Since the mid-1980s to 1990s, modern nasal endoscopic surgical techniques have been flourishing in China, and nasal endoscopic surgery, with chronic sinusitis and nasal polyps as the main treatment objects, has contributed to a marked improvement in the diagnosis and treatment of many diseases in otorhinolaryngology-head and neck surgery, and related monographs have been published. All major and medium-sized hospitals in China have successfully carried out nasal endoscopic surgery, with a large number of cases of over 6000. Recently, there are reports of successful removal of nasopharyngeal fibrovascular tumors, giant skull base and lateral skull base cysts using nasal endoscopy under general anesthesia with controlled hypotension. Along with the deepening of basic and clinical research of nasal endoscopic sinus surgery, the technology of nasal endoscopic surgery has rapidly developed and matured, whether it is endoscopic sinus surgery (ESS) or functional endoscopic sinus surgery (FESS), its connotation is richer than before. The scope of application has been extended to all fields of otorhinolaryngology-head and neck surgery (including nasal, ophthalmic and cranial related surgery), which has promoted the further development of the discipline as a whole. The connotation of nasal endoscopic surgical techniques Based on the results of pathophysiological studies of nasal polyps in chronic sinusitis, scholars have proposed the concept of functional nasal endoscopic sinus surgery and developed a series of different procedures, which have significantly improved the clinical treatment of chronic sinusitis. However, it was also found that: (1) the basis and criteria of “reversible mucosal recovery” are unclear and “reversible recovery” cannot be guaranteed by surgery alone; (2) it is difficult to determine the selection of diseased mucosa during surgery; (3) the regenerated mucosa often loses its normal function; (4) the sinus-to-sinus septum is often Most of the sinus cavities are enlarged and opened to merge with the nasal cavity, so the use of “functional” nasal endoscopic surgery can no longer accurately express the meaning of this surgical technique. For this reason, in the treatment of chronic sinusitis and nasal polyps, the concept or connotation of nasal endoscopic surgical technique should be: the surgical technique to remove the lesion, improve and reconstruct the nasal cavity and sinus ventilation and drainage channels and preserve the basic structure of the nasal cavity and sinus as much as possible under direct observation of the nasal endoscope in order to achieve a cure. The contents include: ① nasal endoscopic surgery under TV surveillance; ② removal of nasal cavity and sinus lesions, restoration or reconstruction of sinus drainage channels; ③ mucous membrane preservation and structural reconstruction; ④ postoperative follow-up and comprehensive treatment. The above is called nasal endoscopic surgery (NES). The concept of functional nasal endoscopic surgery should be used as the basic principle of surgery throughout the surgical operation and management. Comprehensive scholars’ review, nasal endoscopic surgery techniques should include the following parts: ① endoscopic nasal surgery: such as nasal endoscopic management of refractory rhinorrhea, correction of nasal septum deviation, posterior nostril atresia, anterior septal nerve dissection, pterygoid nerve dissection, adenoidectomy and nasopharyngeal lesion removal, etc.; ② endoscopic functional nasal and sinus surgery: such as nasal endoscopic anterior sieve, maxillary sinus (2) endoscopic nasal cavity and sinus functional surgery: such as endoscopic anterior sieve, maxillary sinus, frontal sinus opening, endoscopic sieve sinus, pterygoid sinus opening and whole sinus opening, etc.; (3) endoscopic nasal-eye related surgery and skull base surgery: such as endoscopic lacrimal sac rhinostomy, orbital decompression, optic nerve decompression, cerebrospinal fluid nasal leak repair, nasopharyngeal hemangiofibrosarcoma resection and pituitary tumor resection, etc. Extension of nasal endoscopic surgical techniques Since most of the organs belonging to otorhinolaryngology-head and neck surgery are deep, with narrow lumen, delicate anatomy and complex structure, it brings many inconveniences to clinical observation and treatment. Over the years, many scholars have made unremitting efforts to find methods to be able to peer into deep sites, and at the same time, the benefits of preserving the original nasal cavity and sinus mucosa and structures as much as possible to improve the efficacy have been noted in traditional surgery, and the germ of modern sinus surgery techniques have been birthed in operation and treatment. Due to the related anatomy, pathophysiology, imaging and other research continue to make new progress, promote the application field of nasal endoscopic surgical techniques continue to extend, and to a certain extent update the treatment means of ophthalmology and skull base surgery. 1, nasal cavity, sinus invagination papilloma and other benign occupying lesions, the use of transnasal endoscopic surgical excision, avoiding the traditional nasal lateral incision on the normal anatomical structure of the nasal cavity, sinuses, leaving the disadvantages of facial scarring, surgical efficacy and traditional surgery is not statistically different. 2.Nasal neurosurgery and nasal skull base surgery: Traditionally, nasal nerve and skull base diseases are mostly handled by neurosurgery, which is restricted by the surgical route and destruction of adjacent organs and structures, and cannot solve the problems of nasal cavity and sinuses. With the application of nasal endoscopic surgical techniques, precise observation and less damage are possible, and surgical treatment of deep lesions in the area becomes possible. For example, huge skull base and lateral skull base cysts are opened via nasopharyngeal nasal endoscopy, which simplifies the surgical pathway and operation. Cerebrospinal fluid nasal leakage used to require cranial opening for repair, which is a high surgical risk. With accurate localization, transnasal endoscopic repair with temporalis fascia is precise, safe and reliable, and has become the main treatment for cerebrospinal fluid rhinorrhea. Our hospital has successfully repaired 45 cases of cerebrospinal fluid rhinorrhea by nasal endoscopy in one stage. 3.Nasal-eye related surgery: Due to the anatomical inseparability of nasal-eye (cranial) and the formation of cross-complementary disciplines, nasal endoscopic lacrimal sac rhinostomy is completed, and the operation is simple and short, avoiding facial incision and injury to the medial canthal ligament. The yield rate is 90%. Previously, the pathway of optic nerve decompression surgery was mostly performed through a lateral nasal incision, which often required ligation of the anterior and posterior sieve arteries. The projection of the optic nerve on the lateral wall of the sinus is located at the junction of the butterfly and sieve and the lateral wall of the pterygoid sinus, and the sinus is only separated by a thin bone plate, so the endoscopic decompression of the optic nerve reflects the advantages of direct vision and precision of endoscopic surgery. 4.Head and neck tumor surgery: the application of nasal endoscopic surgery to treat head and neck tumors, including benign and malignant aspects, benign tumors are mainly nasopharyngeal angiofibroma and sinus ossification fibroma, etc., conventional surgery such as through the hard palate or nasal side incision has a large damage, postoperative complications and other problems. The treatment of nasopharyngeal angiofibroma using nasal endoscopic surgery technique and supplemented with arterial vascular embolization and controlled hypotension anesthesia has shown obvious superiority in terms of surgical trauma, postoperative functional preservation and follow-up. More than 20 cases have been treated surgically in our hospital, and the clinical cure rate can reach more than 90%. For malignant tumors such as nasopharyngeal carcinoma, the primary foci are mainly removed under the direct view of nasal endoscope, and the comprehensive treatment such as radiotherapy, chemotherapy and biotherapy has also achieved satisfactory results. Head and neck tumors, especially suspected malignant tumors of the nasal cavity and sinuses are treated with nasal endoscopy-guided sinus exploration surgery, which can solve 2 problems: ① clarify the diagnosis; ② open the sinuses, promote drainage, and help relieve sinus symptoms such as those after radiation therapy. For example, we have resected 4 cases of limited nasal olfactory neuroblastoma and 1 case of metastatic carcinoma by nasal endoscopic surgery, and then performed postoperative radiation therapy, with satisfactory results at 3-year follow-up. 5.Tumor resection in the butterfly saddle: entering the butterfly saddle through the nasal endoscopic sinus is quick, which greatly shortens the operation time; at the same time, the destruction and reconstruction of the nasal cavity, sinus and nasal septum during the incision and approach can be eliminated; the anatomical site and the scope of resected lesion can be accurately determined. In recent years, more than 10 cases of this operation were performed in our hospital, and the pituitary adenoma was removed more completely under endoscopic observation, and the normal pituitary gland was dissected out with satisfactory results. Some scholars in China also reported the successful operation of 16 cases of pituitary adenoma by applying nasal endoscopy and cryosurgery. In 1993, Mckennan performed nasal endoscopy with the assistance of nasal endoscopy for facial nerve decompression and commissurotomy, trigeminal sensory root selective excision, linguopharyngeal nerve and vestibular nerve excision, and auditory neuroma resection, which is considered the ideal method for objective evaluation of microvascular compression and nerve root surgery at the foot of the pontocerebellum. In 1993, Mckennan performed a posterior approach to the inferior occipital ethmoid sinus or a posterior vagal approach to the internal auditory neuroma, and found that the use of an endoscope had the distinct advantage of making the lateral portion of the internal auditory canal more visible to the operator without requiring extensive exposure of the internal auditory canal; no retraction of the cerebellum was required. As the terminal branch of the anterior inferior cerebellar artery, the internal auditory artery is the key to limiting auditory neuroma resection, and Rosenberg reported that the internal auditory artery could be clearly visualized with the endoscope, providing intraoperative protection of the internal auditory artery.Rosenberg applied the endoscope to perform a combined posterior vagal-sigmoid sinus approach for vestibular neurotomy and found that the lateral portion of the internal auditory canal and It was found that the endoscope could be used to visualize the lateral part of the internal auditory canal and the back of the VII and VIII cranial nerves, as well as the V cranial nerve and the IX, X and XI cranial nerves into the jugular foramen, and to determine the position of the VII and VIII cranial nerves and the internal auditory artery in the pontocerebellar horn region and the internal auditory canal. 7.Orbital decompression and optic canal decompression: In 1988, Kennedy pioneered the transnasal approach to orbital decompression under nasal endoscopy and reported the initial experience of 8 cases (13 sides) of orbital decompression; it is believed that transnasal endoscopic surgery has the advantages of small scope of injury, good efficacy and few complications. In 1996, Griffith reported 2 cases of cholesterol granuloma involving the middle cranial fossa tip via nasal endoscopic surgery of the pterygoid sinus, which had the advantages of fewer complications, less injury, preservation of hearing and vestibular function, and good cosmetic effect compared with the middle cranial fossa pathway of the House, and the illumination and magnification of the operative field were better than the external incision pathway, and the postoperative treatment and observation were also The postoperative management and observation are also convenient. In conclusion, today, with the increasing maturity of nasal endoscopic surgery, the scope and field of its application is expanding to almost the entire otorhinolaryngology-head and neck surgery, and extending to the skull base, lateral skull base and nasal-eye related surgery. The extension of this technology reflects the own advantages of nasal endoscopic surgical technology, i.e., the maximum preservation of the structure and function of the organ with precise and complete removal of the lesion, reflecting the future direction of minimally invasive surgical technology. At the same time, it should also be noted that nasal endoscopic surgical technique itself cannot replace all classical or traditional treatments, and the ability to skillfully and correctly apply nasal endoscopic surgical technique is the key in clinical practice.