Surgical Technique

First of all, a type III maxillary sinusotomy is fashioned with its posterior limit extending level with the posterior wall of the maxillary sinus. This often means that the anterior branch of the sphenopalatine artery needs cauterizing. An anteriorly based mucosal flap over the frontal process of the maxilla and the anterior lacrimal crest is elevated to expose the anterior lacrimal crest. The anterior lacrimal crest is removed along its whole length using a Hajek-Kofler punch, and toward the top a coarse diamond burr is used to remove it up to its superior limit. The sac is resected up to its upper third. Bone is removed down to the level of the nasal floor using the side-biting antrum punch forceps. Any remaining bone around the lacrimal fossa, the bony ridge along the anterior rim of the maxilla, and the ridge of bone remaining inferiorly between it and the floor of the nose is drilled down level to the anterior wall and floor of the maxillary sinus (Fig. 14.57 a-d). A

Medial Maxillectomy Procedure
Fig. 14.55 The heavy interrupted line shows the extent of bone that needs to be removed in a medial maxillectomy.

3 mm chisel can be used to remove the thicker bone of the anteroinferior margin that makes up the rim of the pyriform aperture. This now allows you to visualize the entire maxillary sinus, although a 70° endoscope may be needed to see its anterior wall. Any exposed orbital periosteum is left intact (Fig. 14.58a-d). The margins of the opening that expose the maxillary sinus will then be smooth and leave no crest (Fig. 14.59a, b).

Medial Maxillectomy

This procedure is usually combined with an anterior ethmoidectomy. In the radical removal of a tumor, the middle turbinate may also need to be resected (Fig. 14.60).

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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