An educational surgical video by Dr. Cristobal Langdon
At app SurgSchool, we continually strive to deliver cutting-edge educational content to surgical professionals around the world. In this enlightening video, the rhinologist Dr. Cristobal Langdon provides a detailed look at the advanced dissection technique of the frontal sinus and sphenoid. The video meticulously demonstrates the approach to the frontal recess and sinus, the approach to the sphenoid sinus, and the performance of an endoscopic septoplasty, highlighting crucial techniques and key anatomical structures.
Approach to the Recess and Frontal Sinus
The video begins with an examination of the frontal recess and sinus using a 45-degree lens, which provides the superior view essential for this procedure. The first critical step is to identify the Agger Nasi cell, the main landmark for accessing the frontal sinus. He explains that the frontal recess is the space between the lamina papyracea and the lamella of the middle turbinate, with the superior insertion of the uncinate process forming a vertical bar that divides the space.
- Key Structures Identified:
- Agger Nasi cell
- Papyraceous sheet
- middle turbinate
- Frontal sinus drainage pathway
- Supraorbital cell
- anterior ethmoidal artery
- front beak
The technique known as the Trans-Agger approach is used to carefully remove the posterior and superior walls of the Agger Nasi, providing direct access to the frontal recess. Throughout the procedure, mucosal preservation is emphasized to prevent stenosis, although for didactic reasons, the mucosa is removed in the video to better visualize the structures.
Approach to the Sphenoid Sinus
Transitioning to the sphenoid sinus, the Doctor uses a transnasal approach, facilitated by a previous ethmoidectomy and lateralization of the turbinate lamella. Locating and expanding the natural ostium of the sphenoid is crucial. This step is performed with cutting instruments such as mushroom forceps or angled cutting forceps.
- Key Techniques and Considerations:
- Using small, controlled cuts
- Constant display of cutting area
- Knowledge of anatomical variations through preoperative tomography
- Recognition of vital structures such as the optic nerve, internal carotid artery and sella turcica
The completion of a sphenoidectomy is also demonstrated, revealing significant milestones such as the trajectory of the optic nerve, the carotid artery, and the course of the infraorbital nerve.
Endoscopic Septoplasty
The final segment of the video focuses on endoscopic septoplasty, addressing indications such as deviations or posterior spurs that make access to the sinuses difficult. The procedure involves identifying the deviation, making precise incisions and raising mucosal flaps to resect the deviated portions of the septum.
- Step by Step Procedure:
- Incision along septal deviation
- Lifting of upper and lower mucosal flaps
- Resection of the deviation with a chisel
- Smoothing sharp edges with Kerrison tweezers
- Careful removal to avoid mucosal tears and septal perforation
- Replacement and ensuring the integrity of the mucosal flaps
The importance of controlled and meticulous management is emphasized to prevent complications and achieve optimal results.
Conclusion
Dr. Cristobal Langdon's advanced dissection video is a valuable resource for ENT surgeons seeking to improve their understanding and skills in sinus surgery. By highlighting critical anatomical milestones and demonstrating precise surgical techniques, this educational video reinforces the fundamental knowledge necessary for successful frontal and sphenoid sinus surgeries.
