Posterior Wigand approach endoscopic sinus surgery:
Posterior approach endoscopic sinus surgery was popularized by Wigand. This is actually a posterior to anterior approach. This approach is very useful in patients who have undergone previous nasal surgeries with very few intra nasal landmarks or distorted landmarks. In these patients a more consistent landmark needs to be identified before proceeding with the surgery.
The surgical technique used is more or less similar to the traditional ESS technique with a minor difference. First intranasal ethmoidectomy and sphenoidectomy is performed after identifying the anterior face of the sphenoid sinus. The sphenoid ostium is identified and the sinus entered. The choana is also identified. The skull base is followed anteriorly along the fovea ethmoidalis into the posterior and anterior ethmoidal sinuses. Working laterally the lamina papyracea is identified, and now the natural ostium of the maxillary sinus is also identified.
It is always better to start the dissection from a known region to other less easily recognized zones.