Endoscopic dissection of the nose and paranasal sinuses

Endoscopic endonasal surgery is an advanced technique that requires in-depth knowledge of nasal and paranasal sinus anatomy, as well as skill in the use of specific instruments. He Dr. Cristobal Langdon, a prominent rhinologist, has developed an educational video for the Surgical training app SurgSchool, where it addresses endoscopic dissection of the nose and paranasal sinuses. Below is a detailed summary of the video content, structured into key sections.

Introduction to Endoscopic Endonasal Surgery

The video begins with an introduction to the essential instruments used in endoscopic dissection of the nose and paranasal sinuses. These instruments are not only crucial during laboratory dissection, but also when working with human specimens. Becoming familiar with them is essential for the success of the surgery.

Basic Instruments

1. Freer's Dissector or Desperiostizer
   • Uses: Medialization or lateralization of the middle turbinate, palpation and dissection of mucosa and structures, initiation of uncinectomy.
2. Seeker or Feeler
   • Features: Blunt tip and curved back.
   • Uses: Recognition of structures and spaces, medialization of structures to work on the lateral nasal wall.
3. Cottle dissector
   • Uses: Endoscopic septoplasty, mucosal dissection, septum cuts, cartilage and structures such as the uncinate.
4. Sickle Knife
   • Uses: Uncinectomy, work on the middle turbinate (e.g., in cases of concha bullosa).

Tweezers

1. Non-Cutting or Blakesley Forceps
   • Features: Mobile part with window.
   • Uses: Taking tissues without cutting them, with caution to avoid mucosal tears.
2. Cutting Pliers
   • Characteristics: Mobile part that is almost completely inserted into the fixed part.
   • Uses: Precise tissue resection.
3. Retrograde Cutting Forceps or Backbiter
   • Uses: Uncinectomy, creation of a window in the uncinate.
4. Kerrison clamp
   • Uses: Resection of compact bone spicules in a controlled manner.

Interpretation of CT Scans

Review of CT scans is crucial for surgical planning. Dr. Langdon details how to interpret the coronal sections of a simple CT scan of the nose and paranasal sinuses, identifying key anatomical structures.

1. Frontal Sinuses
   • Variability: Agenesis or hyperpneumatization.
2. Maxillary Sinuses and Nasolacrimal Ducts
   • Structures: Most anterior ethmoidal cell (Agger Nasi), infraorbital nerve hanging from a mesentery.
3. Uncinate and Lamina Papyracea
   • Bilateral insertion of the uncinate, impact on frontal sinus drainage.
4. Ethmoidal arteries
   • Techniques to avoid damage to the ethmoidal artery, including the intact bulla technique.
5. Keros Classification
   • Measurement of the depth of the olfactory sulcus to assess the risk of fistula.

Surgical Techniques: Uncinectomy

The video explains in detail the technique of uncinectomy, highlighting the importance of complete resection of the uncinate process to avoid recurrence of the disease.

1. Palpation and Location of the Uncinate
   • Techniques: Use of the sickle knife and retrograde tweezers.
2. Resection with Motorized Instruments
   • Options: Microdebrider, combinations with other tools.
3. Prevention of Complications
   • Strategies to avoid mucosal tears and excessive bleeding.

Maxillary Antrostomy and Ethmoidectomy

Finally, techniques for maxillary antrostomy and ethmoidectomy are discussed.

1. Expansion of the Maxillary Ostium
   • Longitudinal direction to avoid closure due to scarring.
2. Haller Cell Recognition
   • Importance of identifying these cells and their relationship with the infraorbital nerve.
3. Anterior Ethmoidectomy (Bullectomy)
   • Resection of the ethmoidal bulla, identification of the retrobullar recess and anatomical limits.

¡DOWNLOAD THE APP SURGSCHOOL today to access high-quality surgical educational content and improve your surgical skills! Don't miss the opportunity to take your surgical training to the next level!