Department of Otolaryngology, Derriford Hospital, Plymouth, UK.
Eur Arch Otorhinolaryngol. 2012 May;269(5):1451-6. doi: 10.1007/s00405-011-1832-3. Epub 2011 Nov 16.
Surgery of the posterior ethmoid and sphenoid sinuses can be challenging. In 1999, a technique was described for identification of the superior turbinate and utilizing it as a landmark in endoscopic posterior ethmoidectomy and sphenoidotomy. Although this was more than a decade ago, it has not been supported by further studies. In our practice, we have routinely adopted this technique, and have modified it to allow further orientation during endoscopic surgery of the posterior sinuses. To describe a review of our technique, and to prospectively assess the value of the superior turbinate as a useful landmark during endoscopic posterior ethmoidectomy and sphenoidotomy. Fifty patients listed for endoscopic posterior ethmoidectomy with or without sphenoidotomy were included in a prospective study utilising our surgical technique. Data were collated for the success or failure of identification of the landmarks, and for any complications during the surgery. A total of 93 sides of endoscopic posterior ethmoidectomy and 73 sides of endoscopic sphenoidotomy were performed. The superior turbinate was identified in 100% of the cases. The coronal part of the superior turbinate basal lamella was identified in 60.22% of the cases, and the axial part in 88.17% of the cases. The natural sphenoid ostium was identified medial to the posterior part of the superior turbinate in 98.63% of the cases. The axial part of the superior turbinate basal lamella was a constant landmark for the level of the sphenoid ostium. The number of transverse septae between the axial part of the superior turbinate basal lamella and the skull base was studied, and was found never to exceed one septum. No major complications were recorded. One case of small posterior septal perforation was detected with no post-operative effects. Our study represents the first report of identifying the two parts of the superior turbinate basal lamella intra-operatively. It also represents the first report of using the axial basal lamella of the superior turbinate as a landmark for the level of the sphenoid sinus ostium, as well as a landmark for the level of the skull base. The superior turbinate represents a constant landmark for performing a safe posterior ethmoidectomy and sphenoidotomy.
后筛窦和蝶窦的手术具有挑战性。1999 年，有人描述了一种识别上鼻甲并将其用作内镜后筛窦切除术和蝶窦切开术的解剖标志的技术。尽管这已经是十多年前的事了，但它并没有得到进一步研究的支持。在我们的实践中，我们已经常规采用了这种技术，并对其进行了修改，以便在鼻窦内镜手术中进一步定位。为了描述我们的技术，前瞻性评估上鼻甲作为内镜后筛窦切除术和蝶窦切开术有用的解剖标志的价值。50 例接受内镜后筛窦切除术伴或不伴蝶窦切开术的患者纳入前瞻性研究，采用我们的手术技术。收集了识别标志的成功或失败的数据，以及手术过程中的任何并发症。共进行了 93 例内镜后筛窦切除术和 73 例内镜蝶窦切开术。上鼻甲在所有病例中均被识别。冠状部上鼻甲基板在 60.22%的病例中被识别，轴部在 88.17%的病例中被识别。在 98.63%的病例中，自然蝶窦口位于上鼻甲后部的内侧。上鼻甲基板的轴部是蝶窦口水平的恒定标志。研究了上鼻甲基板轴部与颅底之间的横隔数量，发现从未超过一个隔。没有记录到主要并发症。一例小的后筛穿孔被发现，无术后影响。我们的研究首次报道了术中识别上鼻甲基板的两个部分。这也是首次报道将上鼻甲的轴状基板用作蝶窦窦口水平的解剖标志，以及颅底水平的解剖标志。上鼻甲是进行安全的后筛窦切除术和蝶窦切开术的恒定标志。
