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By R Casiano

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Example text

PE = posterior ethmoid. L- 22 Figure 22 Sagittal (a) and endoscopic (b) views showing a wide middle meatal antrostomy. The horizontal and vertical ridge of the maxillary antrostomy (arrows) and adjacent MOF correctly identify the surgeon’s location within the ethmoid sinus and helps maintain the correct anteroposterior trajectory as he or she proceeds toward the sphenoid sinus. The posterior wall of the maxillary sinus (PM) demarcates the relative level of the anterior wall of the sphenoid sinus in the coronal plane.

SP = supreme turbinate. IM = inferior meatus. MM = middle meatus. Asterisks = sphenoethmoidal recess. LS = lacrimal sac. D = lacrimal duct. PF = posterior fontanelle. NS = nasal septum. ET = eustachian tube orifice. Small arrows in the endoscopic view denote the posterior choanal arch. L- 12 Figure 12 Dotted line demarcates the incision for an inferior turbinoplasty. This can be performed with a cutting forceps, sickle knife, or powered instrumentation. L- 13 Figure 13 Endoscopic view showing the proposed incision (dotted line) for the L-shaped posterosuperiorly based mucoperichondrial flap.

The frontal sinus is identified by drawing a line (solid arrow) parallel to the bony nasolacrimal duct (oval) and directed superiorly from the anterior border of the antrostomy or maxillary sinus natural ostium area to a point 5 to 10 mm behind the anterior attachment of the middle turbinate (asterisk). The correct point of entry will be directed superomedially away from the wall of the orbit and anteriorly away from the anterior ethmoid artery (AA). S = sphenoid sinus. PE = area of the posterior ethmoid sinus.

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