By Werner Hosemann, J Fanghänel
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Extra resources for A Dissection Course On Endoscopic Endonasal Sinus Surgery
In 15% of cases the proximal ophthalmic artery runs intradurally in the medial part of the canal, making it susceptible to injury during incision of the nerve sheath. Transnasal decompression of the medial optic nerve can be accomplished over about a 7-mm length of the nerve (Chou et al. 1995, Maniscaldo and Habal 1978). • Working from anterior to posterior, try to pry away pieces of the bony optic canal in the medial direction using the sharp end of the double-ended elevator. • Next, incise the exposed optic nerve sheath longitudinally with a sickle knife.
The opening of the pterygoid canal with the "vidian nerve" lies posteriorly, 3 mm lateral to the sphenopalatine foramen. The canal and nerve can be demonstrated on the lateral floor of the sphenoid sinus in almost 20% of cases. The foramen rotundum (maxillary nerve) is located higher than the pterygoid canal and 8 mm farther laterally. In approximately 30% of cases this nerve forms a prominence in the lateral wall of the sphenoid sinus (Bagatella 1986, Lang 1988). • Create a maximum antrostomy window in the middle meatus.
Generally at this stage you will be workingi in a posterior-to-anterior direction. Simultaneous medial-to-lateral dissection is also performed where necessary. • Mobilized tissue fragments should be carefully andi completely removed. This is necessary to maintainl an optimum view (with the 30° telescope). 31 • The usual result is a conspicuous neo-ostium through which the posterior wall of the frontal sinus can be seen (also the roof of the frontal sinus in favorable cases). 9 Demonstrating the Olfactory Fibers The olfactory fibers course in the upper part of the bony vertical lamella of the middle turbinate.
A Dissection Course On Endoscopic Endonasal Sinus Surgery by Werner Hosemann, J Fanghänel