A glance at Thieme's catalogue reminds one just how much the company has published, in the last two years, covering transnasal approaches to the sinuses and skull base. There are many more reviews of such in the pipeline.
This book does stand out as different, in presenting a systematic approach to the skills and techniques learnt in cadaver dissection. Obviously, it is therefore aimed at the novice (and is ideally suited as an introduction), but even the more experienced can benefit from the later chapters, as the surgery gets more ambitious.
It is a relatively small book, and the first impression was of limited text, with many a blank page, whole pages (attractively, I admit) taken up with chapter titles, very large illustrations and large format, spaced printing.
An early brief chapter largely illustrates, rather than discusses, instrumentation. The next chapter was really eye catching, however, entitled ‘The 15 Commandments in Endonasal Endoscopic Surgery’. These are not thou shalt not kill, bear false witness or steal from thy patients, but instead range from patient positioning and holding of the endoscope to insertion into the nasal airway. Based on real, live patients, some of the commandments are particularly good; for example, that on relative simultaneous positioning of the endoscope and any instrument. Some are very basic indeed or repetitive, and I do wonder if the traditional 10 items might have sufficed. Nevertheless, this really did prove a praiseworthy and memorable style of instruction. I would like to have seen some videos here, but we do get plenty in the following chapters, as we move onto cadaver dissection.
The large colour illustrations, the diagrams and again those videos all combine to provide an excellent guide to surgery, ranging from uncinectomy to opening of the sphenoid sinus or even dacryocystorhinostomy. It is now that the text style (boxed points, many a numbered heading and well spread text) proves exactly right for what is a trainee's work manual. Surgery of the paranasal sinuses is as far as many will go in their subsequent career (at least intentionally anyway). The exercise, however, continues to the ventral skull base, with chapters entitled ‘Tips and Tricks’ and ‘Dissection of Vascularized Pedicled Flaps’ (a clever idea and very well presented).
The lengthy chapter on ‘Endoscopic Approaches in the Sagittal Plane’ had this otologist reviewer momentarily baffled, until ‘the penny dropped’. Just work front to back and keep to the midline until you almost see daylight, now that I understood. So it is that working in the coronal plane gets you out laterally, to allow orbital decompression, medial maxillectomy or surgery of the various skull base fossae.
The title is particularly well thought out. The text style does allow for very easy reading of the step-by-step approach. The colour illustrations are flawlessly reproduced and did need to be in the large format employed. The videos are not just the all too common padding and afterthought, but are an essential complementary tool. The final impression is of a skilled and enthusiastic trainer, and I would imagine the local cadaver dissection course is a masterpiece. I am probably the ideal reviewer for this book as I never did truly master endoscopic nasal surgery, despite much patient instruction from a trainee half my age, and I learnt much from this book. If only this had been published in the late 1970s or my trainee had not decided that a lifetime of rhinology in his native Cyprus was not (strangely) preferable to working in Middlesbrough.
