Abstract:
Introduction: The location of the natural ostium of the sphenoid sinus in the surgical field has been variably reported according to different standard points. However because of severer pathological changes, massive polyps in nasal cavities and altered anatomic reference points, revision endoscopic sinus surgery often challenges surgeon`s skill and experience. Through our endoscopic sinus surgeries, we noticed a constant relationship between middle meatal antrostomy and site of sphenoid face.
Objectives: To establish a novel approach to sphenoid sinus using middle meatal antrostomy as landmark in difficult cases of endoscopic sinus surgery with lost landmarks or revision ones. Study design: A prospective study
Patients and methods: Fifteen patients (6 males, 9 females) with mean age of 37.7 ys, have been operated with endoscopic sinus surgery for different pathologies, after finishing middle meatal antrostomy and sphenoidotomy, we drew an imaginary line between point at most postero-inferior margin of antrostomy (flush with posterior wall of maxillary sinus) directed superio-medially to posterior part of septum and touching superior limit of sphenoid face.
Results: On the images recorded after operation, we measured the angle between this line and horizontal, and found that to range from 40-45º, with a mean of 41.5º, this line had a mean length of 17.1 mm, anterior wall of sphenoid was always below this line.
Conclusion: A reference point on middle meatal antrostomy can be used as constant landmark to identify face of sphenoid sinus; this is mostly helpful in difficult cases of endoscopic sinus surgery.