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Rhinolaryngoscopy for the Allergist
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Jerald W Koepke, William K Dolen
The septum divides the nasal cavity into right and left chambers. The nasal vestibule is the most anterior and inferior portion of the nasal cavity (Fig. 11.3). It is bounded medially and laterally by the alar cartilages and extends to the inferior border of the lateral nasal cartilage. Above the vestibule and in front of the middle meatus is the nasal atrium, and above this is the agger nasi, a prominence which generally contains anterior ethmoid air cells. The nasal floor is formed anteriorly by the maxillary bone and posteriorly by the palatine bone. It is slightly concave and passes horizontally from the vestibule to the choana. The nasal vault narrows superiorly to form the roof of the nose.
Common rhinology and facial plastics viva topics
Published in Joseph Manjaly, Peter Kullar, Advanced ENT Training, 2019
An agger nasi cell is the most anterior ethmoid air cell, lying anterolateral to the frontal recess and anterior to the vertical insertion of the middle turbinate. It is present in almost 90% of adult sinuses. It is an anatomical landmark for the frontal recess.
Anatomy of the Nose and Paranasal Sinuses
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Dustin M. Dalgorf, Richard J. Harvey
Anterior structures encroaching on the frontal recess include the agger nasi, lateral uncinate process and frontal cells (Figure 87.21). The agger nasi is the anterior-most ethmoid air cell and its medial border is formed by the uncinate process.12 The degree of pneumatization of the agger nasi influences the position of the superior uncinate process and thickness of the bony nasofrontal beak.
In vivo analysis of endocanalicular light pipe transillumination in endoscopic dacryocystorhinostomy: Anatomic considerations and cautions for the transitioning
Published in Orbit, 2022
Nina S. Boal, Elizabeth A.Z. Cretara, Benjamin S. Bleier, Allen C. Lam, Daniel R. Lefebvre
As the endoscopic approach for DCR increasingly gains popularity, the authors anticipate that many oculoplastic surgeons transitioning from external to endo-DCR surgery will utilize the light pipe transillumination technique. We think this can potentially be a useful adjunct as long as the main anatomical landmark of the intersection between the maxillary line and its confluence at the axilla of the middle turbinate remains the key target for osteotomy creation, with attention to the removal of the frontal process of the maxilla to incorporate proper anterior removal of bone. Careful attention to the uncinate process as one progress posteriorly and to the possibility of an agger nasi cell as the osteotomy proceeds superiorly is also important. As the authors evolved in their own surgical technique, they no longer employed the use of lacrimal sac endo-illumination for endo-DCR surgery. Of greater utility to an advancing surgeon will be the development of a collegial collaboration between an oculoplastic surgeon and an otolaryngologist. Ultimately, the oculoplastic surgeon will likely perform endo-DCR as a solo surgeon; however, during transition there is great teaching that can occur in both directions. Additionally, many lacrimal patients benefit from adjunctive procedures, including septoplasty and endoscopic sinus surgery, thus it is important to identify these situations pre-operatively and to have a good working relationship with an otolaryngologist.
Association between septoplasty, Lund-Mackay score and Lund-Kennedy score with endoscopic dacryocystorhinostomy results
Published in Orbit, 2021
Sercan Cikrikci, Erol Erkan, Fatih Agdas
Nasal endoscopy and paranasal sinus tomography can help us to evaluate the nasal anatomy, to determine the position of uncinate process and its relationship with the lacrimal system. In addition, potential sinus diseases and pneumotization of the agger nasi can be determined with PNCT. In a study by Lefebvre et al., they suggested that CT scanning for detecting sinonasal malformations, pathologies such as middle turbinate concha bullosa or accompanying sinusitis, is beneficial for a successful end-DCR.15
Outcomes in pediatric powered endoscopic dacryocystorhinostomy: a single-center experience
Published in Orbit, 2019
Nandini Bothra, Milind N. Naik, Mohammad Javed Ali
All surgeries were performed under general anesthesia with intravenous induction and maintenance on inhalational agent sevoflurane by a single surgeon (MJA). Endoscopic surgery was performed with an Image 1 HD system (Karl Storz, Tuttlingen, Germany) using the 2.7 mm, 0-degree pediatric telescope or 4 mm, 0-degree in older children. Powered drill used was a specific diamond DCR burr attached to the Integrated Powered Console using an M5 handpiece (Medtronic, Jacksonville, FL, USA). Nasal decongestion was achieved with infiltration of the lateral wall and head of middle turbinate with 2% xylocaine with 1:80,000 adrenaline followed by nasal packing for 5–10 min. The patient was placed in supine position with head slightly elevated and neck slightly extended (reverse Trendelenburg position). The surgical technique was uniform as described by Wormald’s group earlier.3,6,7 In brief, a 15 no blade was used to fashion a posterior-based nasal mucosal flap centered over the lacrimal sac. This was achieved by a horizontal incision approximately about 6–8 mm above the axilla of the middle turbinate, continued for 8–10 mm anteriorly and then directing it vertically downward to a point just above the insertion of the inferior turbinate, before directing it backward toward the insertion of uncinate process. A Freer periosteal elevator was used to elevate the mucoperiosteal flap to expose the frontal process of maxilla and its junction with the lacrimal bone. A 2-mm Kerrison endoscopic rongeur was used to remove the exposed bone of the frontal process of the maxilla and hence fashion a large osteotomy. The thick frontal process of maxilla above the level of the axilla was uniformly removed using the DCR diamond burr (Medtronic, Jacksonville, FL, USA). Although there may be variations, exposure of agger nasi could be an additional marker for the fundus of the lacrimal sac. The end point of osteotomy was complete exposure of the lacrimal sac including the fundus. The medial wall of the lacrimal sac was then tented using the Bowman’s lacrimal probe and a crescent knife was used to make a vertical incision along the entire length of the lacrimal sac from the fundus down to the nasolacrimal duct and was completed with upper and lower horizontal releasing cuts. The lacrimal sac was completely marsupialized and both the anterior and posterior sac flaps were laid open flat on the lateral nasal wall, to achieve a 360-degree mucosa to mucosa approximation, to encourage healing by primary intention. Mitomycin C (MMC) (0.02%) was applied for 3 min as per the current basic science evidence16,17 and an additional circumostial injection of MMC was performed as per earlier published protocols.18 Bicanalicular Crawford intubation was performed in all patients. A limited anterior nasal packing was placed to soak any minimal postoperative ooze that may occur.