Authors: Ahmed Z Eweiss Ahmed A Ibrahim Hisham S Khalil
Publish Date: 2011/11/16
Volume: 269, Issue: 5, Pages: 1451-1456
Abstract
Surgery of the posterior ethmoid and sphenoid sinuses can be challenging In 1999 a technique was described for identification of the superior turbinate and utilizing it as a landmark in endoscopic posterior ethmoidectomy and sphenoidotomy Although this was more than a decade ago it has not been supported by further studies In our practice we have routinely adopted this technique and have modified it to allow further orientation during endoscopic surgery of the posterior sinuses To describe a review of our technique and to prospectively assess the value of the superior turbinate as a useful landmark during endoscopic posterior ethmoidectomy and sphenoidotomy Fifty patients listed for endoscopic posterior ethmoidectomy with or without sphenoidotomy were included in a prospective study utilising our surgical technique Data were collated for the success or failure of identification of the landmarks and for any complications during the surgery A total of 93 sides of endoscopic posterior ethmoidectomy and 73 sides of endoscopic sphenoidotomy were performed The superior turbinate was identified in 100 of the cases The coronal part of the superior turbinate basal lamella was identified in 6022 of the cases and the axial part in 8817 of the cases The natural sphenoid ostium was identified medial to the posterior part of the superior turbinate in 9863 of the cases The axial part of the superior turbinate basal lamella was a constant landmark for the level of the sphenoid ostium The number of transverse septae between the axial part of the superior turbinate basal lamella and the skull base was studied and was found never to exceed one septum No major complications were recorded One case of small posterior septal perforation was detected with no postoperative effects Our study represents the first report of identifying the two parts of the superior turbinate basal lamella intraoperatively It also represents the first report of using the axial basal lamella of the superior turbinate as a landmark for the level of the sphenoid sinus ostium as well as a landmark for the level of the skull base The superior turbinate represents a constant landmark for performing a safe posterior ethmoidectomy and sphenoidotomy
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