By Werner Hosemann, J Fanghänel
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Extra info for A Dissection Course On Endoscopic Endonasal Sinus Surgery
12 Inferior Turbinoplasty • Make a vertical incision in the head of the inferior turbinate. Insert the sharp end of the double-ended elevator into the wound pouch, passing it to the bone, and outline a medial mucosal flap. • Elevate the mucosal flap by incising the inferior bridges of tissue. Partially resect the anterior and lateral portions of the head of the turbinate. • Return the mucosa and if necessary outfracture the body of the turbinate with the blunt end of the double-ended elevator. 15 Dissection of the Medial Orbit A medial maxillectomy may be indicated for tumor resections.
Endoscopic inspection: note the broad exposure including the prelacrimal recess of the maxillary sinus. The lamina papyracea is very thin in places (50 u) and may be absent at some points. • Remove the lamina papyracea: an anterior area of the lamina papyracea can be carefully perforated by pressure from the sharp end of the doubleended elevator and then undermined. Proceeding in steps, push or fracture the bone medially and inferiorly like an egg shell and remove the pieces. If possible, the periorbita is elevated from the skull base to the infraorbital nerve and from the lacrimal duct to the entrance to the sphenoid sinus (this cannot always be accomplished with the standard instrument set).
The latter arteries are located in the pterygopalatine fossa anterior to the nerves (maxillary nerve, nerve of pterygoid canal - greater petrosal nerve, pterygopalatine ganglion, numerous connections). Key to Fig. 38 1 Maxillary artery 2 Sphenopalatine artery 3 Foramen rotundum 4 Maxillary nerve 5 Inferior alveolar artery and nerve 6 Ostium of sphenoid sinus 7 Pterygopalatine ganglion 8 Mandibular nerve 9 Middle meningeal artery 10 Pharyngeal arterial branch 11 Optic chiasm 12 Inferior turbinate 13 Sphenomandibular ligament 14 Medial pterygoid muscle 15 Parotid gland 16 Oculomotor nerve 17 Pterygoid canal with nerve of pterygoid canal (vidian nerve, from the greater superior petrosal nerve) and artery 18 Posterior septal artery (medial branch of the sphenopalatine artery) 19 Superior and inferior posterolateral branches of the sphenopalatine artery 20 Descending palatine artery 21 Posterior superior alveolar artery 22 Infraorbital artery * Sections at different levels < Fig.