The ethmoid sinuses are shaped like a beehive and are composed of up to 22 smaller cavities or cells. When the anterior ethmoid sinuses are obstructed, typically the frontal and maxillary sinuses will not drain properly, because these two sinuses drain into the anterior ethmoid. This area is known as the ostiomeatal complex. The posterior ethmoid sinuses, if obstructed, can cause significant obstruction to drainage as well.
I specialize in treating patients whose previous sinus surgery has failed. I have found that one of the main causes of a surgical failure is that when the previous surgeon did not open all of the diseased cells in the posterior ethmoid. Retention of residual diseased cells on the lateral wall or the skull base, or failure to properly open the frontal, sphenoid, or maxillary sinuses when necessary can also lead to failure. Scarring in these areas can contribute to a failure, as well as recurrent polyps. It is important that the surgeon be meticulous about ventilating all of the necessary areas which contribute to the disease. Otherwise the surgery is doomed to fail.
There are many schools of thought today regarding which and how many of the ethmoid cells need to be opened. I believe in a conservative approach, preserving as much of the normal mucous membrane as possible while opening all of the obstructed pathways. There are others that call themselves “minimalists”; they believe that you have to open up only a few cells and the rest will take care of itself. Other surgeons will remove all of the mucosa of the ethmoid sinuses, performing a more traditional form of sinus surgery. And then there is the school that still performs a traditional surgery with endoscopic assistance. These surgeons usually remove normal tissue, such as the turbinates, to get better visualization. I come from the school where we are very conservative
with turbinate resection and try to preserve the normal tissue whenever possible.