By Werner Hosemann, J Fanghänel
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Extra info for A Dissection Course On Endoscopic Endonasal Sinus Surgery
30 and 31). • The curved curette is used to enter tissue spaces3 and for probing (without perforating bony lamellae).. • In most cases a "recess" located just lateral to the vertical lamella of the middle turbinate will lead". toward the frontal sinus. • Remove cell septa with the curette to the extentt that they can be removed without damaging the3 mucosa. Generally at this stage you will be workingi in a posterior-to-anterior direction. Simultaneous medial-to-lateral dissection is also performed where necessary.
Then cover the perforation with a small flap of autologous mucosa. • Now incise the periorbita: first incise the periorbita from posterior to anterior, making several passes with the knife (Fig. 41). The posterior-to-anterior cut is advantageous in vivo for keeping fat from herniating into the visual field. Next the periorbita is elevated by making anterior vertical cuts and is subtotally removed. • After exposing the orbital fat, perform the ocular pressure test (Fig. 42). ). The orbital fat can be loosened somewhat and dissected with the sickle knife.
45). Inferior cantholysis Lateral canthotomy Fig. 45 With a small scissors, a lateral horizontal cut is made in continuity with the lateral palpebral fissure, cutting through the skin and to the bony orbit. If anterior traction on the lower eyelid shows that the pressure is still not relieved, an inferior cantholysis is added: a downward cut is made from the initial incision (beneath the outer skin), dividing the inferior palpebral ligament. The lower eyelid can now be pulled slightly away from the globe.