fess

1. Shahin Bastaninejad, MD
Assistant Prof. of ORL-HNS
TUMS
A m i r ’A l a m
H o s p i t a l

2. Outline
⚫
Definition
⚫
Anatomy
⚫
Patientevaluation
⚫
FESS Conceptsof Surgery

4. ⚫Ethmoid anatomy iscomplex: Labyrinth
⚫Lamellae
⚫1st - Uncinate
⚫2nd - Ethmoid bulla
⚫3rd - Basal lamellaof
middle turbinate
⚫4th - Superiorturbinate
Ethmoid anatomy

5. Drainage
⚫Frontal, anterior
ethmoid & maxillary –
OMC
⚫PosteriorEthmoids –
Superior meatus
⚫Sphenoid sinus –
Sphenoid-ethmoidal
recess

6. Middle Turbinate
⚫Three components
⚫First – Anterior, oriented in a sagittal planeand attached
toskull base
⚫Second – Middle, oriented in aVertical plane and
attached to lamina papyracea (basal lamella and
separates ant from postethmoids)
⚫Third – Posterior, oriented in a horizontal plane and
attaches to perpendicularplateof palate (forms roof of
middle meatus, anteriorto sphenopalatine foramen)

7. Middle Turbinate

8. Ostiomeatal Complex (OMC)
⚫
Commondrainage for frontal, maxillaryand anterior
ethmoid sinuses.

9. OMC

10. OMC
⚫Infundibulum – funnel shaped area whereby the
maxillary, antethmoid and frontal sinusesdrains
⚫Uncinateprocess– Sickleshaped bonyethmoidal
structure
⚫Hiatus Semilunaris – Half-moon shapeopening of
infundibulum

12. Uncinate Process
⚫Attaches to the following
structures:
1. Inf & far post. – To
ethmoid process of inf.
Turb

13. Uncinate Process
2. Ant & farsup. – To lamina
papyracea, skull base or
mid turb

14. 3. Laterally – Lamina
papyracea and
fontanelle area

15. Uncinate Process
52
%

17. Bulla Ethmoidalis
⚫Thegreatestanteriorethmoid
aircell, attached to lamina
papyrcea and usuallyopen
into lateral sinus

19. Sinus Lateralis = Suprabullar
recess and retrobullar recess

20. SBR
Sinus Lateralis
RBR
Middle turbinate: Horizontal
and vertical basal lamella

21. Sphenoid Ostium
⚫Medial to posteriorsup. turbinate
⚫Located between nasal septumand inferioraspectof
sup. turbinate
⚫Located at the same level as the roof of the maxillary
sinus
⚫Located 4 microdebrider/suction tip breathsabove the
choanae
⚫Located 7cm from nasal crestat 30°

22. Sphenoid Ostium

23. Sphenoid Sinus
⚫Relationshipsof importantstructures:
⚫Optic nerve – superior-lateral
⚫Carotid artery/cav sinus – mid-lateral
⚫Vidian nerve and maxillary nerve – inferior-lateral

24. Square – ant clinoid process, Circles – opticcanals, triangle – vidian nerve
Asterisk – pneumatization of pterygoid process

25. O – Orbit, Optic Nerve, Onodi Cells
⚫
Check fordehiscence
⚫
Assess foronodi cells (superior-lateral tosphenoid)
⚫
Orbital slope

26. Sphenoid Classification

27. Sellar
Presellar
Conchal Post
sellar

28. Onodi Cells or Sphenoethmoid cells

29. Optic Canal in Onodi Cells

30. anatomic keyhole in SBS

31. LOCR

32. Kerosclassification
Cribriform plate
1-3mm 3-7mm
7-16mm

33. Keros Classification
⚫
Type I
⚫
1-3mm
⚫
Type II
⚫
3-7mm
⚫
Type III
⚫
7-16mm

34. Fovea and Ethmoidal arteries

35. Lens 70 degree – End of surgery

36. Frontal Cells
Kuhn Cells

37. Frontal Recess
⚫Anatomic Boundries:
⚫ Ant – unicate process & aggernasi
⚫ Post – bulla ethmoidalisand suprabullar lamella
⚫ Lateral – laminapapyracea
⚫ Medially – hiatussemilunarisor middle turb
⚫ Inf – Ethmoid infundibulum
⚫ Sup – Foveaethmoidalis, supraorbital aircell, anteriorethmoid
arteryand frontal ostium

38. Draf I
Draf IIA

39. E – Ethmoid Artery

40. Draf
Draf III

41. Frontal Sinus – Mucociliary Pattern
 Save Mucosal Layer in
part
Draf
while
III
Lateral
performing
opertation