By Stilianos E. Kountakis, T. Metin Önerci
This unmarried quantity surgical atlas-like booklet comprises special descriptions of recent surgical ideas in rhinology and sleep apnea surgical procedure. Chapters are contributed by means of surgeons with huge event, who've already released at the particular technique defined. every one bankruptcy comprises diagrammatic or illustrative descriptions of surgical recommendations, and offers suggestions for heading off issues whilst the systems are played. This accomplished paintings serves as a worthwhile source for otolaryngologists in education to enhance their surgical schooling and for training otolaryngologists as a overview resource to top technique the surgical pathologies they come across of their perform of rhinology and therapy of sleep apnea.
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The availability and use of angled telescopes in the office for postoperative debridements is at least as important as their operative use. Finally, the use of reverse light post endoscopes is advantageous during frontal sinus surgery. A reverse endoscope is one that has the light cord attachment, “the post,” pointed up when in use, 180° from its usual location. This allows the light cable to attach on the superior aspect of the endoscope, thereby freeing up more space underneath the telescope for the surgeon to manipulate other instruments.
The frontal sinus drainage pathway has an hourglass shape, and opens in the nose at the level of the frontal recess (Fig. 6). The narrowest point of this tract is called the frontal infundibulum or ostium, and is located at the most inferomedial aspect of the sinus. The frontal ostium is bounded by: The roof of the agger nasi anteroinferiorly The roof of the bulla ethmoidalis or suprabullar cells posteriorly The lamina papyracea laterally The lamella of the middle turbinate anteriorly If the bulla ethmoidalis does not have an anterior insertion on the skull base, the frontal recess communicates with the suprabullar recess [20], and depending on the anterior insertion of the uncinate process, the frontal recess will drain medial or anterior to the uncinate (when it inserts on the lamina papyracea) and lateral or posterior to the uncinate into the anterior ethmoid (when the uncinate inserts on the skull base or on the middle turbinate) [13].
Coronal view of the olfactory clefts and fossae, in a plane transecting the ethmoid bullae. The arrow measures the length of the lateral lamella of the cribriform plate, defining the type of olfactory fossa according to Keros. Note the insertion of the basal lamella of the middle turbinate on the cribriform plate, as well as the relatively thicker fovea ethmoidalis lateral to the cribriform plate. The intracranial bony spur that continues the septum corresponds to the crista galli. In most of the cases, the cribriform plate is symmetrical, however, an asymmetric skull base is an anatomical variant that should be recognized on a preoperative CT scan Fig.