Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA.
Int Forum Allergy Rhinol. 2018 Sep;8(9):1073-1075. doi: 10.1002/alr.22176. Epub 2018 Jul 6.
Aside from endoscopic and image guidance confirmation, the standard method of identifying the lamina involves the surgeon or an assistant applying gentle pressure on the globe externally. This globe push test requires the surgeon to remove one instrument from the endoscopic field or an assistant to press on the globe, and the test is most useful when either the periorbita or periorbital fat is exposed. We propose an alternative, equally accurate, and more efficient technique dubbed the lamina push test.
A blunt instrument is used to gently apply lateral pressure in the expected location of the medial orbital wall. If the lamina has been adequately skeletonized, the entire lamina will be seen to move as a unit. If residual ethmoid partitions are present, no movement or only localized movement is observed.
Using the lamina push test, we have been able to safely identify the lamina papyracea in all patients undergoing endoscopic sinus surgery, without injury to the lamina or orbital contents. The use of direct pressure significantly increases the movement of an intact lamina.
The lamina push test is a safe and effective technique for identification of the medial orbital wall, confirmation of removal of all lateral ethmoid partitions, and verification of lamina integrity. It enables more consistent identification of an intact lamina, allows the surgeon to keep both instruments in the endonasal surgical field, and does not require an assistant.
除了内镜和影像引导确认外，识别眶内侧壁的标准方法还包括术者或助手在外眼部轻轻施压。该眼球推压试验需要术者从内镜视野中移除一种器械，或助手按压眼球，并且当眶骨膜或眶脂肪暴露时，该试验最有用。我们提出了一种替代方法，即同样准确且更有效的技术，称为眶内侧壁推压试验。
使用钝器械在预期的眶内侧壁位置施加侧向压力。如果眶内侧壁已被充分去骨化，则整个眶内侧壁将作为一个整体移动。如果仍存在筛窦分隔，则观察到无运动或仅局部运动。
在所有接受内镜鼻窦手术的患者中，我们使用眶内侧壁推压试验成功地安全识别了纸样板，而不会损伤眶内侧壁或眶内容物。直接施压显著增加了完整眶内侧壁的运动。
眶内侧壁推压试验是一种安全有效的技术，可用于识别眶内侧壁、确认去除所有外侧筛窦分隔以及验证眶内侧壁完整性。它能够更一致地识别完整的眶内侧壁，允许术者在鼻内手术野中保留两种器械，且无需助手。
