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Anatomy of the Nose and Paranasal Sinuses
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Dustin M. Dalgorf, Richard J. Harvey
The ethmoid bulla is the largest and most consistent anterior ethmoid air cell. It attaches to the lamina papyracea laterally and has variable attachments to the skull base and basal lamella creating a series of clefts and spaces that are well described.1 An infra-orbital anterior ethmoid cell can pneumatise into the maxillary sinus as a normal variant called a Haller cell.
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 semilunar hiatus (hiatus semilunaris), is a crescent-shaped cleft located in the middle meatus (Fig. 11.5). The ostium of the nasofrontaI duct and the anterior ethmoid sinus ostia typically are located in the anterior and midportions of the hiatus. The nasofrontal duct may have a separate opening anterior to the semilunar hiatus. The maxillary sinuses open into the posteroinferior portion of the semilunar hiatus. The ostium of the maxillary sinus varies in size in normal individuals from pinpoint to several millimeters in diameter and large accessory ostia may be present. The ethmoid bulla (bulla ethmoidalis) is a bulge containing anterior and middle ethmoid air cells, located posterior and superior to the semilunar hiatus.
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
Posterior structures encroaching on the frontal recess include supraorbital ethmoid cells, suprabulla cells and the ethmoid bulla (Figure 87.23). Supraorbital ethmoid cells are anterior ethmoid air cells that extend superiorly and laterally over the orbital roof.16 These cells are recognized on imaging giving the appearance of a septated frontal sinus on coronal view and a cell located posterior and lateral to the frontal sinus on axial view.16 Supraorbital ethmoid cells have three clinically significant features relevant to the frontal recess: (1) they can cause obstruction of the frontal recess, (2) they can be falsely mistaken for the true frontal sinus leading to incomplete surgical dissection and (3) they are associated with a low position of the anterior ethmoid artery within a mesentery because these cells pneumatize downward from the skull base behind the artery.17 The supraorbital ethmoid cell also creates a very narrow orbitocranial cleft posteriorly that can be very challenging to operate within.18 Suprabulla or frontal bulla cells are pneumatized extensions above the ethmoid bulla up the skull base and on the posterior table of the frontal sinus. These cells can become quite large and mistaken for either the skull base or posterior table of the frontal sinus. Failure to recognize these cells on pre-operative imaging will also result in incomplete surgical dissection of the frontal recess.
Oral antibiotics used in the treatment of chronic rhinosinusitis have limited penetration into the sinonasal mucosa: a randomized trial
Published in Xenobiotica, 2020
Joey Siu, Lilian Klingler, Yi Wang, Cheung-Tak Hung, Soo Hee Jeong, Susan Smith, Malcolm Drummond Tingle, Brett Wagner Mackenzie, Kristi Biswas, Richard George Douglas
Eligible patients were randomised using a random number generator to one of two groups: 1) doxycycline (100 mg orally with food daily for seven days) 2) roxithromycin (300 mg orally at least 30 minutes before food daily for seven days). Patients were diagnosed according to the European Position Paper (EPOS) definition of CRS (Fokkens et al., 2020). Patients started their medications seven days before surgery, taking one dose every morning up to and including the morning of surgery. All patients were recruited during a pre-operative consultation fewer than four weeks before FESS surgery (timepoint 1). During FESS, multiple specimens were collected from the patients in the medication groups (timepoint 2). Samples collected included blood, bilateral middle meatal mucus samples, inferior turbinates, and ethmoid bulla mucosa. Baseline rhinosinusitis symptoms (Toma and Hopkins, 2016) (SNOT-22), nasal endoscopy (Psaltis et al., 2014), radiological Lund-Mackay scores (Hopkins et al., 2007) and patient demographic data were collected at timepoint 1 (Table 1). Nasal endoscopy scores were derived from the Modified Lund-Kennedy System (MLK) for polyps, discharge, and oedema on a scale of 0–12 (Psaltis et al., 2014).
Surgical drainage of pediatric gas-containing orbital subperiosteal abscess
Published in Acta Oto-Laryngologica Case Reports, 2023
Tomoko Iwanami, Ryoji Kagoya, Keiichiro Isozaki, Ken Ito
Intraoperatively, we performed resection of the uncinated process and the ethmoidal bulla, maxillary antrostomy, and right orbital decompression with removal of the orbital lamina (1 cm × 1cm) (Figure 2A). The anterior ethmoidal artery was preserved (Figure 2A). We observed drainage of purulent discharge from the maxillary sinus and the subperiosteal space of the orbital lamina. The maxillary sinus mucosa was edematous (Figure 2B). Both aerobic and anaerobic cultures of pus obtained from the orbital subperiosteal space yielded no growth, which was attributable to 10-day course of intravenous antibiotics administered to the patient.