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Related Concept Videos

Cranial Bones: Lateral View01:27

Cranial Bones: Lateral View

The lateral view of the cranium is dominated by temporal, sphenoid, and ethmoid bones.
The temporal bone forms the lower lateral side of the skull. The temporal bone is subdivided into several regions. The flattened upper portion is the squamous portion of the temporal bone. Below this area and projecting anteriorly is the zygomatic process of the temporal bone, which forms the posterior portion of the zygomatic arch. Posteriorly is the mastoid portion of the temporal bone. Projecting...

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Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
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Published on: July 5, 2021

Lateral frontal sinus access in endoscopic skull-base surgery.

Daniel G Timperley1, Catherine Banks, Daniel Robinson

  • 1Department of Otolaryngology-Head and Neck Surgery, Concord General Hospital, Sydney, Australia. daniel.timperley@gmail.com

International Forum of Allergy & Rhinology
|January 31, 2012
PubMed
Summary

The modified endoscopic Lothrop (MELP) procedure offers excellent lateral frontal sinus access, but orbital roof access is limited, especially laterally. Predicting endoscopic reach is crucial for surgical planning.

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Area of Science:

  • Otolaryngology
  • Neurosurgery
  • Endoscopic Sinus Surgery

Background:

  • The modified endoscopic Lothrop (MELP) or Draf III procedure expands endoscopic access to the frontal sinus.
  • Predicting the extent of endoscopic frontal sinus access, particularly for tumor resection, remains challenging due to limited data.

Purpose of the Study:

  • To evaluate the extent of frontal sinus access provided by the MELP procedure in cadavers.
  • To identify factors influencing endoscopic access to different frontal sinus walls and the orbital roof.

Main Methods:

  • MELP was performed on 10 cadaver heads.
  • Endoscopic access was assessed using a 70-degree diamond burr, evaluating contact with the orbital roof, and anterior/posterior frontal sinus walls.
  • Measurements were taken in millimeters from medial orbital and lateral quartile zones.

Main Results:

  • Excellent anterior and posterior lateral wall access was achieved in 95% of sinuses.
  • Orbital roof access was limited (10.3 ± 4.6 mm), with only 10% of lateral orbital roofs contacted in sinuses extending beyond the midorbital point.
  • Orbital roof access correlated with the anteroposterior distance between the olfactory fossa and frontal beak (r = 0.6, p < 0.01).

Conclusions:

  • The MELP procedure provides excellent lateral endoscopic access to the frontal sinus walls, excluding the sinus floor.
  • Endoscopic access to the orbital roof is reliable only in the medial portion, with minimal access laterally.
  • Understanding these limitations is vital for surgical planning and managing patient expectations regarding endoscopic approaches.