A systematic review of common landmarks in navigated endoscopic sinus surgery (NESS)

Figures & data

Table 1. Papers discussing surgical accuracy and landmarks in FESS and NESS.

Paper bibliographic details	Area of investigation
Baudoin T, et al. Algorithm for navigated ESS. Rhinology, 2013.	NESS landmarks and accuracy
Diklić A, et al. Optimization of paranasal sinus CT procedure: Ultra-low dose CT as a roadmap for pre-functional endoscopic sinus surgery. Phys Med, 2020.	Surgical accuracy in FESS
Bewick J, et al. Anatomic findings in revision endoscopic sinus surgery: Case series and review of contributory factors. Allergy Rhinol (Providence), 2016.	Surgical accuracy in FESS
Levine CG, et al. Revision Functional Endoscopic Sinus Surgery. Otolaryngol Clin N Am, 2017.	Surgical accuracy in revision FESS
Dixon BJ, et al. Three-dimensional virtual navigation versus conventional image guidance: A randomized controlled trial. Laryngoscope, 2016.	Surgical accuracy
Ahmadian A, et al. A region-based anatomical landmark configuration for sinus surgery using image guided navigation system: a phantom-study. J Craniomaxillofac Surg, 2014.	Image-guided accuracy in FESS
Oakly GM, et al. Utility of Image-Guidance in Frontal Sinus Surgery. Otolaryngol Clin N Am, 2016.	Radiologic accuracy in FESS
Hilger AW, et al. Sagittal computerized tomography reconstruction of the lateral nasal wall for functional endoscopic sinus surgery. Clin Otolaryngol Allied Sci, 1999.	Radiologic accuracy in FESS
Jolly K, Kontogiannis T, Pankhania M, Hussain K, Naik PP, Ahmed SK. Use of the medial canthal point (MCP) as a reliable anatomical landmark to the frontal sinus. Laryngoscope Investig Otolaryngol. 2020;5(5):791–795.	Surgical accuracy in FESS
Bolger WE, Stammberger H, Ishii M, Ponikau J, Solaiyappan M, Zinreich SJ. The Anterior Ethmoidal “Genu”: A Newly Appreciated Anatomic Landmark for Endoscopic Sinus Surgery. Clin Anat. 2019;32(4):534–540.	Surgical accuracy in FESS
Walgama ES, et al. The Horizon Sign and Frontal Bar: Two Topographic Landmarks to Confirm Endoscopic Frontal Sinusotomy. Otolaryngol Head Neck Surg, 2019.	Surgical accuracy in FESS
Abdullah B, et al. Is orbital floor a reliable and useful surgical landmark in endoscopic endonasal surgery? A systematic review. BMC Ear Nose Throat Disord, 2018.	Surgical accuracy in FESS
Dedhia RD, et al. Posterior Maxillary Sinus Wall: A Landmark for Identifying the Sphenoid Sinus Ostium. Ann Otol Rhinol Laryngol, 2019.	Surgical accuracy in FESS
Beswick DM, et al. The Utility of Image Guidance in Endoscopic Sinus Surgery: A Narrative Review. JAMA Otolaryngol Head Neck Surg, 2020.	Surgical and Image Guided Surgery accuracy in FESS

Figure 1. Four navigational units: (1) OMC unit; (2) Anterior ethmoid unit; (3) Posterior ethmoid unit; and (4) Sphenoidal unit.

Figure 2. Seven reliable landmarks in NESS: (1) Maxillary sinus ostium; (2) Any point on the orbital wall; (3) Frontal recess; (4) Any point on the skull base; (5) Ground lamella; (6) Fovea posterior; and (7) Sphenoid sinus ostium.

Figure 3. A 3D CT reconstruction highlighting the seven landmarks.

Table 2. A list of seven reliable landmarks in NESS.

The seven most reliable landmarks
1.	Maxillary sinus ostium
2.	Any point on the orbital wall
3.	Frontal recess
4.	Any point on the skull base
5.	Ground lamella
6.	Fovea posterior
7.	Sphenoid sinus ostium