Figure 35

Sagittal (a) and endoscopic (b) views after uncinectomy and identification of the maxillary natural ostium. The frontal recess is identified by drawing a line (solid arrow) parallel to the bony nasolacrimal duct (oval) and directed superiorly from the 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 adjacent to the middle tur-binate vertical lamella (MT). B = area of the ethmoid bulla. I = lateral wall of the infundibulum. IT = inferior turbinate.

inadvertent penetration into the anterior cranial fossa at the level of the anterior ethmoid artery. An upbiting forceps or giraffe forceps is used to carefully collect the bony fragments. As with the ethmoid, maxillary, and sphenoid sinuses, an attempt is made to preserve as much as possible of the frontal recess and frontal ostium mucosa circumferentially to diminish the chance of prolonged healing, fibrosis, or osteoneogenesis, and subsequent ostial stenosis or complete closure. Through-cut forceps or powered instrumentation with angled cannulas can be used effectively for this purpose. In the presence of osteoneogenesis or fibrosis, more advanced endoscopic procedures may be required (see Section G below).

Transillumination can be used to confirm one's position in the frontal sinus. When the frontal sinus is correctly identified the telescope's light will transilluminate the frontal area. A supraorbital extension of an ethmoid cell will transilluminate in the medial canthal area.

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