There are left, right, and intermediate "back-biters". It is best to have the left and right ones, otherwise the handle of the instrument can hit the light attachment of the endoscope as the operator tries to get it in the correct position. The back-biting blade is best introduced closed for undertaking an uncinectomy and then the end of the instrument rotated into the middle meatus under the middle turbinate. The instrument is then rotated and its blade is opened almost vertically, just posterior to the edge of the uncinate process. The blade can then be slipped behind the uncinate process and rotated down into the infundibulum. It is possible to take two to three bites with these back-biters before they need to be removed and cleaned (Fig. 10.18a, b).
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