• Between the endonasal and transoral or Caldwell-Luc approach, the latter gained more popularity and became the preferred approach to the maxillary sinus due to better lighting and visualization.

• In the beginning of the 20th century (c 1900), Adolf Onodi and Hanau Loeb published “The nose: Paranasal sinuses, nasolacrimal passageways and olfactory organ in man,” an important work describing relational anatomy of the middle turbinate.

• Further discoveries in this era included that of Anderson Hilding and Malcolm King, who observed ciliary beating and its contribution to mucociliary transport in canine models.

Development of Endoscopic Access to the Paranasal Sinuses

• Philipp Bozzini (1773–1809), a German physician, developed the first endoscope for inspection of bladder, rectum, and pharynx using a device called a Light Conductor which consisted of an eyepiece and candle contained within a fully enclosed box.

• This was further modified by Nitze in 1879 into a small cystoscope for urologic examinations, which was subsequently adapted for use by Hirschman in 1901 to visualize the maxillary sinus via an oroantral fistula.

• A breakthrough was made in 1960 when Harold Hopkins of Imperial College, London, developed a fiber optic rod endoscope (Hopkins rod) for sinuscopy—the advantages of this design were largely increased lighting, visualization, and ease of use.

• Storz (Germany) developed this technology further and introduced angled scopes from 0° to 120° in the same design as a Hopkins rod.

• Hopkins rod endoscopes were then used to further understanding of the anatomy and physiology of the paranasal sinuses. This renewed scientific interest in the field of rhinology and transition surgical treatment of the sinuses away from radical open and frequently ablative surgery to more directed treatment aimed at opening ostia to enhance drainage and restore function via an endonasal approach.

The Concept of Functional Endoscopic Sinus Surgery

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