By Werner Hosemann, J Fanghänel
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Extra info for A Dissection Course On Endoscopic Endonasal Sinus Surgery
Elevate the mucosal flap by incising the inferior bridges of tissue. Partially resect the anterior and lateral portions of the head of the turbinate. • Return the mucosa and if necessary outfracture the body of the turbinate with the blunt end of the double-ended elevator. 15 Dissection of the Medial Orbit A medial maxillectomy may be indicated for tumor resections. It involves creating a maximum communication between the nose and maxillary sinus, extending from the nasal floor to the orbital floor and from the anterior wall to the posterior wall of the maxillary sinus.
The vertical lamella of the middle turbinate can now be resected. Identify the cribriform plate and the lateral wall of the olfactory fossa, which is usually thin. Explore the site where the anterior ethmoidal artery enters the olfactory fossa (frequent dehiscences, see above). " Then cover the perforation with a small flap of autologous mucosa. • Now incise the periorbita: first incise the periorbita from posterior to anterior, making several passes with the knife (Fig. 41). The posterior-to-anterior cut is advantageous in vivo for keeping fat from herniating into the visual field.
2000). The anterior ethmoid and the agger nasi show varying degrees of anterior extension in relation to the lacrimal Fig. 33 Anatomy of the lacrimal drainage system. passages. In almost half of cases, the surgeon cannot avoid opening anterior ethmoid cells when thoroughly exposing the lacrimal sac (Talks and Hopkisson 1996). The lacrimal bone is usually only about 100 u thick in the area of the lacrimal sac, making it highly vulnerable (Hartikainen et al. 1996), especially during anteriorto-posterior dissection in the middle meatus.
A Dissection Course On Endoscopic Endonasal Sinus Surgery by Werner Hosemann, J Fanghänel