Surgical Treatment of Sinusitis Dr Vishal Sharma Maxillary
![Surgical Treatment of Sinusitis Dr. Vishal Sharma Surgical Treatment of Sinusitis Dr. Vishal Sharma](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-1.jpg)
![Maxillary Sinusitis Surgical Treatment Methods: 1. Antral Washout 2. Intra-nasal Inferior meatal antrostomy (INA) Maxillary Sinusitis Surgical Treatment Methods: 1. Antral Washout 2. Intra-nasal Inferior meatal antrostomy (INA)](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-2.jpg)
![Antral Washout (proof puncture, antral lavage) Antral Washout (proof puncture, antral lavage)](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-3.jpg)
![Indications Diagnosis & treatment of chronic maxillary sinusitis not responding to conservative medications Cytology/culture Indications Diagnosis & treatment of chronic maxillary sinusitis not responding to conservative medications Cytology/culture](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-4.jpg)
![Tilley Lichwitz Antrum Puncture Trocar & Cannula Tilley Lichwitz Antrum Puncture Trocar & Cannula](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-5.jpg)
![Higginson Syringe Higginson Syringe](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-6.jpg)
![Trocar directed towards I/L tragus Trocar directed towards I/L tragus](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-7.jpg)
![Hole made 1. 25 cm behind anterior end of inferior turbinate Hole made 1. 25 cm behind anterior end of inferior turbinate](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-8.jpg)
![Antral irrigation Antral irrigation](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-9.jpg)
![Anesthesia: L. A. for adults. G. A. for children & uncooperative pt. Position: Sitting Anesthesia: L. A. for adults. G. A. for children & uncooperative pt. Position: Sitting](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-10.jpg)
![Complications 1. Hemorrhage ( Lateral Sphenopalatine artery) 2. Pain & swelling of cheek (breach Complications 1. Hemorrhage ( Lateral Sphenopalatine artery) 2. Pain & swelling of cheek (breach](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-11.jpg)
![Intranasal antrostomy (INA) • Region of antral puncture in inferior meatus perforated with Tilley's Intranasal antrostomy (INA) • Region of antral puncture in inferior meatus perforated with Tilley's](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-12.jpg)
![](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-13.jpg)
![Caldwell – Luc Surgery George Caldwell, 1893, New York Henri Luc, 1897, Paris Caldwell – Luc Surgery George Caldwell, 1893, New York Henri Luc, 1897, Paris](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-14.jpg)
![Indications Chronic refractory maxillary sinusitis Oro-antral fistula closure Foreign body removal from maxillary antrum Indications Chronic refractory maxillary sinusitis Oro-antral fistula closure Foreign body removal from maxillary antrum](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-15.jpg)
![Exposure of incision site Exposure of incision site](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-16.jpg)
![Incision 4 cm long, sub-labial, horizontal incision made 3 mm above & parallel to Incision 4 cm long, sub-labial, horizontal incision made 3 mm above & parallel to](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-17.jpg)
![Incision deepened till periosteum Incision deepened till periosteum](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-18.jpg)
![Anterior wall broken with osteotome Anterior wall broken with osteotome](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-19.jpg)
![Hole made in anterior wall Hole made in anterior wall](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-20.jpg)
![Suction of maxillary sinus Suction of maxillary sinus](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-21.jpg)
![Inferior meatal antrostomy Inferior meatal antrostomy](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-22.jpg)
![Packing of maxillary sinus Packing of maxillary sinus](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-23.jpg)
![Packing of sinus & nose Packing of sinus & nose](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-24.jpg)
![Incision closed Incision closed](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-25.jpg)
![Complications Facial: Cheek edema, ecchymosis, subcutaneous emphysema, infraorbital n. paresthesia Orbital: Hematoma, extraocular muscle Complications Facial: Cheek edema, ecchymosis, subcutaneous emphysema, infraorbital n. paresthesia Orbital: Hematoma, extraocular muscle](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-26.jpg)
![Ethmoid Sinusitis Surgical Treatment Methods: 1. Intra-nasal microscopic ethmoidectomy 2. Extra-nasal Ethmoidectomy a. Lynch Ethmoid Sinusitis Surgical Treatment Methods: 1. Intra-nasal microscopic ethmoidectomy 2. Extra-nasal Ethmoidectomy a. Lynch](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-27.jpg)
![Lynch Howarth ethmoidectomy Lynch Howarth ethmoidectomy](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-28.jpg)
![Patterson ethmoidectomy Patterson ethmoidectomy](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-29.jpg)
![Trans-antral ethmoidectomy • Caldwell – Luc surgery done to reach maxillary antrum • Ethmoid Trans-antral ethmoidectomy • Caldwell – Luc surgery done to reach maxillary antrum • Ethmoid](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-30.jpg)
![Frontal Sinusitis Surgical Treatment Methods: 1. Trephination of frontal sinus 2. Modified Lothrop procedure Frontal Sinusitis Surgical Treatment Methods: 1. Trephination of frontal sinus 2. Modified Lothrop procedure](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-31.jpg)
![Frontal sinus trephination Frontal sinus trephination](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-32.jpg)
![Frontal sinus trephination 2 -cm incision made 1 cm below medial end of eyebrow Frontal sinus trephination 2 -cm incision made 1 cm below medial end of eyebrow](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-33.jpg)
![Frontal sinus trephination Frontal sinus trephination](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-34.jpg)
![Osteoplastic flap procedure Osteoplastic flap procedure](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-35.jpg)
![Osteoplastic flap procedure Osteoplastic flap procedure](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-36.jpg)
![Lothrop Procedure Removal of frontal sinus (inferior septum + floor) + superior part of Lothrop Procedure Removal of frontal sinus (inferior septum + floor) + superior part of](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-37.jpg)
![Lothrop Procedure Lothrop Procedure](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-38.jpg)
![Sphenoid sinus Surgical Treatment Methods: 1. Trans-nasal trans-septal approach 2. Sublabial trans-septal approach 3. Sphenoid sinus Surgical Treatment Methods: 1. Trans-nasal trans-septal approach 2. Sublabial trans-septal approach 3.](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-39.jpg)
![Sublabial trans-septal approach Sublabial trans-septal approach](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-40.jpg)
![External ethmoidectomy approach External ethmoidectomy approach](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-41.jpg)
![Endoscopic approach Endoscopic approach](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-42.jpg)
![Functional Endoscopic Sinus Surgery Functional Endoscopic Sinus Surgery](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-43.jpg)
![F. E. S. S. F. E. S. S.](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-44.jpg)
![Anatomy of lateral wall Anatomy of lateral wall](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-45.jpg)
![Steps of F. E. S. S. 1. Uncinectomy (Infundibulotomy) 2. Anterior ethmoidectomy 3. Middle Steps of F. E. S. S. 1. Uncinectomy (Infundibulotomy) 2. Anterior ethmoidectomy 3. Middle](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-46.jpg)
![Steps of F. E. S. S. Steps of F. E. S. S.](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-47.jpg)
![Left nasal cavity Left nasal cavity](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-48.jpg)
![Left middle meatus Left middle meatus](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-49.jpg)
![Left middle meatus Left middle meatus](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-50.jpg)
![Incision on uncinate process Incision on uncinate process](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-51.jpg)
![Incision completed Incision completed](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-52.jpg)
![Uncinate process removed Uncinate process removed](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-53.jpg)
![Opening of bulla ethmoidalis Opening of bulla ethmoidalis](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-54.jpg)
![Bulla ethmoidalis removed Bulla ethmoidalis removed](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-55.jpg)
![Natural & accessory ostia exposed Natural & accessory ostia exposed](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-56.jpg)
![Middle meatal antrostomy done Middle meatal antrostomy done](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-57.jpg)
![Opening made on basal lamella Opening made on basal lamella](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-58.jpg)
![Basal lamella removed Basal lamella removed](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-59.jpg)
![Posterior ethmoidectomy done Posterior ethmoidectomy done](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-60.jpg)
![Anterior sphenoid sinus wall Anterior sphenoid sinus wall](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-61.jpg)
![Interior of sphenoid sinus Interior of sphenoid sinus](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-62.jpg)
![Skull base clearance done Skull base clearance done](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-63.jpg)
![Frontal recess opened Frontal recess opened](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-64.jpg)
![Final FESS cavity Final FESS cavity](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-65.jpg)
![](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-66.jpg)
![Surgical Navigation Surgical Navigation](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-67.jpg)
![Complications Major (1%) Major epistaxis Orbital hematoma Diplopia Blindness or ed visual acuity Internal Complications Major (1%) Major epistaxis Orbital hematoma Diplopia Blindness or ed visual acuity Internal](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-68.jpg)
![Thank You Thank You](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-69.jpg)
- Slides: 69
![Surgical Treatment of Sinusitis Dr Vishal Sharma Surgical Treatment of Sinusitis Dr. Vishal Sharma](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-1.jpg)
Surgical Treatment of Sinusitis Dr. Vishal Sharma
![Maxillary Sinusitis Surgical Treatment Methods 1 Antral Washout 2 Intranasal Inferior meatal antrostomy INA Maxillary Sinusitis Surgical Treatment Methods: 1. Antral Washout 2. Intra-nasal Inferior meatal antrostomy (INA)](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-2.jpg)
Maxillary Sinusitis Surgical Treatment Methods: 1. Antral Washout 2. Intra-nasal Inferior meatal antrostomy (INA) 3. Caldwell - Luc surgery 4. Middle meatal antrostomy 5. Functional Endoscopic Sinus Surgery (FESS)
![Antral Washout proof puncture antral lavage Antral Washout (proof puncture, antral lavage)](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-3.jpg)
Antral Washout (proof puncture, antral lavage)
![Indications Diagnosis treatment of chronic maxillary sinusitis not responding to conservative medications Cytologyculture Indications Diagnosis & treatment of chronic maxillary sinusitis not responding to conservative medications Cytology/culture](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-4.jpg)
Indications Diagnosis & treatment of chronic maxillary sinusitis not responding to conservative medications Cytology/culture sensitivity of antral contents Contraindications Age < 3 yrs Hypoplastic maxilla with thick bony walls Acute maxillary sinusitis untreated by antibiotics Trauma to maxillary sinus or Fracture of orbital floor Drainage of maxillary antral hematoma
![Tilley Lichwitz Antrum Puncture Trocar Cannula Tilley Lichwitz Antrum Puncture Trocar & Cannula](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-5.jpg)
Tilley Lichwitz Antrum Puncture Trocar & Cannula
![Higginson Syringe Higginson Syringe](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-6.jpg)
Higginson Syringe
![Trocar directed towards IL tragus Trocar directed towards I/L tragus](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-7.jpg)
Trocar directed towards I/L tragus
![Hole made 1 25 cm behind anterior end of inferior turbinate Hole made 1. 25 cm behind anterior end of inferior turbinate](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-8.jpg)
Hole made 1. 25 cm behind anterior end of inferior turbinate
![Antral irrigation Antral irrigation](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-9.jpg)
Antral irrigation
![Anesthesia L A for adults G A for children uncooperative pt Position Sitting Anesthesia: L. A. for adults. G. A. for children & uncooperative pt. Position: Sitting](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-10.jpg)
Anesthesia: L. A. for adults. G. A. for children & uncooperative pt. Position: Sitting / supine. Technique: Puncture lateral wall of inferior meatus with Tilley-Litchwitz antral trocar & cannula, just anterior to turbinate genu, trocar directed towards tragus of ipsilateral ear, with gentle boring action. Advance till it hits posterior wall, then withdraw slightly. Remove trocar & wash sinus with saline at 370 C with pt leaning forwards & saying k k. Wash till clear fluid comes. Remove cannula.
![Complications 1 Hemorrhage Lateral Sphenopalatine artery 2 Pain swelling of cheek breach Complications 1. Hemorrhage ( Lateral Sphenopalatine artery) 2. Pain & swelling of cheek (breach](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-11.jpg)
Complications 1. Hemorrhage ( Lateral Sphenopalatine artery) 2. Pain & swelling of cheek (breach of anterior wall) 3. Orbital damage (perforation of orbital floor) 4. Perforation of posterior wall (maxillary artery injury) 5. Vasovagal attack 6. Fatal air embolism
![Intranasal antrostomy INA Region of antral puncture in inferior meatus perforated with Tilleys Intranasal antrostomy (INA) • Region of antral puncture in inferior meatus perforated with Tilley's](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-12.jpg)
Intranasal antrostomy (INA) • Region of antral puncture in inferior meatus perforated with Tilley's antral harpoon. • Antrostomy enlarged with Tilley's antral burr or Myle’s nasoantral perforator.
![](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-13.jpg)
![Caldwell Luc Surgery George Caldwell 1893 New York Henri Luc 1897 Paris Caldwell – Luc Surgery George Caldwell, 1893, New York Henri Luc, 1897, Paris](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-14.jpg)
Caldwell – Luc Surgery George Caldwell, 1893, New York Henri Luc, 1897, Paris
![Indications Chronic refractory maxillary sinusitis Oroantral fistula closure Foreign body removal from maxillary antrum Indications Chronic refractory maxillary sinusitis Oro-antral fistula closure Foreign body removal from maxillary antrum](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-15.jpg)
Indications Chronic refractory maxillary sinusitis Oro-antral fistula closure Foreign body removal from maxillary antrum Fungal maxillary sinusitis Elevation of orbital floor fractures Ethmoidectomy (trans-antral) Biopsy of suspicious neoplasm of maxillary antrum Orbital floor decompression Antrochoanal polyp (recurrent) Route to pterygo-palatine fossa (Vidian nerve, Max Artery) Dental / dentigerous cyst (maxillary antrum) removal
![Exposure of incision site Exposure of incision site](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-16.jpg)
Exposure of incision site
![Incision 4 cm long sublabial horizontal incision made 3 mm above parallel to Incision 4 cm long, sub-labial, horizontal incision made 3 mm above & parallel to](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-17.jpg)
Incision 4 cm long, sub-labial, horizontal incision made 3 mm above & parallel to the gingival margin, from lateral incisor to 2 nd molar tooth.
![Incision deepened till periosteum Incision deepened till periosteum](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-18.jpg)
Incision deepened till periosteum
![Anterior wall broken with osteotome Anterior wall broken with osteotome](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-19.jpg)
Anterior wall broken with osteotome
![Hole made in anterior wall Hole made in anterior wall](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-20.jpg)
Hole made in anterior wall
![Suction of maxillary sinus Suction of maxillary sinus](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-21.jpg)
Suction of maxillary sinus
![Inferior meatal antrostomy Inferior meatal antrostomy](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-22.jpg)
Inferior meatal antrostomy
![Packing of maxillary sinus Packing of maxillary sinus](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-23.jpg)
Packing of maxillary sinus
![Packing of sinus nose Packing of sinus & nose](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-24.jpg)
Packing of sinus & nose
![Incision closed Incision closed](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-25.jpg)
Incision closed
![Complications Facial Cheek edema ecchymosis subcutaneous emphysema infraorbital n paresthesia Orbital Hematoma extraocular muscle Complications Facial: Cheek edema, ecchymosis, subcutaneous emphysema, infraorbital n. paresthesia Orbital: Hematoma, extraocular muscle](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-26.jpg)
Complications Facial: Cheek edema, ecchymosis, subcutaneous emphysema, infraorbital n. paresthesia Orbital: Hematoma, extraocular muscle trauma, diplopia, globe trauma, blindness Oral: Trauma to teeth roots, Superior alveolar nerve damage, Dental anesthesia, Oroantral fistula Vascular: Internal maxillary artery injury
![Ethmoid Sinusitis Surgical Treatment Methods 1 Intranasal microscopic ethmoidectomy 2 Extranasal Ethmoidectomy a Lynch Ethmoid Sinusitis Surgical Treatment Methods: 1. Intra-nasal microscopic ethmoidectomy 2. Extra-nasal Ethmoidectomy a. Lynch](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-27.jpg)
Ethmoid Sinusitis Surgical Treatment Methods: 1. Intra-nasal microscopic ethmoidectomy 2. Extra-nasal Ethmoidectomy a. Lynch Howarth procedure b. Patterson trans-orbital procedure c. Trans-antral (Jansen Horgan procedure) 3. Functional Endoscopic Sinus Surgery
![Lynch Howarth ethmoidectomy Lynch Howarth ethmoidectomy](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-28.jpg)
Lynch Howarth ethmoidectomy
![Patterson ethmoidectomy Patterson ethmoidectomy](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-29.jpg)
Patterson ethmoidectomy
![Transantral ethmoidectomy Caldwell Luc surgery done to reach maxillary antrum Ethmoid Trans-antral ethmoidectomy • Caldwell – Luc surgery done to reach maxillary antrum • Ethmoid](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-30.jpg)
Trans-antral ethmoidectomy • Caldwell – Luc surgery done to reach maxillary antrum • Ethmoid cells approached via postero-superomedial angle of maxillary antrum
![Frontal Sinusitis Surgical Treatment Methods 1 Trephination of frontal sinus 2 Modified Lothrop procedure Frontal Sinusitis Surgical Treatment Methods: 1. Trephination of frontal sinus 2. Modified Lothrop procedure](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-31.jpg)
Frontal Sinusitis Surgical Treatment Methods: 1. Trephination of frontal sinus 2. Modified Lothrop procedure 3. Osteoplastic Flap surgery 4. Functional Endoscopic Sinus Surgery
![Frontal sinus trephination Frontal sinus trephination](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-32.jpg)
Frontal sinus trephination
![Frontal sinus trephination 2 cm incision made 1 cm below medial end of eyebrow Frontal sinus trephination 2 -cm incision made 1 cm below medial end of eyebrow](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-33.jpg)
Frontal sinus trephination 2 -cm incision made 1 cm below medial end of eyebrow & deepened up to bone. Frontal sinus floor opened by drilling with burr. Opening enlarged with Citelli’s punch forceps to drain pus. Drainage tube inserted inside frontal sinus cavity & sutured in place. Regular lavage of the frontal sinus done through drainage tube for 48 -72 hours post-operatively.
![Frontal sinus trephination Frontal sinus trephination](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-34.jpg)
Frontal sinus trephination
![Osteoplastic flap procedure Osteoplastic flap procedure](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-35.jpg)
Osteoplastic flap procedure
![Osteoplastic flap procedure Osteoplastic flap procedure](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-36.jpg)
Osteoplastic flap procedure
![Lothrop Procedure Removal of frontal sinus inferior septum floor superior part of Lothrop Procedure Removal of frontal sinus (inferior septum + floor) + superior part of](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-37.jpg)
Lothrop Procedure Removal of frontal sinus (inferior septum + floor) + superior part of nasal septum
![Lothrop Procedure Lothrop Procedure](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-38.jpg)
Lothrop Procedure
![Sphenoid sinus Surgical Treatment Methods 1 Transnasal transseptal approach 2 Sublabial transseptal approach 3 Sphenoid sinus Surgical Treatment Methods: 1. Trans-nasal trans-septal approach 2. Sublabial trans-septal approach 3.](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-39.jpg)
Sphenoid sinus Surgical Treatment Methods: 1. Trans-nasal trans-septal approach 2. Sublabial trans-septal approach 3. External ethmoidectomy approach 4. Endoscopic intra-nasal approach 5. Functional Endoscopic Sinus Surgery
![Sublabial transseptal approach Sublabial trans-septal approach](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-40.jpg)
Sublabial trans-septal approach
![External ethmoidectomy approach External ethmoidectomy approach](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-41.jpg)
External ethmoidectomy approach
![Endoscopic approach Endoscopic approach](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-42.jpg)
Endoscopic approach
![Functional Endoscopic Sinus Surgery Functional Endoscopic Sinus Surgery](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-43.jpg)
Functional Endoscopic Sinus Surgery
![F E S S F. E. S. S.](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-44.jpg)
F. E. S. S.
![Anatomy of lateral wall Anatomy of lateral wall](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-45.jpg)
Anatomy of lateral wall
![Steps of F E S S 1 Uncinectomy Infundibulotomy 2 Anterior ethmoidectomy 3 Middle Steps of F. E. S. S. 1. Uncinectomy (Infundibulotomy) 2. Anterior ethmoidectomy 3. Middle](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-46.jpg)
Steps of F. E. S. S. 1. Uncinectomy (Infundibulotomy) 2. Anterior ethmoidectomy 3. Middle meatal antrostomy 4. Perforation of basal lamella 5. Posterior ethmoidectomy 6. Sphenoid sinus exploration 7. Skull base disease clearance 8. Frontal recess exploration
![Steps of F E S S Steps of F. E. S. S.](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-47.jpg)
Steps of F. E. S. S.
![Left nasal cavity Left nasal cavity](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-48.jpg)
Left nasal cavity
![Left middle meatus Left middle meatus](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-49.jpg)
Left middle meatus
![Left middle meatus Left middle meatus](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-50.jpg)
Left middle meatus
![Incision on uncinate process Incision on uncinate process](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-51.jpg)
Incision on uncinate process
![Incision completed Incision completed](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-52.jpg)
Incision completed
![Uncinate process removed Uncinate process removed](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-53.jpg)
Uncinate process removed
![Opening of bulla ethmoidalis Opening of bulla ethmoidalis](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-54.jpg)
Opening of bulla ethmoidalis
![Bulla ethmoidalis removed Bulla ethmoidalis removed](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-55.jpg)
Bulla ethmoidalis removed
![Natural accessory ostia exposed Natural & accessory ostia exposed](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-56.jpg)
Natural & accessory ostia exposed
![Middle meatal antrostomy done Middle meatal antrostomy done](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-57.jpg)
Middle meatal antrostomy done
![Opening made on basal lamella Opening made on basal lamella](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-58.jpg)
Opening made on basal lamella
![Basal lamella removed Basal lamella removed](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-59.jpg)
Basal lamella removed
![Posterior ethmoidectomy done Posterior ethmoidectomy done](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-60.jpg)
Posterior ethmoidectomy done
![Anterior sphenoid sinus wall Anterior sphenoid sinus wall](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-61.jpg)
Anterior sphenoid sinus wall
![Interior of sphenoid sinus Interior of sphenoid sinus](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-62.jpg)
Interior of sphenoid sinus
![Skull base clearance done Skull base clearance done](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-63.jpg)
Skull base clearance done
![Frontal recess opened Frontal recess opened](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-64.jpg)
Frontal recess opened
![Final FESS cavity Final FESS cavity](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-65.jpg)
Final FESS cavity
![](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-66.jpg)
![Surgical Navigation Surgical Navigation](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-67.jpg)
Surgical Navigation
![Complications Major 1 Major epistaxis Orbital hematoma Diplopia Blindness or ed visual acuity Internal Complications Major (1%) Major epistaxis Orbital hematoma Diplopia Blindness or ed visual acuity Internal](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-68.jpg)
Complications Major (1%) Major epistaxis Orbital hematoma Diplopia Blindness or ed visual acuity Internal carotid injury Intracranial hemorrhage CSF leak / Meningitis Pneumocephalus Anosmia Nasolacrimal duct trauma Minor (7%) Minor epistaxis Hyposmia Adhesions (synechiae) Headache Periorbital echhymosis Periorbital hematoma Dental / facial pain
![Thank You Thank You](https://slidetodoc.com/presentation_image_h2/6702abb2e221d6a8108da0cc9a42066f/image-69.jpg)
Thank You
Dr vishal sharma
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