Trimarchi M, Tomazic P V, Bertazzoni G, Rathburn A, Bussi M, Stammberger H
Department of Otorhinolaryngology, San Raffaele Scientific Institute and Vita-Salute University, Milano, Italy;
Department of General Otorhinolaryngology, Head and Neck Surgery, Medical University Graz, Graz, Austria;
Acta Otorhinolaryngol Ital. 2014 Aug;34(4):259-63.
The anterior wall of the maxillary sinus represents a blind spot in maxillary sinus endoscopic surgery because of the absence of proper visualisation and instrumentation to reach it. The aim of this study was to validate a new approach through the oral cavity into the nose with a flexible video endoscope (oro-nasal endoscopic approach; ONEA) to visualise the entire anterior maxillary wall including the anteromedial angle. We started from a dried bone cadaver model, and then dissected fresh-frozen cadavers. The maxillary sinus was explored with a rigid and a flexible endoscope entering from the nose. Next, a flexible endoscope was introduced through the mouth and back up through the choana, it accessed the maxillary middle antrostomy, entering inside the sinus and looking at the anterior wall. A small ruler inserted inside the sinus demonstrated all the angles visualised. The new ONEA technique allows complete visualisation of the anterior wall of the maxillary sinus with inspection of all blind spots. It is therefore possible to detect lesions that would normally not be visible with a normal rigid endoscope. We demonstrate the validity of a novel technique that allows visualisation of the infero-medial angle of the anterior wall of the maxillary sinus.
上颌窦前壁是上颌窦内镜手术中的一个盲点，因为缺乏合适的可视化手段和器械来抵达此处。本研究的目的是验证一种通过口腔进入鼻腔的新型方法，即使用软性视频内镜（经口-鼻内镜入路；ONEA）来观察包括前内侧角在内的整个上颌窦前壁。我们首先从干燥骨尸体模型开始，然后解剖新鲜冷冻尸体。分别使用硬性和软性内镜从鼻腔进入对上颌窦进行探查。接下来，将软性内镜经口腔插入，再经后鼻孔向上，进入上颌窦中鼻道开窗处，进入窦腔内并观察前壁。插入窦腔内的一把小尺子显示了所有可视角度。新的ONEA技术能够完整观察上颌窦前壁，并检查所有盲点。因此，有可能检测到使用普通硬性内镜通常无法看到的病变。我们证明了一种能够观察上颌窦前壁下内侧角的新技术的有效性。
