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Functional Endoscopic Sinus Surgery: Maxillary Antrostomy with Anterior Ethmoidectomy

This procedure was performed on a 6 year old male with chronic rhinosinusitis who had failed medical management and was subsequently found to have maxillary hypoplasia with computed tomography.

Surgeon: Gresham T. Richter, M.D.

1% lidocaine with epinephrine to achieve vasoconstriction is injected into the lateral nasal wall and middle turbinate. The middle turbinate is then gently medialized for exposure/visualization of the free edge of the uncinate process. The natural maxillary ostium is then identified and its position confirmed using a ball tip probe and the image guided navigation system. Retrograde dissection is performed with backbiting forceps and a microdebrider is used to remove the uncinate to its superior attachment, thus creating the uncinate window. The posterior fontanelle is then removed to further enlarge the maxillary ostium. The walls of the anterior ethmoid cells are then fractured and removed until the basal lamella of the middle turbinate, which separates the anterior ethmoid cells from the posterior, is visualized. The basal lamella is then removed to expose the posterior ethmoid cells. Finally, the inferior turbinate is fracture medially to allow debridement of excess tissue before being fractured laterally back to its original position.
-Chronic or recurrent acute sinusitis refractory to medical management -Maxillary neoplasms -Nasal polyps
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Oxymetazoline soaked pledgets are placed in the nasal cavity for 30 minutes preoperatively. Preoperative imaging is uploaded into the image guided navigation system
Maxillofacial CT scan without contrast
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-Epistaxis -Orbital injury -Damage to the nasolacrimal duct
None
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