Bolger W E, Keyes A S, Lanza D C
Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20817, USA.
Otolaryngol Head Neck Surg. 1999 Mar;120(3):308-13. doi: 10.1016/S0194-5998(99)70267-6.
Endoscopic surgery of the posterior ethmoid and sphenoid sinuses can present the operator with a considerable challenge. Although endoscopic training and physician experience have increased significantly in the past decade, surgical complications such as optic nerve trauma and cerebrospinal fluid leak still occur. Surgeons reporting such complications cite a lack of orientation within the dissection field as a primary cause. Because endoscopic sinus surgery is now being performed more routinely, surgical strategies designed to reduce the risk of complications are more important than ever. An anatomic landmark that could reliably orient the dissection within the posterior ethmoids and guide the surgeon to the sphenoid sinus could reduce the possibility of such adverse outcomes. In our experience identification of the superior meatus and superior turbinate provides a reliable landmark within the dissection field that can ensure surgical orientation to the operator. This technique allows safe, reliable dissection of the posterior ethmoids and an efficient approach to the sphenoid sinus, especially in patients undergoing revision surgery. In this article our technique for the identification and definition of the superior meatus and superior turbinate is presented, and the advantages of using this landmark in sinus surgery are discussed. In our experience identification of the superior meatus, superior turbinate, posterior skull base, and medial orbital wall defines a parallelogram-shaped box, which delineates the sphenoid face. This box provides the necessary orientation to guide the surgeon's entrance into the sphenoid sinus through the posterior ethmoid sinus (as Messerklinger described). Techniques for identifying the superior turbinate and meatus and for entering the sphenoid are detailed.
后筛窦和蝶窦的内镜手术对术者而言可能是一项颇具挑战的操作。尽管在过去十年中，内镜培训和医生经验都有了显著增加，但诸如视神经损伤和脑脊液漏等手术并发症仍有发生。报告此类并发症的外科医生指出，解剖区域内缺乏方向感是主要原因。由于现在内镜鼻窦手术开展得更为常规，旨在降低并发症风险的手术策略比以往任何时候都更为重要。一个能够可靠地确定后筛窦内解剖方向并引导术者找到蝶窦的解剖标志，可降低此类不良后果的发生可能性。根据我们的经验，识别上鼻道和上鼻甲可在解剖区域内提供一个可靠的标志，能确保术者的手术方向。这项技术可实现后筛窦的安全、可靠解剖，并能高效进入蝶窦，尤其是在接受翻修手术的患者中。本文介绍了我们识别和界定上鼻道及上鼻甲的技术，并讨论了在鼻窦手术中使用这一标志的优势。根据我们的经验，识别上鼻道、上鼻甲、后颅底和眶内侧壁可确定一个平行四边形框，该框勾勒出蝶窦面。这个框为引导术者通过后筛窦进入蝶窦提供了必要的方向（正如梅塞尔克林格所描述的那样）。文中详细介绍了识别上鼻甲和鼻道以及进入蝶窦的技术。
