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| Name | Endoscopic sinus surgery: Posterior ethmoidectomy dissection. |
| Video Uploader | Video From Dr Ricardo Bartel |
| Upload Date | This Video Uploaded At 28-09-2020 10:28:44 |
| Video Discription | www.instagram.com/doctorbartel Entry to the posterior ethmoid cells should be a planned event. The basal lamella of the middle turbinate is identified and opened with through-cutting forceps medially just superior to its horizontal part. The basal lamella is then opened to access the posterior ethmoid air cells. Posterior ethmoid surgery follows the same principle of identifying a cell, removing bone and mucosa on a broad front to identify the next cell, and then entering the next cell, at all times exercising care to avoid dissecting in deep and narrow tunnels. The limits of posterior ethmoidectomy are the skull base, medial orbital wall, and sphenoid sinus. It is important to be aware of the posteriorly sloping nature of the skull base and to stay low during the dissection. A useful maneuver is to employ up-turned through-cutting forceps to estimate the distance of the skull base behind the bony lamellae and removing them accordingly. Alternatively, retrograde dissection can start posteriorly by opening the sphenoid, identifying the skull base, then following it forward into the posterior and anterior ethmoids. This is particularly useful when the skull base is difficult to identify with antegrade dissection or in revision surgery when landmarks have been obliterated. Laterally, the skull base adjacent to the medial orbital wall is -10 times thicker than it is medially, where the fovea ethmoidalis, cribriform plate, and variable-length lateral lamella of the middle turbinate pose potential risks for skull base injury. A sphenoethmoidal (Onodi) cell is an anatomical variant that is present in 4.7% of the population. It increases the risk of inadvertent injury to the optic nerve and carotid artery, which are more commonly dehiscent in this area. It is therefore an anatomical variant that must be looked for carefully during preoperative planning. The other structures at risk are the orbit, the skull base, and the sphenoid sinus contents. #sinussurgery #earsurgery #endoscopicearsurgery #doctor #medicine #medicina #surgery #cirugia #surgeon #cirujano #otolaryngology #ent #otolaryngologist #otorrinolaringologia #orl #otorrino #anatomy #anatomia #meded #medicaleducation #otology #rhinology #endoscopicsinussurgery #sinusitis #otitis |
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