By Werner Hosemann, J Fanghänel
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Extra info for A Dissection Course On Endoscopic Endonasal Sinus Surgery
35 Stenting of the lacrimal passages after previous fenestration of the right lacrimal sac from an endonasal approach (West technique). The stent is introduced through the external lacrimal passages and is grasped endonasally with a forceps. It should be noted that the lacrimal sac generally extends up past the insertion of the middle turbinate (compare with Fig. 36) (from Hosemannetal. 2000). Measuring 5-8 mm in diameter, the sphenopalatine foramen lies in the superior meatus near the posterior end of the middle turbinate in 90% of cases (Lee et at.
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).
A rudimentary or conchal type of sphenoid sinus is very rare. In two-thirds of cases the carotid artery forms a prominence in the lateral sinus wall (Figs. 43 and 44). The optic nerve forms a significant prominence in the anterosuperior lateral wall in approximately 20% of cases. In one-third of these cases the optic canal passes more or less freely through a broad sphenoid sinus. The free course of the nerve through the sphenoid sinus is the result of a heavily pneumatized anterior process of the clinoid.
A Dissection Course On Endoscopic Endonasal Sinus Surgery by Werner Hosemann, J Fanghänel