Alternative Surgical Techniques

Some workers have advocated finding the sphenoid sinus from a lateral to medial approach by going through the posterior end of the superior turbinate. This can be done, but it runs the potential risk of going through the skull base or damaging the optic nerve if

Fig. 5.74a Line diagram to represent the anterior aspect of the right sphenoid and posterior ethmoid sinuses. (1) Define the most posterior-superior-lateral part of the posterior ethmoid sinuses. (2) Move vertically downward and do not push through the back wall. (3) Move horizontally medially; it is at this point that the sphenoid sinus can safely be identified. b An-tero-medial view of the right sphenoid and posterior ethmoid sinuses.

Nerves Middle Turbinate

Fig. 5.74a Line diagram to represent the anterior aspect of the right sphenoid and posterior ethmoid sinuses. (1) Define the most posterior-superior-lateral part of the posterior ethmoid sinuses. (2) Move vertically downward and do not push

Superior TurbinateHypertrophied TurbinatesMost Posterior Sinuses Superior Turbinate

Fig. 5.75a, b The most superior-lateral-posterior aspect of the posterior ethmoid sinuses. c, d Move vertically downwards.

Posterior Ethmoid

Fig.5.75e, f Then move horizontally-medially where the rior wall of the posterior ethmoid sinuses can then be traversed sphenoid can safely be found and the sphenoid ostium opened safely and enlarged. It is important to preserve the superior as necessary. The instrument may fall into the sinus or gentle turbinate. pressure may be needed. g-j The medial aspect of the poste-

Fig.5.75e, f Then move horizontally-medially where the rior wall of the posterior ethmoid sinuses can then be traversed sphenoid can safely be found and the sphenoid ostium opened safely and enlarged. It is important to preserve the superior as necessary. The instrument may fall into the sinus or gentle turbinate. pressure may be needed. g-j The medial aspect of the poste-

Superior Ethmoid Turbinates

Fig.5.76a-d This shows how dangerous it is to puncture a posterior ethmoid cell laterally. The optic nerve (arrow) can be exposed laterally. Note that it is safer to enter the sphenoid sinus from the posterior ethmoids at their most medial point.

Fig.5.76a-d This shows how dangerous it is to puncture a posterior ethmoid cell laterally. The optic nerve (arrow) can be exposed laterally. Note that it is safer to enter the sphenoid sinus from the posterior ethmoids at their most medial point.

there is an unrecognized posterior ethmoid air cell that rides above the sphenoid sinus or around the optic nerve (Fig. 5.77). It also removes valuable olfactory mucosa that should be preserved wherever possible.

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