polypi intranasal ethmoidectomy is rarely performed because access is limited
and adequate drainage of the labyrinth of cells is not easily achieved.
External ethmoidectomy is recommended for chronic infection of the
ethmoidal sinuses with evidence of complications, usually an extension into
the orbit. It is also performed for frequent recurrences of nasal polypi which
are not controlled by simple removals and when a more radical cure is
desirable. The standard operation is through an incision around the inner
Fig. 35. Radical frontal operation. A, Incision. B, Opening of frontal sinus. C, Ethmoidal cells
opened and drainage into nose created.
canthus through which the ethmoidal labyrinth is reached and the cells
exenterated ensuring a wide drainage into the nasal cavity. The incision is
closed and the stitches removed in a week. The after-treatment is that of
external frontal sinus operation.
The Patterson operation is an external ethmoidectomy in which the
incision starts near the inner canthus and extends downwards and laterally in
the natural fold between the lower eyelid and the cheek, thus achieving an
almost invisible scar. The exposure of the ethmoidal cells is claimed to be
much wider than in the standard approach.