Medical knowledge | Surgery » Hirschberg Andor - Anatomical basis of endoscopic sinus surgery, ESS

Hirschberg Andor  Anatomy from books  Anatomy in cadavers  Endoscopic anatomy  All three are necessary Gold standard of endoscopic anatomy: excellent visualisation with good angles, resolution and brilliance           Inferior and middle turbinates Proc. uncinatus, infundibulum Bulla ethmoidalis Lamina papyracea, Haller’s cell, sinus lateralis and terminalis Cellulae ethmoidalis anterior Ground lamella Recessus frontalis Cellulae ethmoidalis posterior  Ónodi’s cell Sinus maxillaris Sphenoid sinus Attachment of the anterior part Lateral portion of lamina cribriformis (conchal lamina) 14,5 mm conchal lamina 40,6 mm Anterior Lang, J. 1989 Basal (plate) lamella Transversal, beveled or frontal plate Horizontal plate Lang, J 1989; Drainage of the frontal recess     Thin, crescent or sickle shaped, sagittal planed, bony ethmoid lamella Medial border of the infundibulum Superior attachment:

different variations Middle meatus Crescent shaped inferior portion turns posteriorly and covers the hiatus maxillaris Infundibulum • • • • • • • Infundibulum      Hiatus semilunaris (HS): two dimensional arced opening, entrance to the infundibulum. HS inferior and superior Infundibulum: clove shaped, inferiorly blind shallow space Borders: proc. uncinatus, lam papyracea, bulla ethmoidalis Recessus terminalis: Superiorly closed recess if the uncinate process is attached to lamina papyracea Middle meatus opens to the antral sinus through the infundibulum MT RB LP RF If uncinate process is attached to the l.papyracea, the infundibulum ends blindly in the terminal recess. Above and behind the bulla within the middle meatus: sinus lateralis, recessus suprabullaris Left side Right side Agger nasi cells: protrusion of the lateral nasal wall anteriorly to the anterior attachment of the middle turbinate Posterior

ethmoid cells which are pneumatized laterally and superiorly to the sphenoid sinus are frequently referred to as Onodi cells. Posterior spheno-ethmoidal cell: exceeds the frontal wall (> 1,5 cm) of the sphenoid, and/or encloses more than half of the optic nerve canal Conchal lamina Keros-classification left Left side Ethmoid roof Sinus lateralis Lamina papyracea Middle turbinate Bulla ethmoidalis Rec. terminalis Proc. uncinatus Postoperative result • Messerklinger: obstruction of transition space  Stammberger, Kennedy, Wigand, Draf • Indication  Conservative treatment fails • Principle  Infundibulotomy: opening and drainage of the transition space(s)