الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
Sinus surgery, in part, because of the critical anatomic relationships and surgical dangers and in part, because of a lack of knowledge of patho-physiology has always been controversial. The choice of an operative approach, either external or intranasal, has been one source of controversy. The extent of surgery has been another source of controversy. Use of rigid intranasal endoscope, while providing answers for many controversial questions, has raised many new areas of discussion. The initial instrumentation available for endoscopic sinus surgery consisted primarily of instruments without suction which tend to strip mucosa from the underlying bone (Blakesley’s forceps and cupped forceps). (Grab and tear) instrument. The introduction of suction forceps was an advance in this regard but not completes solution. Suction was not available for all instruments. The most significant development in addition to the suction forceps is the availability of thru-cutting instrumentation. Low profile heads and ergonomic designs in addition to convenient shapes which permit the goal of FESS. Fess goal should be to open the diseased sinus at the natural ostium and, whenever possible, to remove completely the underlying bony partitions in areas adjacent to chronic disease. The microdebrider system designed for simultaneous resection and evacuation of soft and bony tissues and fluids in otorhinolaryngology and head & neck surgical procedures (Xomed User Manual) Unlike conventional non powered suction instruments, sinonasal soft tissue shavers have the advantage of evacuating the tissue from the surgical site without the need to remove the instrument, providing potentially continuous suction of blood and secreted tissue from the field with the opportunity for improved visualization and precision and less frequent interruption during the procedure. Biopsy specimens, however a still obtained best with a conventional instrument. Another disadvantage of the shavers is that the feel of palpation one gets with a conventional instrument is lost. Smaller, lighter hand pieces are designed to return this important feed back to the surgeon. The description of a new technique provokes the question of whether that new technique provides a significant advance in methodology over the conventional; procedure i.e. is the new technique more effective & safer than the standard method? In this study we were aiming to evaluate the use of the Microdebrider as compared with standard functional endoscopic sinus surgical technique in management of chronic sinusitis. This study was conducted on 60 patients, 46 males and 14 females. Those subjects had an average age of 21.1 year old (Range from15 to 35 years). The average age for males was 21.7 years (Range 15-42 years) and for females was 19.75 years (Range 15-24 years) Those patients were classified into 2 groups, 30 subjects each. The 2 different surgical technique conventional functional endoscopic sinus surgery (FESS) & powered endoscopic sinus surgery (PESS) were used. We were using one technique for each group. Te powered endoscopic sinus surgery using microdebrider was performed for group II and conventional endoscopic sinus surgery using cold instrument standard technique was performed as described by Stammbeger for group I. Variables examined in both groups include amount of intra-operative bleeding, operative time, average time to healing, percentage of symptom free, post operative synechia formation, post operative lateralization of the middle turbinate, post operative ostial reocclusion, major complication. The real time suction offers better anatomical orientation & surgical precision. This thesis found that the group operated using Microdebrider shows significant difference in the following variants: faster healing time, shorter operative time with less operative bleeding. While there was no significant difference in postoperative synechia, ostial reocclusion, lateralization of the middle turbinate and percentage of symptoms relieve.