Surgical Technique

The posterior ethmoidal cells are entered through the basal lamella and it is safest to enter these medially and inferiorly (Fig. 5.72 a-u). Enlarge access to these

Basal Lamella Anatomy

Fig. 5.67 A sphenoethmoid air cell above the sphenoid sinus— note the optic nerve in its lateral wall (arrow).

Basal Lamella Middleturbinate
Fig. 5.68 The sphenoid ostia can be seen high on the anterior wall of the sphenoid—note that the bone becomes thin about 1 cm above the shoulder of the posterior choana.
Intersinus Septum Maxillary Sinus

Fig. 5.69 An axial CT scan showing asymmetry of the sphenoid intersinus septum.

Fig. 5.67 A sphenoethmoid air cell above the sphenoid sinus— note the optic nerve in its lateral wall (arrow).

Fig. 5.69 An axial CT scan showing asymmetry of the sphenoid intersinus septum.

Lateral Wall Sphenoid Sinus
Fig. 5.70 Note the bulge of the carotid artery in the lateral Fig. 5.71 The optic nerve can be seen high in the lateral wall wall of the sphenoid sinus (arrow). of the sphenoid sinus (arrow).
Nerves Middle Turbinate

Fig.5.72a-d The ethmoid bulla has been removed to reveal the basal lamella, which is punctured medially using straight Blakesley forceps. This is done medial to the medial wall of the maxillary sinus and above the horizontal inferior base of the ground lamella. Note the maxillary ostium in the bottom left-

Fig.5.72a-d The ethmoid bulla has been removed to reveal the basal lamella, which is punctured medially using straight Blakesley forceps. This is done medial to the medial wall of the maxillary sinus and above the horizontal inferior base of the ground lamella. Note the maxillary ostium in the bottom left-

hand corner. e-h A Hajek punch being used to open the posterior ethmoid sinuses. Note preservation of the superior turbinate and its olfactory mucosa.

Basal Lamella Middle Turbinate
Fig. 5.72 i, j The middle turbinate is lateralized and the "window" between it and the inferior turbinate can be seen from the medial side. This allows the height of the roof of the sphe

noid and posterior ethmoids to be compared. k, l The sphenoid sinus is located near the midline 1 cm above the posterior choana where the bone is thin.

Sphenopalatine Artery
Fig. 5.72 m, n The jaws of the Blakesley forceps are opened septal branch of the sphenopalatine artery. q, r A few upward before it is withdrawn to help open the ostium. o, p The Hajek bites enlarge the ostia up to the skull base. punch is used to take one downward bite in order to avoid the
Torbinate Ostia
Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

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