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2009년 8월 Ethmoid bone dissection-lateral nasal sinus anatomy

2009년 8월 Ethmoid bone dissection-lateral nasal sinus anatomy

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2009년 8월 4일 안성용

Nasal turbinate

Paranasal sinuses
; frontal sinus, maxillary sinus, ethmoid sinus, sphenoid sinus

The Ostiomeatal Complex(OMC)
; air cells of anterior ethmoid and ostia ; middle meatus ; final sections of the common drainage and ventilation pathway of the frontal, maxillary, and anterior ethmoid sinuses

The Ostiomeatal Complex(OMC) 2
Agger nasi cell Uncinate process Bulla ethmoidalis Hiatus semilunaris inferior Middle turbinate Maxillar sinus ostium Frontal sinus ostium

Agger nasi cell
- located medial to lacrimal sac and fossa anterior to the uncinate process - product of pneumatization of the lacrimal bone

Uncinate process
; sickle-shaped, thin, bony plate ; attachment anterior : anterosuperiorly, attached to the MT : form the inferomedial wall of agger nasi cell inferior : inferior turbinate and palatine bone posterior : parallel to the curvature of bulla ethmoidalis superior : attach to lacrimal bone base of the skull or LP always fuses with the MT anterosuperiorly

Uncinate process 2

Middle turbinate
- conchal head, conchal neck, conchal sinus - conchal sinus, cavity between ethmoid bulla and MT - 3 discernible component 1st. Part ; anterior and medial position, sagittal plane attach vertically to the skull base, LT, lateral lamella 2nd. Part ; frontal plane attach laterally to the lamina papyracea in an oblique fashion 3rd. Part ; (basal lamella) horizontal plane attach laterally to the perpendicular plate of palatine

Middle turbinate 2
Plane Vertical(Sagittal plane) Oblique(Frontal plane) Horizontal plane Attachment Crista ethmoidalis and the skull base Lamina papyracea Lamina papyracea & lamina perpendicularis

Three part Anterior 1/3 Middle 1/3 Posterior 1/3

Basal lamella
1st. Uncinate process 2nd. Bulla ethmoidalis 3rd. Basal lamella of the middle turbinate 4th. Lamella of the superior turbinate 5th. Lamella of the supreme turbinate

Bulla Ethmoidalis
- most constant landmark - Boundary anterior ; convex curvature posterior free border of UP superior ; Fovea posterior ; basal lamella(variable) lateral ; lamina papyracea medial ; covered by middle turbinate

Hiatus Semilunaris Inferior
- sickle-shaped 2D cleft - average width, 1.5mm - between the ethmoidal bulla and free edge of uncinate process

Ethmoid infundibulum
- well-defined 3D cleft between anterior wall of ethmoidal bulla and posterior wall of uncinate process - medial ; uncinate process lateral ; formed by LP, frontal process of the maxilla depth ; average depth, 2mm(variable, 0.5~10mm)

Hiatus Semilunaris Superior
- between ethmoid bulla(anteriorly and inferiorly) and skull base(superiorly) and basal lamella(posteriorly)

Lateral sinus
- not always present - boundary superior ; fovea inferior ; roof of the ethmoid bulla posterior ; basal lamella of the MT lateral ; lamina papyracea medial ; middle turbinate dorsal ; space between bulla ethmoidalis and basal lamella open ; between bulla ethmoidalis and middle turbinate

Lateral sinus 2
- divided into suprabullar recess and retrobullar recess a. suprabullar recess ; a space bordered by the ethmoidal bulla(inferiorly) ethmoidal fovea(superiorly) b. retrobullar recess ; bordered by ethmoidal bullar(anteriorly) basal lamella(posteriorly)

Maxillary sinus ostium
- usually located posterior and inferior at the angle formed by the ethmoidal bulla and uncinate process

Fontanelle area
- 2 distinct areas on the lateral nasal wall where the nasal muconsa and mucoperiosteum of the maxillary sinus - anterior fontanelle : anterior and inferior to the inferior attachment of the uncinate process - posterior fontanelle : superior to the posterior insertion of the uncinate process

Frontal sinus ostium
- located at the bulla-uncinate angle anteriorly and superiorly

Supraorbital Ethmoid air cell
- arise from pneumatization of the orbital process of the frontal bone(15~21%) - located just posterior to the frontal sinus ostium - AEA, just posterior to the supraorbital cell

Anterior Ethmoid artery
- orbital branch of ophthalmic a. exit the orbit through ant. Ethmoidal foramen → pass into orbito-cranial canal in the roof of the ethmoid → enter the lateral lamella and olfactory fossa

cf. posterior ethmoid artery : ophthalmic artery : posterior ethmoid canal - optic foramen(5~10mm)

Posterior ethmoid cell
- larger in size, fewer in number than the anterior ethmoid cells - anterior ; basal lamella posterior ; anterior wall of sphenoid sinus lateral ; lamina papyracea medial ; superior meatus and superior turbinate superior ; fovea ethmoidalis inferior ; posterior part of middle turbinate

Sphenoethoidal cell(Onodi cell)
- lateral and superior extension of posterior ethmoids - relation to the optic nerve and/or internal carotid artery

Roof of Ethmoids
- anterior 2/3, frontal bone, fovea ethmoidalis - medially, join the lamina cribrosa - height of the roof(Keros)

Lateral lamella
- thinnest at the location of anterior ethmoid arterial passage (0.05mm. 1/10 of thickness of fovea ethmoidalis)

Cribriform plate
- perforated by the olfactory nerve fiber - attach to the crista gali and perpendicular plate middle turbinate lateral lamella

Olfactory fossa
- located between the crista gali medially cribriform plate inferiorly lateral lamella laterally - olfactory bulb

Frontal recess
- the space where the frontal sinus open - boundary anterior ; uncinate process and agger nasi cell posterior ; bulla ethmoidalis and suprabullar lamella lateral ; lamina papyracea medial ; hiatus semilunaris inferior or neck of MT inferior ; ethmoid infundibulum superior ; fovea ethmoidalis, supraorbital cell, anterior ethmoid artery, frontal ostium

Frontal recess

Frontal recess 2
- size of the frontal recess, determined by the size of the surrounding anterior ethmoid air cell(bulla ethmoidalis, agger nasi cell, supraorbital cell and frontal cells)

Frontal cells
- Kuhn type I : a single small cell above the agger nasi cell II : multiple small cells above the agger nasi cell III : a single large cell above the agger nasi cell extending to the frontal sinus IV : a single small cell inside the frontal sinus

Spatial relationship
- superior ; anterior cranial fossa - anterior ; spheno-ethmoid recess, superior turbinate, and posterior ethmoid - inferior ; nasopharynx - posterior ; basi-sphenoid sella posterior cranial fossa - lateral ; middle cranial fossa, cavernous sinus

Classification
: basis of pneumatization - conchal(2~3%) - presellar(11%) - sellar(86%)

Neurovascular relationship
- optic nerve - internal carotid artery - maxillary nerve(V2) in the foramen rotundum - Vidian nerve in the pterygoid canal

Sphenoid sinus ostium
- 1~5mm in size - round, oval or vertical cleft - located just medial to the posterior end of the superior turbinate - close to the midline in the anterior sphenoid wall at the junction of the upper 1/3 and lower 2/3

Supraoptic and Infraoptic recess
- pnumatization extends into the lesser sphenoid wing (size and depth, degree of pneumatization of the anterior clinoid process)

Sphenoid rotrum
- midline projection of anterior sphenoid wall - articulate, perpendicular plate of ethmoid and vomer

Sphenoethmoid recess - a space behind and above the most superior turbinate - boundary superior ; cribliform plate inferior ; nasopharynx anterior ; uppermost concha (superior or supreme turbinate) posterior ; anterior wall of sphenoid sinus medial ; nasal septum

Cavernous sinus - CN III, IV, V, VI - carotid artery

- Reference
1) N.J. Bhatt Endoscopic Sinus Surgery new horizons p.48~51 2) 이비인후과학 두경부외과학 3) R. Kamel. Endoscopic anatomy of the lateral nasal wall, ostiomeatal complex and anterior skull base

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