BrazJOtorhinolaryngol.2015;81(3):231
www.bjorl.org
Brazilian
Journal
of
OTORHINOLARYNGOLOGY
EDITORIAL
Is
the
training
for
paranasal
sinus
surgery
really
effective
in
our
medical
residencies?
夽
O
treinamento
da
cirurgia
de
seios
paranasais
é
realmente
efetivo
em
nossas
residências
médicas?
SinceHirschmann introduced an endoscope intothe max-illary sinus through the canine fossa in 1901, there have been significant technological advances in this field, that haveaffectedparanasalsinussurgicaltechnique.However, 70 years elapsed, before Messerklinger and Draf, popu-larized endoscopic sinus surgery tothe extent that today theyarealmosttheexclusivesurgicaltechniquesforsinus surgery,andhave virtuallyreplacedopen techniques,also knownasclassicapproaches.
This presents a problem in the teaching offered by medicalresidencies,thatnowdedicatethemselvesalmost exclusivelytotheendoscopictechniquesandhaveforgone orliterallyforgottentotrainyoungsurgeonsintheso-called classic techniques. This is because the chief residents at mostotorhinolaryngologyresidencyprogramshavenotbeen adequatelytrainedinconventionalsurgicaltechniquesand arenotqualifiedtoteachtheclassicapproaches.
Thereisnodoubtthatproceduresperformedthroughthe endoscopicapproachhavegainedpopularity,notonlyin oto-laryngologybutalsoinotherareasofmedicine.Forinstance, wehaveobservedthesamephenomenonoccurringin video-laparoscopicsurgeries.Thefamousphrase‘‘greatsurgeons, largeincisions’’hasbeenreplaced,foratleasttwodecades, by small orifices, and due to its undeniable advantages, endoscopicsurgerycurrentlystandsasthemethodofchoice formostsurgeons.
In the current scenario, withhigh-definition video sys-tems and next-generation endoscopic instruments and equipment,thequestionis:does theopenorclassic tech-niquestillhaveaplaceinthesurgicalarsenalofparanasal sinus surgery? Surely, the answer is ‘‘yes’’, for it is not
夽 Pleasecitethisarticleas:StammAC.Isthetrainingforparanasal
sinussurgery reallyeffective inourmedicalresidencies?.Braz J Otorhinolaryngol.2015;81:231.
unusualthatendoscopicsurgeriesbecomeopen ones,due totechnicaldifficulties, insufficient or inadequate instru-ments, and even complications. For all these reasons, I believewe shouldresumeteachingandtrainingouryoung surgeonstoadd these classicalprocedures totheir arma-mentarium;otherwise,whentheopentechniqueisindicated or required, the young surgeon will have to call the ‘‘doctor,’’whomaynotbepresentorevenavailable.
Conversely, it is undeniable that surgery performed throughtheendoscopicapproachnotonlyhasrevolutionized sinonasalsurgical techniques,but hasalso become essen-tialinmanysituations.Eveninsimpleprocedures,suchas surgeryofthenasalturbinatesandseptoplasty, the endo-scopehasbecomeanextremelyusefultool.However,open surgical procedures still have their place; these include amongothers,punctureofthecaninefossa,the Caldwell-Lucprocedure, and the ‘‘midfacialdegloving approach,’’ which is particularly useful in the treatment of lesions locatedinthelateralregionofthefrontalsinus.
Conflicts
of
interest
Theauthordeclaresnoconflictsofinterest.
AldoC.Stamma,b aDepartmentofOtorhinolaryngologyandHeadandNeck
Surgery,UniversidadeFederaldeSãoPaulo(UNIFESP),São Paulo,SP,Brazil
bCentrodeOtorrinolaringologiadeSãoPaulo,Hospital
ProfessorEdmundoVasconcelos,SãoPaulo,SP,Brazil E-mails:cof@centrodeorl.com.br,astamm@terra.com.br
http://dx.doi.org/10.1016/j.bjorl.2015.03.002
