dr. praveen presentation
TRANSCRIPT
SURGICAL ANATOMY OF LATERAL WALL OF NOSE & FESS
Presented by Dr. Praveen Kumar JR-III
DEPARTMENT OF OTORHINOLARYNGOLO AND HEAD & NECK SURGERYMLB MEDICAL COLLEGE, JHANSI (U.P.)
Nasal cavities• Begin at the piriform aperture• End at the posterior choanae• Boundaries :
– Roof– Floor– Septal wall– Lateral wall
Nasal cavitiesRoof• Nasal bones• Nasal spine of the frontal bone• Floor of the frontal sinus• Cribriform plate of ethmoid boneFloor• 3/4 : palatal process of maxillary bone• 1/4 : horizontal process of palatine bone
Nasal cavities
Nasal septum• Vomer• Perpendicular plate of ethmoid bone• Quadrilateral cartilage• Nasal crest, anterior nasal spine• Membranous septum and columella
Nasal septum
Lateral Wall
Lateral wall• Nasal surface of maxilla, superior, middle and inferior
conchae, perpendicular plate of palatine boneBony structure• Ethmoid bone ; Superior & Middle concha,Uncinate
process, Cribiform plate• Inferior concha bones• Maxilla bone; Palatine & Alveolar & Frontal process• Palatine bone; Perpendicular & Horizontal plate• Lacrimal bone• Sphenoid bone; Medial pterygoid plate• Nasal bone
Lateral wallConchal bone• Supreme • Superior • Middle • InferiorMeatus• Superior • Middle • Inferior• sphenoethmoidal recess
Lateral wallSuperior meatus• Superior to SM Sphenoethmoidal recess Sphenoidal sinus drainage• Inferior to SM Opening of posterior ethmoidal air cellsMiddle meatus• Uncinate process; hook shape bone• Hiatus semilunaris; posteroinferior• Maxillary sinus opens • Ethmoidal infundibulum
– Fronto-nasal recess • Frontal sinus opening
– Anterior• Anterior ethmoidal air cells opening• Ethmoid bulla
– Opening of middle ethmoid air cell
Lateral wall
Inferior meatus• Nasolacrimal duct opening• Sphenopalatine foramen • Posterior end of MT• Neurovascular bundle• Leading into pterygopalatine fossa
Lateral wall
Lateral Wall
I Part II Part III Part
Vertical Oblique Horizontal
Types of Attachment of Middle turbinate
ATTACHMENT OF MIDDLE TURBINATE
segment Bone of insertion Plane of insertion Site of insertion
Anterior 1/3 ethmoid Saggital
(vertical)
Lalateral lamella of
lamina cribosa
Middle 1/3 ethmoid Frontal
(oblique)
Lamina papyracea
Posterior 1/3 Ethmoid,
maxilla,
palatine
horizontal Post part of lateral
nasal wall
I. Unciate process II. Bulla ethmoidalis III. Horizontal part of middle turbinate IV. Superior turbinate V. Supreme turbinate
Types of Unciate attachment
Type – I Type – II Type – III
Lamina papyracea
Fovea ethmoidalis
Middle turbinate
Attach to
Bulla Ethmoidalis•Anterior ethmoid air cells attached to lamina papyrcea and usually open into lateral sinus
Bulla Ethmoidalis
TYPES OF FRONTAL CELL
Type I
Type III
Type II
Type IV
a single air cell above agger nasi
series of air cells above agger nasi but below the orbital roof
cells extends into the frontal sinus but is contiguous with agger nasi cell
Cells lies completely within the frontal sinus
Types of Sphenoid Sinus on basis of pneumatization
Complications of FESS
Complication : NLD injury
Complication : ACF injury
Complication : CSF Leak
Complication : Orbital Haemorrhage
Complication : Medial rectus injury
Complication :Pneumo-encephaloceole
Complication : Medial rectus injury
Complication :Pneumo-encephaloceole
Complication : Optic Nerve injury
Complication : Haemorrhage
BALLOON SINOPLASTY
• 31 million Americans suffer from chronic sinusitis
• Surgical treatment for chronic sinusitis has evolved tremendously since its inception
Inclusion & Exclusion criteria• Inclusion criteria :
– Adult > age of 18 years – Chronic sinusitis unresponsive to medical
management
• Exclusion criteria: – Extensive sinonasal polyps, cystic fibrosis– Extensive previous sinonasal surgery– Extensive sinonasal osteoneogenesis– Sinonasal tumors,– History of facial trauma – Ciliary dysfunction– Pregnancy
Sino Nasal Outcome Test (SNOT-20)
• 0 = Not present/no problem
• 1 = Very mild problem
• 2 = Mild or slight problem
• 3 = Moderate problem
• 4 = Severe problem
• 5 = Problem as “bad as it can be”
Lund- Mackay scores
• CLinical Evaluation to confirm sAfety and efficacy of sinuplasty in the paRanasal sinuses(CLEAR STUDY)
• Multi-center prospective non-randomized study– Bolger et al. (2007): 10 centers (24-week , 109
patients)– Kuhn et al. (2008): 7 centers (1 year f/u, 66 patients)
Luma Sinus Illumination System (Luma light)
Friedman M.Laryngoscope. 2009 Jul;119(7):1399-402.
Schematics of Balloon Sinuplasty
Measurement of success in balloon sinuplasty
• SNOT-20
• CT sinus
• Lund-Mackay CT score
• Nasal endoscopy to look for ostia patency
Thank you