New Innovation in Endoscopic Approach to The Uncinate Process â??Rafidain Techniqueâ?

The endoscopic uncinectomy is considered as a crucial surgical step to perform endoscopic middle meatus antrostomy therefore there are different surgical techniques to do endoscopic uncinectomy. However, most common surgical approaches are Stammberger classical technique and Swing-Door technique which was introduced by Professor P.J.Wormald in 1998. This is a single center prospective study to emerge an alternative surgical approach “Rafidain technique” to perform simple, safe uncinectomy for 20 patients in Al-Mawani Teaching Hopsital. The purpose of this study is to create a new simple, safe endoscopic uncinectomy in comparison to current surgical techniques. Different endoscopic uncinectomy techniques: The endoscopic sinus surgery begins with uncinectomy to continue with middle meatus antrostomy which either by sickle knife which is inserted in the soft attached end of the UP in the lateral wall of the nose then by using Zurich Scissors (from Karl Storz, Nasal Scissors, Zurich model) we can cut the inferior and superior ends of the UP and it can be removed by Blakesely forceps. This technique has some risk of lamina papyrecea injury (2%), ethmoidal sinus injury and missing of the natural maxillary sinus ostium while the other technique is swing door technique which is performed by using backbiting forceps after insertion of the forceps in the ethmoidal infundibulum and cut inferiorly and superiorly then removes the UP. The last technique has also risk of nasolacrimal injury especially when there is a dehiscence of the nasolacrimal duct. Alternatively, there are other options for uncinectomy such as using the shaver system or via Hajek punch forceps. Rafidain Technique: In this new approach we can perform the endoscopic uncinectomy in a retrograde manner by using special instrument which is invented to this purpose. The instrument has two ends, one end is a malleable ball tip seeker and the other end is a sharp malleable knife which is designed to cut the UP in its posterior surface.

Author(s): Rafid Yaseen Jabbar

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