The Clinical Application of Endoscopic Sphenoidotomy and Anatomical Role of the Superior Turbinate

BACKGROUND AND OBJECTIVES: Recently, endoscopic sinus surgery (ESS) is commonly performed to treat the sphenoid sinus disease. Identification of the natural ostium of sphenoid sinus (SS) according to surgeon's operating view play an important role in endoscopic sphenoid approach. This study is undertaken to investigate the role of superior turbinate (ST) as an anatomic landmark of natural ostium of SS in endoscopic sphenoidotomy. MATERIALS AND METHODS: Medical records and computed tomography (CT) images of 77 patients from March 2006 to December 2007 who underwent ESS were analyzed. We tried to investigate the location and distance of the natural ostium on the superior turbinate, skull base and nasal septum. We also measured the anterior wall thickness of the SS by using CT images. RESULTS: The natural ostium of the SS was located on the medial side of the ST in all patients who underwent endoscopic sphenoidotomy (45 cases). The level of posteroinferior end of the ST corresponded to the inferior portion of anterior wall of the SS. The lateral portion thickness of the anterior wall of the SS was thinner than the medial portion (77 cases). CONCLUSION: During an endoscopic sphenoidotomy, the superior turbinate is an important anatomic landmark for identifying the natural ostium of the SS. When widening the anterior wall of SS is performed, we sug-gest that the procedure should be directed to the lateral 1/3 portion, considering the thickness of anterior wall of SS.

The Effects of Ostium Reopening and Stress on the Recovery of Maxillary Mucosal Lesion in Rabbits with Maxillary Sinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There have been many studies concerning histologic changes and effectiveness of specific treatment in the experimentally induced sinusitis model, but there are few studies about natural course of paranasal sinusitis. This study aimed to analyze the natural course of sinusitis and the influence of stress on the natural disease course. MATERIALS AND METHOD: Natural ostia of 120 rabbits were occluded and reopened at 10 days after occlusion. Rabbits were divided into six groups according to duration from reopening to sacrifice. Each group was sacrificed at 1, 4, 8, 12, 19, 26 days after reopening of the natural ostium. Each group was divided into a control and stress subgroups. Radiologic, gross and histologic findings were analyzed. RESULTS: Percentage of rabbits showing partial or total haziness was highest at 3 days after reopening in the control subgroup and at 11 days in the stress subgroup. Percentage of the rabbits showing moderate or severe amount of pus in the sinus on gross examination was highest at 4 days in both subgroups. Degree of epithelial loss was most severe at 4 days in both subgroups. Subepithelial thickness was largest and inflammatory cell infiltrations were most severe at 8 days in both subgroups. Although there was a lack of statistical significance, stress subgroups showed more severe gross, radiologic, and histologic findings than those of control subgroups. CONCLUSION: This study shows that maxillary sinusitis is induced by natural ostium occlusion only and is improved with time without any treatment, and that stress might influence the severity of maxillary sinusitis.

Intranasal Transethmoid Approach to the Sphenoid Sinus Ostium in Endoscopic Sinus Surgery: A Safe Technique Using the Superior Turbinate As a Key Landmark / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Identification of the natural ostium verifies the safest entry to the sphenoid sinus (SS) in endoscopic sinus surgery (ESS). In order not to destabilize the middle turbinate (MT), new techniques have recently been introduced on transethmoid approaches to the SS ostium after ethmoidectomy. The aims of this study are to introduce an intranasal transethmoid approach to the SS ostium for sphenoidotomy using the superior turbinate (ST) as a key landmark without destabilization of the MT in ESS for chronic sinusitis with concurrent sphenoiditis and to determine its efficacy by evaluating the outcome of the patients. MATERIALS AND METHODS: Fifty-three chronic sinusitis patients (37 males and 16 females, aged 14 to 63 years) with concurrent sphenoiditis in one or both SSs and their 75 SSs were included in this study. Sphenoidotomy was performed in all patients. The SS ostium was identified just medial to the ST remnant. Number of SSs where the ostium was identified was determined, and surgical complications were evaluated. To assess olfactory changes, a butanol threshold test was performed before and after the surgery. RESULTS: The SS ostium was identified in 73 (97.3%) of the 75 SSs. The preoperative threshold (3.9+/-3.0) in the butanol test significantly improved to 5.1+/-2.5 after the operation in the 75 nasal sides. Olfactory function of only 3 (4.0%) sides worsened after surgery. There were no major complications in all patients. Conclusion: This technique may be an effective and safe approach to the SS ostium in ESS for chronic sinusitis with concurrent sphenoiditis without destabilization of the MT.

Surgical anatomy of natural ostium of the sphenoid sinus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is important for surgeons to identify the location of natural ostium of the sphenoid sinus during sphenoidotomy for sphenoiditis and transsphenoidal approach (TSA). But, it is not easy for a beginner to find it. This study aimed to investigate from a clinical aspect the location of natural ostium of the sphenoid sinus using korean adult cadaveric heads. Material and methods : One hundred sagittally-divided adult cadaveric heads were used. After removing the mucosa of anterior wall meticulously, they were carefully examined and documented serially by photography. The items analyzed were the distance from and the degree of nasal sill and limen nasi to the natural ostium of sphenoid sinus, and the distance from the posteroinferior end of the superior turbinate and the skull base to the natural ostium of the sphenoid sinus. In addition, we tried to investigate whether the natural ostium opens into the medial or lateral to the posterior end of the superior turbinate. RESULT: The natural ostium of the sphenoid sinus was located at 34.3 3.8o and 62.7 9.0 mm away from the nasal sill, and at 35.9 3.8o and 56.5 3.2 mm away from the limen nasi. It was located approximately in the middle of the anterior wall of the sphenoid sinus and medially to the posterior end of the superior turbinate in about 83%. CONCLUSION: By identifying the posteroinferior end of the superior turbinate, the location of natural ostium of the sphenoid sinus can be identified. We recommend that surgeons should look for the natural ostium in the middle of the anterior wall of the sphenoid sinus and medial to the posterior end of the superior turbinate.