In Reply.—Dr Lapidot appears to have several misconceptions about functional endoscopic sinus surgery. Dr Greenfield does deserve our recognition for his early and persistent advocacy of more accurate diagnosis in sinus disease, utilizing nasal endoscopy, sinuscopy, and multiplanar tomography, and for drawing our attention to the inaccuracies of routine sinus roentgenograms. However, the interpretation of significant findings, rationale for therapy, and surgical approach used by Dr Greenfield differ substantially from the approach described.
The technique that I have termed functional endoscopic sinus surgery was originally developed by Messerklinger based on a lifetime experience in nasal endoscopy and research in the field of mucociliary clearance, and initially utilized over a decade ago. The key to this technique is the accurate diagnosis of areas of ventilatory and mucociliary obstruction, usually in the ostiomeatal complex. No attempt is made to exenterate all disease from the secondarily involved sinuses, which usually improve spontaneously,