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Nasopharynx
Published in Neeraj Sethi, R. James A. England, Neil de Zoysa, Head, Neck and Thyroid Surgery, 2020
An open medial maxillectomy can be used for tumours not extending into the lateral infratemporal fossa and is approached by a midfacial degloving. A lateral rhinotomy is employed if the superior ethmoids are involved. The sequence of bony cuts is: Osteotomy below inferior orbital rimOsteotomy antrum to vestibuleOsteotomy across frontal process of maxillaOsteotomy along floor of noseOsteotomy through lacrimal boneOsteotomy vertically through posterior end of medial antrum
Head and neck
Published in Aida Lai, Essential Concepts in Anatomy and Pathology for Undergraduate Revision, 2018
Attachments of orbicularis oculi muscle– origin (palpebral part): medial palpebral ligament– origin (orbital part): nasal part of frontal bone + frontal process of maxilla– insertion (palpebral part): lat. palpebral raphe– insertion (orbital part): circle around orbit– nerve SS: zygomatic branch of facial n. (CNVII)– function: closes eyelids gently (palpebral part) or forcefully (orbital part)
Test Paper 7
Published in Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike, Get Through, 2017
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike
All Le Fort fractures involve the pterygoid plate. In addition, Le Fort I involves maxilla and nasal septum. Le Fort II involves nasal bones, frontal process of maxilla, maxillary sinus, medial and inferior orbital wall. Le Fort III, in addition to II, involves lateral orbital wall and zygomatico-frontal suture. Le Fort II fracture is also called pyramidal fracture.
High-resolution computed tomography assessment of bony nasolacrimal parameters: variations due to age, sex, and facial features
Published in Orbit, 2021
Zhiheng Lin, Namita Kamath, Adeela Malik
The majority of NLDs have an oval configuration, with a greater diameter AP compared to transverse at the narrowest points, suggesting that transverse diameter is most important in flow limitation. In only 12 NLDs were the transverse measurements greater than the AP, and in 4 NLDs they were equivalent (i.e. a circular NLD). A greater value in any NLD measure correlated very strongly (p < .001) positively with any other NLD measure except for length, e.g. a larger entrance area correlates with a larger exit and larger minimum diameters. Our results showed a significant correlation between longer NLDs and larger exits of the NLD, but narrower minimum AP diameters, suggesting longer NLDs have a more hourglass rather than cylindrical shape, and are perhaps more prone to obstruction as a result. We also found a wider upper face correlates with a wider nose but more importantly with a larger NLD, which agrees with previous work in multiple races also using the inter-frontozygomatico suture distance as a landmark.12 Kang et al. found taller noses relate to a thinner frontal process of the maxilla in Koreans, but another study found no such link, nor in this study.5,11 We found a thicker frontal process of maxilla correlated only with a larger NLD entrance. This study reveals that a taller nose correlates significantly with a narrower NLD, at the entrance, exit, and minimum transverse diameter. This has not been published before.
The importance of endoscopy in lacrimal surgery
Published in Expert Review of Ophthalmology, 2018
Akshay Gopinathan Nair, Swati Singh, Saurabh Kamal, Mohammad Javed Ali
Some of the initial challenges for oculoplastic surgeons are unfamiliar nasal anatomy which is often variable; newer instruments, lack of binocularity with nasal endoscopes, achieving dexterity and instruments maneuvering within the confines of nasal cavity [14]. The use of a trans-canalicular light source and observing it through the nasal endoscope allows a quick and easy way to find the location of lacrimal sac on the lateral nasal wall for the uninitiated ophthalmologist. The brightest light point indicates the location of common canaliculus and the surrounding few millimeters area would correspond to where the lacrimal sac is located. Although it is easy, it does not help in identifying the entire intranasal surface marking of lacrimal sac in relation to the lateral nasal wall and therefore the precise knowledge of the important nasal structures is essential. Previously it was thought that up to 20% of the lacrimal sac lies above the level of middle turbinate, therefore until the late 1990s the idea of creating a superior osteotomy was not popular. A landmark study by Wormald described that the significant part of the sac lies above the level of common canaliculus and major portion of lacrimal sac is situated above the level of the axilla of middle turbinate on the lateral nasal wall [13]. It was hence identified as an important step to remove the superior thick frontal process of maxilla during En-DCR to ensure the complete exposure of sac. This not only has implications in En-DCR but even in external DCR, when often times, surgeons do not remove bone above the level of the common canaliculus, thus highlighting the importance of endoscopy.
Outcomes of primary powered endoscopic dacryocystorhinostomy in syndromic congenital nasolacrimal duct obstruction
Published in Orbit, 2020
Swati Singh, Dinesh Selva, Arpita Nayak, Alkis Psaltis, Mohammad Javed Ali
DCR in patients with craniofacial anomalies can pose a surgical challenge due to multiple anatomical abnormalities. Some of these include a high riding lacrimal sac, distorted and confined nasal anatomy, disturbed endoscopic landmarks and a thick frontal process of maxilla. The purpose of this study was to evaluate the outcomes of primary powered endoscopic DCR in patients with craniofacial syndromes with associated complex and refractory CNLDO.