Diagnostic and Therapeutic Sinonasal Endoscopy in Pediatric Patients

Fifty years ago, the extracorporeal cold light and its transmission by glass fibers, along with the Hopkins rod lens system, were introduced. The development and application of these new technologies to upper airways allowed studying, understanding, and improving knowledge of the anatomy, physiology, and diseases of the nasal cavity and sinuses. In particular, some fundamental concepts of modern rhinology are based on endoscopic nasal findings and Messerklinger’s investigations of the pathophysiology of sinus mucosa. These studies radically changed traditional understanding of sinus inflammation and revolutionized its treatment using endoscopic conservative surgical management (Messerklinger, 1966, 1967, 1978). In the 1980s, Kennedy (Kennedy, 1985) first utilized this surgical technique in the United States and termed it functional endoscopic sinus surgery (FESS). At the beginning, the technique was performed only for treatment of rhinosinsusitis in adult patients. In following years, the surgical indications were extended to selected malignant neoplasms (Kennedy & Senior, 1997; Lund, 1997; Nicolai et al., 2009, 2011). Due to the good results observed by FESS, in 1990s the development of smaller endoscopes and instrumentation adapted for pediatric patients was encouraged. For the treatment of recurrent or chronic rhinosinusitis in children, favorable results were obtained with endoscopic surgery (Lusk & Muntz, 1990; Wolf et al., 1995). During subsequent years, other diseases of sinuses were treated successfully with a nasal endoscopic surgical approach (Triglia & Nicollas, 1997: Berlucchi et al., 2003, 2010; Woodworth et al., 2004; Nicollas et al., 2006; Durmaz et al., 2008; Al-Mazrou et al., 2009; Presutti et al., 2009; Nicolai et al., 2010). In this chapter, a description of endonasal diagnostic techniques and a brief report of sinonasal disorders that may be effectively treated by FESS in pediatric patients are presented. Finally, fundamental surgical steps and their relation between pediatric endoscopic sinus surgery (PESS) and facial growth is briefly discussed.