Boezaart Grading System in Endoscopic Sinus Surgery
The Boezaart grading system is a 5-point scale (0-5) used to assess the quality of the surgical field during functional endoscopic sinus surgery (FESS), with scores ranging from 0 (minimal bleeding, excellent field) to 5 (severe bleeding, poor visualization). 1, 2
Grading Scale Structure
The Boezaart scale provides real-time assessment of surgical field quality during FESS:
- Score ≤2 is defined as a "clean surgical field" with acceptable visualization for safe surgical dissection 1
- Higher scores (3-5) indicate progressively worse bleeding and compromised surgical field quality 2, 3
- The scale is used to evaluate the surgical field at regular intervals (typically every 15 minutes) throughout the procedure 3, 4
Clinical Application
This grading system serves as an objective measure to compare different anesthetic techniques and interventions aimed at reducing intraoperative bleeding:
- Studies comparing total intravenous anesthesia (TIVA) versus inhalational anesthesia demonstrate that TIVA produces significantly superior Boezaart scores (better surgical field visibility) 5
- Interventions like desmopressin premedication (40 μg intranasal) have been shown to improve Boezaart scores, with patients having approximately 2 times higher probability of achieving good surgical field scores compared to placebo 1
- Patient positioning, specifically 15° reverse Trendelenburg position, significantly improves Boezaart scores (median 1.7) compared to horizontal positioning (median 2.0) 3
Practical Significance
The Boezaart grading system directly impacts surgical safety and efficiency by providing standardized assessment of the operative field: