Purpose of review: The technologic cornerstones of endoscopic sinus surgery initially rested on the endoscope and CT scanning. In the mid-1990s, the advent of powered instrumentation, in particular the microdebrider, advanced the surgeon's ability to treat polypoid disease, sinus and nasal disease in a bleeding field, choanal atresia, antral choanal polyps, and inferior turbinate hypertrophy. This review evaluates both positive and negative tissue effects secondary to powered instrumentation.
Recent findings: Recent reports of deleterious outcomes with powered instrumentation require a reevaluation of the role of powered instrumentation and consideration of factors that lead to injury. The rapidity of injury makes the powered instrument especially dangerous in inexperienced hands. One third of participants in a recent survey were unaware that powered instruments could be involved in orbital injury and half were unaware that cranial injuries could be secondary to powered instrumentation.
Summary: Microdebriders will continue to advance the field of endoscopic surgery, providing clearer operative fields and causing less tissue trauma in experienced hands. However, the severity of complications, including the potential for rapidly aspirating orbital and cerebral contents when laminae are violated, must be appreciated and respected.