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Use of Rubens pillow in functional endoscopic sinus surgery

Published online by Cambridge University Press:  11 March 2010

O Mulla ,
F Agada  and
D R Strachan
O Mulla
Affiliation:
Department of ENT, Bradford Royal Infirmary, UK
F Agada
Affiliation:
Department of ENT, Bradford Royal Infirmary, UK
D R Strachan*
Affiliation:
Department of ENT, Bradford Royal Infirmary, UK
*
Address for correspondence: Mr D R Strachan, Consultant ENT Surgeon, Bradford Royal Infirmary, Bradford, BD7 9RJ, UK. E-mail: david.strachan@bradfordhospitals.nhs.uk
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Abstract

Functional endoscopic sinus surgery is a common procedure in almost all ENT departments. Commonly, a head ring is used for head support during this procedure. We believe that the Rubens pillow enables better head stability and provides a better operating surface for surgical instruments.

Keywords

Paranasal SinusesEndoscopyOtorhinolaryngologic Surgical ProceduresOperating Rooms

Information

Type
Short Communications
Information
The Journal of Laryngology & Otology , Volume 124 , Issue 11 , November 2010 , pp. 1200 - 1201
Copyright
Copyright © JLO (1984) Limited 2010

Introduction

Functional endoscopic sinus surgery (FESS) has evolved since the early days of Messerklinger, over 40 years ago, when the concept was introduced. Stammberger and Kennedy's further refinement of the technique has enabled FESS to become a common procedure, now performed for a variety of indications.

Procedure

Functional endoscopic sinus surgery is often performed under general anaesthesia, with the patient in a supine position and their head supported on a standard head ring in the reversed Trendelenburg position. The use of this head ring is important in FESS, as it aims to support the head to give some degree of stability during the procedure. However, such head rings have their drawbacks, including inadequate head stability in some patients, inadequate support for the cervical spine curvature, and lack of an adjacent flat surface alongside the head. The last issue is of particular relevance to those endoscopic surgeons who use a demisting pad when operating. Sterilisation drapes around the head and head ring tend to ‘tent up’ and move when pressure is applied to them, such as when a demisting pad is used to clean the endoscope (Figure 1).

Fig. 1

Standard head ring FESS setup illustrating use of demisting pad on uneven surface.

The Rubens pillow was first described by C Montague Ruben in 1959 as a ‘pillow with a central hollow which is 3 inches in depth, which has a firm lateral flat surface on either side for instruments or support’. It was introduced primarily for the benefit of ophthalmologists, as it gives very good stability to the head and allows surgeons to rest their wrists, thus limiting involuntary tremor.

Conclusion

One of the authors (DS) has been using the Rubens pillow as an alternative to the standard head ring for several years, and this has now become routine practice for all FESS procedures in our unit. The advantages include excellent head stability, additional cervical spine curvature support, and the provision of a firm, flat surface adjacent to the head even after sterilisation drapes have been applied. This provides a convenient location adjacent to the head for the demisting pad, which greatly reduces its tendency to move when an endoscope is being cleaned and ‘de-fogged’ (Figure 2).

Fig. 2

Rubens head ring FESS setup illustrating use of demisting pad on firm surface.

The Rubens pillow was first described by C Montague Ruben in 1959 as a ‘pillow with a central hollow which is 3 inches in depth, which has a firm lateral flat surface on either side for instruments or support’1.

The Ruben pillow is available in various sizes and is still widely used by ophthalmologists2.

Acknowledgement

The featured illustrations were prepared by Bex Chandelle.

References

1 Ruben, CM. Operation – table head – pillow. Br J Ophthalmol 1959;43:117CrossRefGoogle ScholarPubMed
2 Halliday, BL. A new surgical head rest. Br J Ophthalmol 1988;72:284–5CrossRefGoogle ScholarPubMed
Figure 0

Fig. 1 Standard head ring FESS setup illustrating use of demisting pad on uneven surface.

Figure 1

Fig. 2 Rubens head ring FESS setup illustrating use of demisting pad on firm surface.