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02 Uncinectomy and Middle Meatal Antrostomy

  • Gently medialise the middle turbinate with a Freer elevator.

  • Perform an inferior cut through the uncinate process with back-biting forceps – 2 or more bites may be necessary.

  • Perform a superior cut through the uncinate with either the back-biting forceps or a sickle knife.

  • Fracture the uncinate process forwards with a double right angle ball probe.

  • Amputate the uncinate process with either 45º thru-cut forceps or a 2mm Kerrison punch.

Note:

Incomplete uncinectomy is the leading cause of failure to identify the natural maxillary sinus ostium.

  • Identify the natural ostium of the maxillary sinus, using a 30º endoscope if necessary.

  • Place a double right angle ball probe into the ostium and gently fracture the inferior portion of the uncinate process away from the lateral nasal wall.

Note:

It is important not to create a false opening into the maxillary sinus by placing the double right angled ball probe into the posterior fontanelle of the maxillary sinus ostium. An angled endoscope will allow you to confirm the opening of the natural ostium. It is also important to realise the uncinate process is not purely a vertical strip of bone. It is usually a curved bone, extending postero-inferiorly to the maxillary sinus ostium.