Endoscopic sinonasal dissection guide by Roy R. Casiano

By Roy R. Casiano

Endoscopic Sinonasal Dissection advisor demonstrates the main correct options that let citizens to securely navigate the complicated anatomy of the nostril and paranasal ...

summary: Endoscopic Sinonasal Dissection advisor demonstrates the main appropriate recommendations that let citizens to securely navigate the advanced anatomy of the nostril and paranasal

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The tip of the forceps, or opening of the microdebrider cannula, should always be pointed superomedially, parallel and adjacent to the medial orbital wall, to avoid inadvertent orbital penetration (Fig. 25). ■ Posterior Ethmoidectomy Key Landmarks (Fig. 26) ■ Transitional antrostomy ridge ■ Middle turbinate basal or ground lamella 5 cm from the columella ■ Horizontal line from the posterior MOF to the posterior nasal septum ■ Ethmoid roof (fovea ethmoidalis) The posterior ethmoid air cells may be entered safely through the most horizontal portion of the middle turbinate basal or ground lamella (Fig.

4. the lamina papyracea 5. the nasal septum 6. the arch of the posterior choana Using these landmarks, revision endoscopic sinus surgery (ESS) for recurrent or persistent disease in the maxillary, ethmoid, sphenoid, or frontal sinuses can be safely performed. May was one of the first to acknowledge that in advanced sinus disease anatomical landmarks, such as the uncinate process, basal lamella, and superior or middle turbinates are not always readily identifiable. He was also one of the first to point out that the floor of the orbit, as seen through an antrostomy, serves as a consistent landmark from which other structures may be found.

The MOF helps in maintaining the surgeon oriented in the correct anteroposterior trajectory as he/ she proceeds with the ethmoidectomy toward the sphenoid sinus (Figs. 19A,B). 34 CHAPTER 5 ■ Basic Endoscopic Sinonasal Dissection A B Fig. 19 (A,B) Transantral view looking medially (left side). CHAPTER 5 In the absence of any “normal” ostiomeatal complex landmarks, or when there is difficulty identifying the natural ostium of the maxillary sinus, the maxillary sinus should be entered through the posterior fontanelle, superior to the posterior one-third of the inferior turbinate.

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