By Werner Hosemann, J Fanghänel
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Additional resources for A Dissection Course On Endoscopic Endonasal Sinus Surgery
Cover a perforation in the skull base. The anatomical foundations of these measures can be analyzed by completing the dissection exercises described above. One additional emergency measure should be known but is difficult to simulate in a dissection model: • Decompress the orbit by means of a lateral canthotomy and inferior cantholysis (Fig. 45). Inferior cantholysis Lateral canthotomy Fig. 45 With a small scissors, a lateral horizontal cut is made in continuity with the lateral palpebral fissure, cutting through the skin and to the bony orbit.
The lacrimal bone is usually only about 100 u thick in the area of the lacrimal sac, making it highly vulnerable (Hartikainen et al. 1996), especially during anteriorto-posterior dissection in the middle meatus. Fig. 34 Distance of the fundus of the lacrimal sac from the anterior insertion of the middle turbinate. The vertical distance (measurement 1) is approximately 10 mm. This distance is about 2 mm less when measured along the longitudinal axis of the lacrimal sac (opposite side in the diagram).
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. 2002). Next to it, the sagittally oriented perpendicular plate of the palatine bone forms an ethmoid crest to which the posterior part of the middle turbinate is attached.