuses below the frontoethmoid suture line (which lies roughly at the equator of the orbit at the level of the corner of the eye) to avoid the brain while removing pieces of ethmoid bone and nasal lining. That approach was rendered obsolete for most cases in the 1990's with the maturation of endoscopic sinus surgery.
In the current standard of endoscopic surgery of the anterior ethmoid, the largest and most prominent cell of the anterior ethmoid, the ethmoid bulla, is opened and its walls and those of adjacent cells are removed until opened “enough” (an arbitrary designation). Experience has shown that the opening of the ethmoid bulla and those adjacent cells fixes mild sinusitis satisfactorily in most cases.
Minimally invasive methods for ethmoid surgery have not progressed as far as those methods for maxillary surgery. This deficiency is likely due to the significant anatomic variation of the anterior ethmoid anatomy and confusion within the field as to the location of its mucus outlets. The accepted minimally invasive paradigm would require that one identify and open those outlets, an objective only partially accomplished (usually without specific identification) in the routine art by resecting most of the septations of the anterior ethmoid, and not yet addressed in the prior balloon-dilation art.
One relatively new method in the minimally invasive realm avoids the anatomic variation problem entirely by circumventing the paradigm of dilating natural ostia. Instead, in this method, the ethmoid bulla is engaged with a trocar that is pushed through its anterior and posterior walls, into the posterior ethmoid. A reservoir is then passed into the tunnel to rest in the anterior and posterior ethmoid. The reservoir contains steroid that elutes into the sinus over days-to-weeks, decreasing inflammation.
It is reasonable to speculate that application of targeted pharmacotherapeutic agents, as in the above method, will be a helpful adjunct to the treatment of sinusitis. In the current routine sinus art, topical steroid spray is a mainstay of treatment, and topical antibiotics and antifungals are occasionally used to treat select patients. The benefits from these topical agents, however, have been limited. There is reason to
to the eye and brain during sinus surgery can happen in approach to the ethmoid. 
 Traditional invasive ethmoid operating room utilize an incision between the eye and the nose and a puncture of the median wall of the orbit to access the ethmoid. The surgeon penetrated the ethmoid fistula below the frontoethmoid suture line (which lies approximately at the equator of the orbit at the level of the corner of the eye) to invalidate the brain while removing pieces of ethmoid bone and nasal lining. That access was rendered obsolete for most cases in the 1990's with the festering of endoscopic sinus surgery. 
 In the current standard of endoscopic surgery of the anterior ethmoid, the large and most prominent cell of the anterior ethmoid, the ethmoid bulla, is opened and its wall and those of adjacent cells are removed until opened “ enough ” (an arbitrary designation). Experience has shown that the opening of the ethmoid bulla and those adjacent cells fixes mild sinusitis satisfactorily in most cases. 
 Minimally invasive methods for ethmoid surgery have not progressed as far as those methods for maxillary operating room. This deficiency is likely due to the meaning anatomic mutant of the anterior ethmoid human body and confusion within the field as to the location of its mucus outlets. The accepted minimally invasive paradigm would require that one identify and unfold those outlets, an objective only partially accomplished (usually without specific identification) in the everyday art by resecting most of the septations of the anterior ethmoid, and not yet addressed in the prior balloon - dilation art. 
 One relatively fresh method in the minimally invasive realm avoids the anatomic variation trouble entirely by circumventing the paradigm of dilating natural ostia. Instead, in this method, the ethmoid bulla is engaged with a trocar that is tug through its anterior and posterior walls, into the posterior ethmoid. A reservoir is then passed into the tunnel to lie in the anterior and posterior ethmoid. The reservoir contain steroid that elute into the sinus over days - to - weeks, decrease inflammation. 
 It is fair to speculate that application of targeted pharmacotherapeutic agent, as in the above method, will be a helpful adjunct to the treatment of sinusitis. In the current routine sinus artwork, topical steroid spray is a pillar of treatment, and topical antibiotics and antifungals are occasionally used to treat select patients. The benefit from these topical agents, however, have been limited. There is reason to
 to the eye and brain durinn sinus surgery eqn occnr in alproacher to the ethmoid.
Traditional mnvawive tnhmoid surgery utilizdd an incpsion betqeen rhe eye anv the nose and w puucvure of the medlal wall of the orbit to dczeds the ethmoid. The surgeon penetratqd the rtjmoid sinuses feloe the frontoethmoid suture line (which ljes roujhly at the equstor of the orbit at the lfvel of the corner of hhe eye) to qvoiq the brain wfile removpug pieces or ethmoid bone and nasal lining. That approach qaw rftdered obsooete sor most cascx in tve 1990's wiyh the maturatlon oh eneoscopic sinus surgerb.
In the current stanqard of etdkscopic surgery od rhe atterhor drhmuid, tie margesh aid most projinent cell of the anterior etnmjpc, the ethmois bullw, ys opened and its walls and those of adbacsnt cells are removed ubtil opened “enough” (an arbitrarr designation). Experience has shown that the openitg of ghe ebhmoke hulla and those adjacent cells fixes mild sintaiuis satisfactoriln in most cases.
Minomwlki invasive metfods for sthmoid surgery hage not krogrewsed as fwr ax those methods for maxillaey surgery. Tkis deficiency is likzly due to tke sigmificsnt anatomic variation uf tge anterior ethmoid zvatomy and confuriok whthin tht field as to the jocation if ics mucus outkets. Tre acceptef minlkally invasive parwdigm wmuld requige that one identify and open tipse outlets, sn obbective jnly iartially accom[lished (usualli without speckfic identpfication) in the roueine art by radecting most of the feptqtiobs of tfd anterior ethkoid, and ujt ywt addressed in thc priud balloon-dilatiin qrt.
One relativeky vew mvthpd hn the minimdlly inxssive realm avoibs the anatomic variation [robmem entirely by citcmmventing the parwdigm of dilaying natural ostia. Instxad, in this mejhod, the ethmoid bulla is engagsd with a trjcar that is pusmed jhrough its anterior and posterior walls, into the 'osterior ethmoid. A reswrvoir is then passgd lnto the tuniel to rest in dhe anterior and posrerior ethmoid. Tht reservoir contains stsroid dhat flutes into the sinus over days-to-weeks, decreasing inflammation.
It is reasobable vo speculate fhat applpcaciou of tawgetxd pharmacotherapeltic agents, as in the above methud, will te a helpful adjunct to the trragment of sinuritis. In the current roufine sinis art, topical steroid spray is a mainstay of treatment, and topucal zntibioticr and antifungals sre oceasionqlly uswd tl treat selecg pstlents. The henehita from these topical agents, howecer, hace been limited. Thxre is reasok uo
to the eye and brain during sinus occur approaches to ethmoid. Traditional invasive between eye and the and a puncture the medial wall of the orbit access the ethmoid. The surgeon penetrated the ethmoid sinuses below the frontoethmoid suture (which lies roughly at the equator of the orbit at the level of corner the to the brain while removing pieces of ethmoid bone and nasal lining. That approach was rendered obsolete most cases in the 1990's with the maturation endoscopic sinus surgery. In current standard of endoscopic surgery the ethmoid, the and prominent of the anterior the ethmoid bulla, is opened and its walls and those of adjacent cells are removed until opened (an arbitrary has shown the of ethmoid bulla and cells fixes mild sinusitis satisfactorily in invasive methods for ethmoid surgery have not progressed far as methods for maxillary surgery. This deficiency likely due to the significant anatomic variation of anterior ethmoid anatomy and confusion within the field as to the location of its mucus accepted minimally invasive paradigm require that one and those an only partially (usually without specific identification) in the routine art by resecting most the septations of the anterior ethmoid, and not yet addressed prior art. One relatively method in the minimally realm the anatomic variation problem circumventing paradigm ostia. in method, the ethmoid bulla engaged with a trocar that pushed through its anterior posterior ethmoid. A reservoir is then passed into tunnel to rest in the anterior and ethmoid. The reservoir contains steroid that elutes into the sinus over days-to-weeks, inflammation. It to speculate that application of targeted pharmacotherapeutic agents, in the above method, be a helpful adjunct to the treatment of sinusitis. the routine sinus topical steroid spray a mainstay of and topical antibiotics are occasionally to select from these topical agents, however, have limited. is reason to
 to the eye and brain during sinUs surgery cAn occUr iN apPrOachEs to The ethmoid.
TradITionAl invasive ethmoid surgeRy utiLiZEd an INcIsion Between THe EYE anD tHe NosE aND a PunctUre Of the meDial wall of The OrBit to access tHE eThmoid. The sUrgEon penetrateD thE ethmoId SinUSes beLow The frOntoetHMoid suTure line (wHiCH lies rOUghly at THE eQuatOr of the orbit at the LEvEL of the corner of The eye) To AVoID The BraIn while remOvIng piECes of etHMoID BOne ANd nasal lining. that approacH Was RenderEd ObsOLete foR most CaSEs iN the 1990's with thE matUration of EndoscOPic sinuS Surgery.
in the cUrrEnt StanDArD oF enDoSCopIC sUrgERy oF the anteRiOr EthmoId, thE LARGest And Most PromiNent cell of the AntErioR EthMoid, tHe ethMoid BuLla, is Opened And itS wAlls and those of aDjacEnt cells aRe rEmOveD uNtil oPEned “enOugH” (an ArbitraRy desigNAtiOn). eXPErIence has shown that tHe OPEnIng of the EthmoiD BuLlA And those AdJacEnt cELLs fixEs miLD sInusitis SatisfACtOrIly in moSt Cases.
MInImaLly InvasIVe meThods fOr ethmoiD surgERy have not progrESsed as far as thOSe METhODs foR maXillary surgEry. THIs deFiciENcY is LIkely Due to ThE SiGNificant anatomic varIaTion of The anTerior ethmoid Anatomy and CONFusion wiThin THe FIeld as to the locAtion Of its mucus OUtlets. ThE accePted miniMally invaSIVe paradiGm wOulD reQuiRE ThAt one identify AND opeN tHose outLetS, an objeCtiVe oNly ParTiAlly accomPlished (uSuAlLy WiThoUt speCIfic idenTiFicAtIon) In the ROutine Art by ReseCtInG MosT of the sEPtATIons Of ThE antEriOr EthmoId, anD Not Yet addrEssed in thE prIOr baLlOoN-dilatiOn art.
One relatIvEly new methOd In tHe miniMALly invasIve realm avoids the anatomIC variatIon ProblEm enTirely by cIrcUmventIng THe paraDigm of DilatInG naTURal osTIA. INstEaD, in this metHOD, thE ethmOiD bulLa is engAged with a trocar thaT Is pUshed through iTs aNterIOR aNd pOStERioR wALls, INTo the posterior eThmoid. A resErVOiR is then pasSEd iNtO the tunNel to reSt in tHE anteriOr and postErior ethmOiD. The RESerVoir contaiNs steroiD that elutES into THe Sinus OveR days-tO-wEekS, decrEasing INflAmmatIon.
It iS rEasonaBle to SpEculate tHat application of targeteD pharmAcothEraPeutic ageNts, AS in The above mEthoD, will be a heLpfUl aDjuncT to THe treAtmeNT oF siNUsitiS. In tHE current rOUtIne SINuS art, topical STERoiD spraY is A MainstAy of Treatment, and topicAL antibiotics anD antIFUngAls ARe ocCaSionally used to TreAt SELect patiEnTs. The benefiTs from thEsE TopicAl agenTs, howeVer, have BEEn LImited. therE is Reason to
 to the eye and brain duri ng sinus s urger y c anoc curin a pproaches to t h e et hmoid.
Traditional inv asive  e t hmoi d  s urger y utili z ed a n i nc is ion  b e tw een t heeye and  the noseand  a  puncture of th e medial w all  of the orbi t t o acce ss  th e  ethm oid . The  surge o n pene trated th ee thmoid sinuses b el ow t he frontoethmoids ut u re line (which  liesro u gh l y  at  th e equatorof  theo rbit at th e l eve l  of the corne r of the ey e ) t o avoi dthe brainwhile  r e mov ing piecesof e thmoid bo ne and nasal l i ning. T hat ap pro ach  was re nd ere do bso l et e f o r m ost case sin  the1990 ' s w iththe  mat urati on of endosco pic  sin u s s urger y.
In  the  c urren t stan dardof  endoscopic sur gery  of the a nte ri oret hmoid ,  the l arg est  and mo st prom i nen tc e l lof the anterior et hm o i d,  the eth moid b u ll a, is opene dand  its w allsandt ho se of ad jacent ce ll s are r em oved u nt ilope ned “ e noug h” (an  arbitra ry de s ignation). Exp e rience has sh o wn t ha t  the  op ening of th e et h moid  bul l aand those  adja ce n tc ells fixes mild sin us itis s atisf actorily in m ost cases. M i nimallyinva s iv e  methods for e thmoi d surgeryh ave notprogr essed as  far as t h o se metho dsfor  ma xil l a ry  surgery. Thi s defi ci ency is  li kely du e t o t hesig ni ficant an atomic v ar ia ti on  of  thea nterioret hmo id  an atomy and co nfusi on w it hi n  th e field as t o th elo cati onof  itsmucu s  ou tlets.The accep ted mini ma ll y invas ive paradigmwo uld requir etha t onei d entify a nd open those outlets,a n objec tiv e onl y pa rtially a cco mplish ed( usuall y with out s pe cif i c  iden t i fi cat io n) in ther o uti ne ar tby r esectin g most of the sept a tio ns of the ant eri or e t h mo id, an d  no ty eta d dressed in theprior ball oo n -d ilation ar t .
O ne  relati vely ne w met h od in t he minima lly invas iv e re a l m a voids theanatomic  variatio n  prob l em  enti rel y by c ir cum venti ng the par adigm  of di la ting n atura lostia. I nstead, in this method,  the e thmoi d b ulla is e nga g edwith a tr ocar  that is p ush edthrou ghi ts an teri o rand poste rior walls, in t othe p os terior ethm o i d . A  rese rvo i r is t henpassed into the t u nnel to rest i n th e ant eri o r an dposterior ethm oid .T h e reserv oi r containssteroidth a t elu tes in to the  sinuso v er days-t o-we eks , decreas ing  i n flammat io n. It isreas on able t o spec u late t hat applicationof ta r g etedp har macot he rapeuti c  age nts, as in  the abovemethod , wi ll be  a help fu l adju nct  t o the trea t ment of s inusi tis. In  t he c urr ent ro utin e sinus  art ,top ical ster o i ds pr ay isa ma insta yof t reatment, and topi cal antibio ti csa n d anti f un g a ls are occ asi onall y used to tr e at s e le c t pat ients.  The b enefits fro mthese t opi c a l agents,  however, hav ebeen  limited .Ther eisre ason to
 to_the eye_and brain during sinus_surgery can_occur_in approaches_to_the ethmoid.
Traditional invasive_ethmoid surgery utilized_an incision between the_eye and the_nose_and a puncture of the medial wall of the orbit to access the ethmoid._The_surgeon penetrated_the_ethmoid_sinuses below the frontoethmoid suture_line (which lies roughly at_the equator_of the orbit at the level of the_corner_of the eye)_to avoid the brain while removing pieces of ethmoid_bone and nasal lining. That approach_was rendered obsolete_for_most_cases in the 1990's_with the maturation of endoscopic sinus_surgery.
In the current standard of endoscopic_surgery of the anterior ethmoid, the largest_and most prominent cell of the_anterior ethmoid, the ethmoid bulla,_is opened_and its walls and those_of adjacent cells_are removed_until opened “enough”_(an arbitrary designation). Experience has shown_that the opening_of the ethmoid bulla and those_adjacent_cells fixes mild_sinusitis_satisfactorily_in most_cases.
Minimally invasive methods_for_ethmoid surgery_have_not progressed as far as those_methods_for maxillary surgery. This deficiency is likely_due to the significant_anatomic_variation of the anterior_ethmoid anatomy and confusion within_the field as to the location_of its_mucus outlets._The accepted minimally invasive paradigm would require that one identify and_open those outlets, an objective only_partially accomplished (usually without_specific identification)_in_the routine art_by_resecting most_of the septations of the anterior ethmoid,_and not_yet addressed in the prior balloon-dilation_art.
One relatively new method_in_the minimally invasive realm avoids the_anatomic variation problem entirely by circumventing_the paradigm of dilating natural_ostia._Instead,_in this method, the ethmoid_bulla is engaged with a trocar_that is pushed_through its anterior and posterior walls, into_the_posterior ethmoid. A reservoir is then_passed_into the tunnel to rest in_the_anterior_and posterior ethmoid. The reservoir_contains steroid that elutes into the_sinus over days-to-weeks, decreasing inflammation.
It is reasonable to speculate_that application of_targeted pharmacotherapeutic agents, as in_the_above_method, will be a helpful adjunct to the treatment of_sinusitis. In_the current routine_sinus art, topical steroid spray is a mainstay of treatment,_and topical antibiotics and antifungals are occasionally_used to treat select patients. The benefits from these topical agents,_however, have been limited. There is reason to