Maxillary sinus
The maxillary sinus may suffer several different pathologies that may be corrected easily with minimally invasive endoscopic procedures. Our efforts must be directed during the surgeries at the uncinate process, and the natural maxillary ostium because th
- PDF / 1,919,408 Bytes
- 13 Pages / 612 x 794 pts Page_size
- 31 Downloads / 222 Views
Maxillary sinus
The maxillary sinus may suffer several different pathologies that may be corrected easily with minimally invasive endoscopic procedures. Our efforts must be directed during the surgeries at the uncinate process, and the natural maxillary ostium because they are the most important structures involved in the corrective procedures. Maxillary sinus surgery is underestimated because it is the easiest to imagine, however middle antrumostomy and ostiumplasty should not be done unless there is a pathology within said sinus. The management of the natural ostium should follow the physiological principals that are shown by the mucociliary clearance patterns. One must not touch the ostium whenever possible and maxillary sinus surgery usually consists only in marsupializing the infundibulum to visualize and decompress the natural maxillary ostium. The two most important aspects of this procedure are to be acquainted with the anatomy and physiology of the natural maxillary ostium, and to have clear criteria in the management of the ostium once the endoscopic paranasal sinus surgery (ESS) commences.
Details of the anatomy This is one of the fundamental things that have not been adequately understood by surgeons all over the world. To avoid recurrence of the disease, it is very important to understand the two portions of the uncinate process, the localization of the infundibulum and identify correctly where the natural maxillary ostium is (Fig. 1). The uncinate process has two portions: a bony and mucosal portion. The bony skeleton of the uncinate process is formed by a vertical plate and a horizontal one that follow the inferior and anterior border of the ostium at a 60° angle. The vertical plate is adhered to the orbit most of the times, while other times it may be dislocated or deviated in such a way that it obstructs the infundibulum. The horizontal plate projects itself at the level of the anterior edge of the maxillary sinus and is the most important as it contains ethmoid cells that may become diseased, may contribute to edema and because it may block the infundibulum. This plate may also be deformed, displaced or destroyed by an infection or an occupying lesion, vgr, nasal polyposis. It is for this reason that the horizontal plate needs to be removed in all cases of illness if one wants to obtain a correct infundibulectomy and/or decompression of the ostium. The mucosal portion that covers the uncinate process may be inflamed due to allergy or infection and can contribute to the obstructive process.
Directed Endoscopic Paranasal Sinus Surgery (DESS) Maxillary sinus surgery should be done in such a way to cause the least amount of damage to the sinus and its vital draining structures. In most cases it is important to preserve the mucosa, the natural ostium and the fontanels. To obtain the best results, it is necessary to use adequate instruments, have the knowledge of the correct steps in the surgical technique, to follow the current indications and to be able to anticipate complications.
C. Yañez, Endos
Data Loading...
