In general, with the maxillary sinus, the natural ostium must be included in the antrostomy to prevent recirculation, Dr. Palmer said. Consider a ‘mega-ostium’ or endoscopic medial maxillectomy in cases of recurrent maxillary sinusitis, he said.
Explore This Issue
January 2007Ethmoid Issues
Finally, panelists discussed issues related to the ethmoid sinus.
Dr. Palmer pointed out that with posterior ethmoid entry, watch where the perforation is done and avoid CSF leaks. Enter the basal lamina inferiorally and medially-the site acts as a fulcrum to direct the angle of the endoscope, he said.
CSF leaks can occur via surgical trauma in the posterior ethmoid roof or the lateral lamella of the cribriform plate. Leaks can be dramatic if caused by the powered instruments that are used to ‘skeletonize’ the skull base.
The key to safe surgery in the posterior ethmoid and sphenoid is to always know where the superior turbinate is-as there are not many landmarks in this region for endoscopic navigation. Also, be careful when entering the sphenoid.
You need to identify the variations on the preoperative CT, he said. At the same time, Dr. Palmer cautioned doctors to not blindly trust image-guided devices.
A key tip when it comes to the ethmoid sinus is to do complete removal of the bony septa in the ethmoid cavity, since this will help prevent recurrence in a complete ethmoidectomy, said Dr. Palmer. Paying special attention to the anatomy of the ethmoid roof and the lamina papyracea will help prevent complications.
©2007 The Triological Society