The use of nasal endoscopes and special surgical instruments for sinus surgery was pioneered by Austrian rhinologist Messerklinger in the early 1970s, hence the name Messerklinger Technique (MT). Initially, this technique consisted of operating on the sinuses on the basis of endoscopic examination of the nasal cavity and sinuses, with the aim of completely removing lesions in hidden areas of the sinuses, especially in patients with multiple nasal polyps, by relying on the wide view and refractive vision of the nasal endoscope. This procedure is known as Endoscopic Sinus Surgery (ESS). As the physiology of the nasal sinus mucosa and the pathophysiology of sinusitis and nasal polyps have been studied, attention has been paid to the importance of the anatomical structure of the nasal sinuses and the specific and nonspecific protective functions in the development and regression of sinusitis. Reliable experimental and clinical bases have been obtained and a series of brand new theories have been proposed in terms of mucus cilia transport function, mucosal secretion function, important role of middle turbinate, relationship between anatomical abnormalities and sinusitis and nasal polyp occurrence, and post-surgical regression of diseased sinus mucosa. Therefore, Kennedy, an American rhinologist, was the first to propose the concept of functional endoscopic sinus surgery in 1986.
The basic starting point of Functional Endoscopic Sinus Surgery (FESS) is to correct the anatomical abnormalities of the nasal cavity and sinuses, to open the sinus complex and sinus openings, to re-forge the ventilation and drainage of the nasal cavity and sinuses, and to preserve as much as possible the physiological functional units such as the mucosa and middle turbinates of the sinuses on the basis of complete removal of irreversible lesions. The basic principle of surgery is to create conditions to improve and restore the morphology and physiological function of the mucosa of the nasal cavity and sinuses in order to cure sinusitis. This view was recognized by the international rhinological community in the early 1990s and rapidly spread, leading more and more rhinosurgeons to abandon their accustomed radical surgical approach in favor of a small or limited procedure to address a wide range of sinus lesions.
The advantages of Functional Endoscopic Sinus Surgery (FESS) allow it to be used in pediatric sinus surgery, challenging traditional surgical concepts. It is now possible to perform procedures that were previously unattainable and is now pushing rhinology to new heights.