title: Five 'nontraditional' techniques for use in patients with recalcitrant sinusitis.
abstract: OBJECTIVE
  Although endoscopic sinus surgery remains the mainstay of surgical approaches to treating paranasal sinus disease, some disease may require alternative approaches. We review here five techniques: endoscopic middle turbinectomy, maxillary sinoscopy, the Caldwell-Luc procedure, intranasal inflammatory polyp steroid injection, and frontal sinus trephine.
  
  
  RESULTS
  Recent findings suggest that endoscopic sinus surgery is limited in certain cases to access particular anatomic sites that may contain disease. The anterior, inferior maxillary wall and the frontal sinus may be accessed externally with minimal morbidity, and this access may be critical to treating the disease. The middle turbinate can contribute to preoperative and postoperative obstruction of sinus drainage, and resection of it can benefit the patient in many ways. Finally, the management of intranasal inflammatory polyps remains a challenge. In both preoperative and postoperative patients, the polyps may not respond to standard and even aggressive topical therapies. Intrapolyp steroid injection can provide a substantial anti-inflammatory effect and may avoid surgery for some patients.
  
  
  CONCLUSIONS
  This article will review five ancillary procedures that add to the rhinologist's skill set to treat difficult or recalcitrant paranasal sinus disease.
authors.affiliation: Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee 37232-8605, USA. john.s.schneider@vanderbilt.edu
authors.forename: John S
authors.initials: JS
authors.lastname: Schneider
authors.forename: Alfredo
authors.initials: A
authors.lastname: Archilla
authors.forename: James A
authors.initials: JA
authors.lastname: Duncavage
mesh_terms: D004724:Endoscopy / Q000379:methods*; D006801:Humans; D009298:Nasal Polyps / Q000628:therapy; D011677:Punctures; D012852:Sinusitis / Q000628:therapy*; D013256:Steroids / Q000008:administration & dosage*; D014207:Trephining / Q000379:methods*; D014420:Turbinates / Q000601:surgery
chemical_list: D013256:Steroids