Endoscopic and Sinus CX Manual

Usamah Hadi graduated from the American University of Beirut and was
granted his Doctorate in Medicine in 1980 and received his American Board
Certification in Medicine. After spending four years at the same institute
and completing a residency in Otorhinolaryngology, Head and Neck
Surgery, Dr. Hadi joined the Massachusetts Eye and Ear Infirmary – Harvard
Medical School in Boston, U.S.A., in 1992, where he finished a fellowship
in Endoscopic Sinus Surgery. In 1998, he became a Fellow of the American
College of Surgeons (F.A.C.S.). In 2005, Dr. Hadi was appointed Head of
Department of Otorhinolaryngology at the Beirut Governmental Rafic Hariri
Hospital, Lebanon. In addition, in 2007, he became Clinical Professor at
the Department of Otorhinolaryngology, Head and Neck Surgery at the
American University of Beirut Medical Center, Beirut, Lebanon. In 2010, he
was a charter member of the Pan Arab Rhinology Society (PARS) which
was involved in organizing several conferences in the Arab region. In 2012,
Usamah Hadi, M.D., F.A.C.S. Dr. Hadi was elected President of the Lebanese Society of Otolaryngology,
Head and Neck Surgery. He is regularly involved in medical teaching,
gives lectures and courses for medical students and residents addressing
a wide range of topics, such as anatomy of the head and neck, in-depth
exploration of the pathophysiology of allergic rhinitis, olfactory disorders,
and various sinonasal diseases and their medical and surgical management.
He also mentors graduate-level microbiology students and has served as a
member of the examination committee supervising many thesises. On both
a national and regional level, Dr. Hadi conducts the Functional Endoscopic
Sinus Surgery Course including hands-on cadaver dissections. He has
published more than 50 scientific papers in the field and has given technical
presentations and lectures at more than 30 international and national
meetings, serving as moderator at more than ten international conferences
and numerous others in his home country and neighbouring regions. His
primary research aim is on allergic rhinosinusitis and diseases related to the
nose. Among his other research work are studies that focus on pathogens
and biofilm formation. In collaboration with the microbiology department,
Dr. Hadi conducts research on the pathogenesis of chronic rhinosinusitis.
He contributes to numerous charitable institutions, including Lions Club and
human rights organizations by providing medical care and services to needy
people in Lebanon.
Dr. Hadi is married to his wife Layla, a pharmacist, for more than 20 years
and has four lovely children.
®
ENDOSCOPIC AND SINONASAL

DISSECTION MANUAL FOR
ENDOSCOPIC SINUS SURGERY
Usamah HADI, M.D., F.A.C.S.
Clinical Professor
Otorhinolaryngology, Head and Neck Surgery
Department of Otorhinolaryngology, Head and Neck Surgery
American University of Beirut Medical Center
Beirut, Lebanon
4 Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
Illustrations: Endoscopic and Sinonasal Dissection Manual for Endoscopic Sinus Surgery
Dr. Katja Dalkowski Usamah Hadi, M.D, F.A.C.S.
Hauptstraße 64, 91054 Erlangen, Clinical Professor
Germany Otorhinolaryngology, Head and Neck Surgery
E-Mail: kdalkowski@online.de Department of Otorhinolaryngology, Head and Neck Surgery
www.med-design.info/ American University of Beirut Medical Center
Beirut, Lebanon
With assistance of:
Abdo Jurjus,a Ph.D., Professor
Akaber Halawi,b M.D., Chief Resident
Alyssa Kanaan,b M.D., 3rd-year Resident
Solara Sinno,b B.S., Project Coordinator
Important notes: a) Department of Human Morphology, Faculty of Medicine,
Medical knowledge is ever changing. As new American University of Beirut, Lebanon

b) Department of Otorhinolaryngology Head and Neck Surgery,
research and clinical experience broaden our
knowledge, changes in treat ment and therapy Faculty of Medicine, American University of Beirut, Lebanon
may be required. The authors and editors of the
material herein have consulted sources believed to be
reliable in their efforts to provide information that is Correspondence address of the author:
complete and in accord with the standards accepted Usamah Hadi, M.D, F.A.C.S.
at the time of publication. However, in view of the Clinical Professor, Otorhinolaryngology, Head and Neck Surgery
possibility of human error by the authors, editors, or
Department of Otorhinolaryngology, Head and Neck Surgery
publisher, or changes in medical knowledge, neither
the authors, editors, publisher, nor any other party who American University of Beirut Medical Center
has been involved in the preparation of this booklet, Beirut, Lebanon
warrants that the information contained herein is in Phone: +96 11 75 17 01
every respect accurate or complete, and they are +96 13 69 00 44
not responsible for any errors or omissions or for the +96 113 43 95 69
results obtained from use of such information. The Fax: +96 117 51 70
information contained within this booklet is intended for E-mail: uhadi@dm.net.lb
use by doctors and other health care professionals. This uh00@aub.edu.lb
material is not intended for use as a basis for treatment
decisions, and is not a substitute for professional
consultation and/or use of peer-reviewed medical All rights reserved.
literature.
1st edition 2012
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Endoscopic and Sinonasal Dissection Manual 5
Table of Contents
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Your Cadaver – Your Patient. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Dissection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Anatomical Variation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Preparation and Maintenance of a Cadaver Specimen. . . . . . . . 8
Safety Issues in the Cadaver Lab . . . . . . . . . . . . . . . . . . . . . . . . . 9
Practical Hints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
1.0 Anatomy of the Lateral Nasal Wall. . . . . . . . . . . . . . . . . . . . . . . . . 10

Anatomical Reference Structures . . . . . . . . . . . . . . . . . . . . . . . . . 10
Ostiomeatal Complex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
2.0 Basal Lamella of the Middle Turbinate . . . . . . . . . . . . . . . . . . . . . 12

Middle Turbinate Dissection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Variations of the Middle Turbinate . . . . . . . . . . . . . . . . . . . . . . . . . 15
3.0 Uncinate Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Uncinate Process (UP) and Maxillary Line . . . . . . . . . . . . . . . . . . 16
Anatomical Variants of the Uncinate Process Insertion . . . . . . . 18
Radiologic Examples of Uncinate Process Variants . . . . . . . . . . 18
4.0 Hiatus Semilunaris and Ethmoid Infundibulum . . . . . . . . . . . . . . 19

The Ethmoid Infundibulum – A Three-Dimensional Cavity . . . . . 20
5.0 Anterior Ethmoid Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

General Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Agger Nasi Cell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Agger Nasi Cell and Frontal Recess . . . . . . . . . . . . . . . . . . . . . . . 23
6.0 Ethmoid Bulla. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Boundaries of the Ethmoid Bulla . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Topographical, Morphological and Surgical Aspects . . . . . . . . . 25
The Variable Depth of the Olfactory Fossa
(Keros Classification) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
7.0 Anterior Ethmoid Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
8.0 Posterior Fontanelle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
9.0 Middle Meatal Antrostomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Sites of Bone Dehiscence in the Maxillary Sinus . . . . . . . . . . . . . 32
Accessory Ostia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Anatomical Relationship between Uncinate Process and
Maxillary Sinus Ostium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Size of the Middle Meatal Antrostomy Window and|Its
Impact on Treatment Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Patency of Middle Meatal Antrostomy . . . . . . . . . . . . . . . . . . . . . 34
Classification of Middle Meatal Antrostomy (MMA) –
Size and Surgical Approaches . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Type 1 – Small-Sized Middle Meatal Antrostomy . . . . . . . . . . . . . 35
Small Natural Maxillary Sinus Ostium . . . . . . . . . . . . . . . . . . . . . . 36
Type 2 – Medium-Sized Middle Meatal Antrostomy. . . . . . . . . . . 37
Type 3 – Large-Sized Middle Meatal Antrostomy. . . . . . . . . . . . . 37
Type 4 – Extensive Middle Meatal Antrostomy and Medial
Maxillectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
10.0 Sinus lateralis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Suprabullar Recess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Retrobullar Recess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Horizontal Lamella of the Middle Turbinate . . . . . . . . . . . . . . . . . 41
11.0 Superior Turbinate and Meatus . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Posterior Ethmoid Cell (PE) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Lateral Lamella of Anterior and Posterior Ethmoid Partitions
(1–4). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
12.0 Frontal Sinus Beak, Frontal Sinus Ostium and Frontal Recess . . 45
Frontal Recess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Frontal Sinus Drainage – The Draf I Approach . . . . . . . . . . . . . . . 47
Frontal Sinus Drainage – The Draf IIa Approach . . . . . . . . . . . . . 48
Frontal Sinus Drainage – The Draf IIb Approach . . . . . . . . . . . . . 49
Frontal Sinus Drainage – The Draf III Approach . . . . . . . . . . . . . . 50
13.0 Sphenoethmoid Recess and Sphenoid|Ostium . . . . . . . . . . . . . . 51

Sphenoid Ostium and Sphenoid Intersinus Septum . . . . . . . . . . 52
Sphenoid Sinus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Sphenoid Sinus and Carotid Artery . . . . . . . . . . . . . . . . . . . . . . . . 55
Onodi Cell (Sphenoethmoid Cell). . . . . . . . . . . . . . . . . . . . . . . . . . 56
14.0 Sphenopalatine Foramen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

Anatomical-Topographical and Morphological Aspects. . . . . . . 57
15.0 Nasolacrimal Sac and Duct . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Anatomical-Topographical and Morphological Aspects. . . . . . . 59
16.0 Endoscopic Approach to Pituitary Gland and Related Tumors . 60
17.0 Orbital Decompression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
18.0 Optic Nerve Decompression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
19.0 Iatrogenic CSF Leakage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
20.0 Lateral Canthotomy and Inferior Cantholysis. . . . . . . . . . . . . . . . 65
Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Words from the Heart …
To my wife, Layla, for her love, understanding, support

and|encouragement.
To our four children, Nisrine, Nadine, Dalia and Youssef, for
their patience and tolerance with the many long hours away
from them, yet still nourishing me with the joys of fatherhood
all year long.
To my parents and family, for their love, support and
education they bestowed on me, and for which I will always
be greatly indebted to them.
To my surgical teachers and mentors, Salah Salman,
Georges|Zaytoun, Nabil Fuleihan and many others not
mentioned by name, for their constant encouragement,
inspiration and assistance throughout my professional career.
To my residents and patients, for their trust and continued
stimulation to always embark on new frontiers.
Introduction
Your Cadaver – Your Patient

The head that will be used for dissection was donated by a person who
wished to make a contribution to your education as a physician. The value
of the gift that the donor has made to you cannot be measured. However, it
can only be repaid by the proper care and use of the specimen. The cadaver
must be treated with the same respect and dignity that are usually reserved
for the living patient.
Dissection
Dissection is the careful and thoughtful separation of body parts. The
essence of good dissection is to expose each structure, fully, clearly and
cleanly. Cleaning a structure, therefore, means much more than mere
recognition of its existence. Examination of the structure of the body in
the lab gives us the opportunity to learn by direct observation. The three-
dimensional relationships between anatomical structures are of utmost
importance for any surgical approach. While participating in this short
dissection course, today, it is recommended to adopt the perspective above.
In return, you will be rewarded with the most memorable learning experience
of your medical career.
Anatomical Variation
All bodies have the same basic morphological plan, but no two bodies are
identical, while minor variations commonly occur and should be expected.
There are many specimen on the basis of which you can examine, identify
and learn anatomical variations.
Preparation and Maintenance of a Cadaver Specimen

Specific work routines are employed to preserve, prepare and maintain all
organic substrates of pathogenic materials in cadavers, which are usually
fixed with a mixture of the following chemical agents:
Alcohol Glycerin Phenol Formaldehyde H2 O
30% 5% 5% 5% 55%
A cadaver will usually take between 12–20 liters. Perfused cadavers are
subsequently maintained in plastic bags for at least 15 weeks prior to
dissection.
Safety Issues in the Cadaver Lab

While in the lab
Protect your clothing by wearing a long laboratory coat or apron.
Do not wear sandals or open-toed shoes in the laboratory, as a dropped
scalpel can seriously injure your feet.
Disposable gloves must be worn to prevent contact with human tissue.
When cutting bones, wear glasses or goggles to protect your eyes
against flying chips.
Practical Hints
Upon entering the laboratory, you will learn, that the cadaver head was
temporarily frozen, then put at 4°C for 2 weeks, and should now be at
room temperature for work.
The veins, in general, are sometimes full of clotted blood. Occasionally,
the arteries are injected with red dye, which is not the case here.
Desiccation of the cadaver will quickly render the specimen useless for
study or training. Therefore, cover the specimen when you finish and
keep it moist throughout the course.
All pieces of the specimen that are taken out during dissection should
be stored in a special container.
Any reusable glassware or utensils that have been contaminated
with body fluids should be placed in a disinfectant (fresh 10% bleach
solution) and later autoclaved.
Thoroughly wash your hands with soap and warm water before leaving
the laboratory.
10 1 Anatomy of the Lateral Nasal Wall Endoscopic and Sinonasal Dissection Manual
1.0 Anatomy of the Lateral Nasal Wall
Anatomical Reference Structures

Using a HOPKINS® 0°-telescope you can visualize
1. the nasal floor,
2. the inferior turbinate and meatus (IT),
3. the middle turbinate and meatus (MT),
4. the superior turbinate and meatus (ST) and
5. the Eustachian tube orifice.
1 Sagittal cadaver specimen demonstrating gross anatomy of the lateral nasal wall.
2 Endoscopic view of the inferior nasal 3 Endoscopic view of the middle nasal 4 Non-enhanced coronal CT section
turbinate. turbinate. showing inferior turbinate and meatus (IT),
middle turbinate and meatus (MT),
superior turbinate and meatus (ST).
Endoscopic and Sinonasal Dissection Manual 1 Anatomy of the Lateral Nasal Wall 11
Ostiomeatal Complex
6 Schematic depiction of the ostiomeatal complex (green area). 5 Endoscopic view of the ostiomeatal complex.
12 2 Basal Lamella of the Middle Turbinate Endoscopic and Sinonasal Dissection Manual
2.0 Basal Lamella of the Middle Turbinate
1 Schematic drawing of the basal lamellae of the ethmoid bone.

1) Basal lamella of the uncinate process
2) Basal lamella of the ethmoid bulla
3) Basal lamella of the middle turbinate
4) Basal lamella of the superior turbinate
5) Anterior wall of the sphenoid sinus
2 Axial CT section of the ethmoid cells 3 Gross anatomy of a cadaver specimen demonstrating the basal lamella of the middle
showing the vertical lamella (VL) of the turbinate with vertical lamella (VL), frontal lamella (FL) and horizontal lamella (HL).
middle turbinate.
Endoscopic and Sinonasal Dissection Manual 2 Basal Lamella of the Middle Turbinate 13
4 Coronal CT section of the ethmoid sinus showing the horizontal lamella (HL) of the middle
turbinate.
5 Schematic three-dimensional depiction of the basal lamella of the middle turbinate.

14 2 Basal Lamella of the Middle Turbinate Endoscopic and Sinonasal Dissection Manual
Middle Turbinate Dissection

1. The vertical lamella (VL) of the middle turbinate (MT) should be
medialized gently to prevent the risk of fracturing the skull base and
causing a cerebrospinal fluid leak.
2. The basal lamella of the MT naturally contributes to the development of
the sinus lateralis (also termed supra- and retrobullar recess).
3. The basal lamella (frontal lamella, FL) may be deflected anteriorly or
posteriorly by relatively large ethmoid cells.
4. The frontal lamella may be fused with the posterior wall of the ethmoid
bulla.
5. Dissection of the frontal oblique portion of the basal lamella is initiated
inferomedially to enter the posterior ethmoid sinus.
6. The horizontal lamella should be left intact to prevent destabilizing the
middle turbinate.
6 Gross anatomy of the middle turbinate: vertical lamella (VL), frontal lamella (FL) and
horizontal lamella (HL).
a b
7 a) Endoscopic view of the frontal lamella (FL) of the middle turbinate.
b) Sagittal CT section of paranasal sinuses showing the basal lamella of the middle
turbinate.
Endoscopic and Sinonasal Dissection Manual 2 Basal Lamella of the Middle Turbinate 15
Variations of the Middle Turbinate

Paradoxical Curvature
Concave medially rather than laterally.
Found in 11–29% of patients.
Does not obstruct the ostiomeatal complex.
Concha bullosa
Aeration of any part of middle turbinate can obstruct the ostiomeatal
complex.
a b
8 a) Endoscopic view of a paradoxically curved middle turbinate (MT) and nasal septum (S).
b) Coronal CT section at the level of the ethmoid sinuses demonstrating a paradoxically
curved middle turbinate (MT) and nasal septum (S).
a b
9 a) Endoscopic view of the pneumatized anterior aspect of the middle turbinate, also termed
concha bullosa (Cb)
b) Coronal CT section of the anterior ethmoid sinus area showing a bilateral concha bullosa
(CB).
16 3 Uncinate Process Endoscopic and Sinonasal Dissection Manual
3.0 Uncinate Process
Uncinate Process (UP) and Maxillary Line

The middle turbinate is medialized to visualize
1. the shape and size of the middle turbinate (MT),
2. the ethmoid bulla (BE),
3. the free margin of the uncinate process (UP),
4. the line of the frontal maxillary process (also termed ‘maxillary line’).
1 Schematic drawing of the basal lamellae

of the ethmoid bone.
2 Gross anatomy demonstrated by

a sagittal cadaveric section: the
middle turbinate (MT) is reflected upward
revealing the ethmoid bulla (BE), uncinate
process (UP) and a curved landmark
referred to as frontal maxillary process
line (d).
Endoscopic and Sinonasal Dissection Manual 3 Uncinate Process 17
Identify the uncinate process (UP), which

is a thin, curved bony plate, resembling a hook, that extends from
anterosuperior to posteroinferior along the lateral nasal wall
‘guards’ the natural maxillary ostium and
consists of three layers.
If the incision is not carried backwards posteriorly to a sufficient extent,
the remaining portion of the UP may impair vision of the maxillary sinus
ostium.
a b
3 a) Endoscopic view of the ethmoid bulla (BE), uncinate process (UP) and frontal maxillary
process line (d).
b) Coronal CT section at the level of the ethmoid region showing the uncinate process (UP).
4 Sagittal cadaveric section: the middle

turbinate has been reflected upward
exposing the uncinate process (arrow).
18 3 Uncinate Process Endoscopic and Sinonasal Dissection Manual
a b
5 a) Endoscopic view of the uncinate process (yellow double-tipped pointer).
b) Coronal CT section of the ethmoid sinus region. The arrow indicates the uncinate
process.
Anatomical Variants of the Uncinate Process Insertion
6 Schematic drawings demonstrating three

anatomical variations of the superior and
anterior insertion of the uncinate process.
a) Insertion on the medial orbital wall
(lamina papyracea),
b) on the skull base,
c) on the middle turbinate (adapted from
Kennedy DW, Bolger WE, Zinreich SJ.
Diseases of the Sinuses: Diagnosis and
Management. Hamilton, Canada, BC
Decker; 2001.)
These variants may obstruct the natural mucociliary drainage pathways of the nasal and
paranasal sinuses, and may thus become the pathogenic cause of disease.
Radiologic Examples of Uncinate Process Variants
a b c
7 UP insertion on the orbit. Coronal CT UP insertion on the skull base. Coronal CT UP insertion on the middle turbinate.
section demonstrating the insertion of the section of paranasal sinuses demonstrating Coronal CT section of paranasal sinuses
uncinate process on the medial orbital the insertion of the uncinate process on the demonstrating the insertion of the uncinate
wall (lamina papyracea). skull base. process on the left middle turbinate.
Endoscopic and Sinonasal Dissection Manual 4 Hiatus Semilunaris and 19
for Endoscopic Sinus Surgery Ethmoid Infundibulum
4.0 Hiatus Semilunaris and Ethmoid Infundibulum

Identify the hiatus semilunaris, which
is a two-dimensional crescent-shaped cleft located between the free
margin of the uncinate process and the ethmoid bulla (Fig. 1, arrow),
leads to a three-dimensional space, termed ‘ethmoid infundibulum’
(dotted white line on CT image, Fig. 2b)
1 Gross anatomy of a sagittal cadaver

section demonstrating the hiatus
semilunaris, a two-dimensional, crescent-
shaped cleft (double-tipped arrow).
a b
2 a) Endoscopic view of the inferior semilunar hiatus (double-tipped arrow).
b) Coronal CT section of the paranasal sinuses demonstrating the inferior semilunar hiatus,
highlighted by a double-tipped arrow and dashed lines.
20 4 Hiatus Semilunaris and Endoscopic and Sinonasal Dissection Manual
Ethmoid Infundibulum for Endoscopic Sinus Surgery
The Ethmoid Infundibulum – A Three-Dimensional Cavity
The ethmoid infundibulum is located lateral to the hiatus semilunaris inferior.

Perform the exercises below and focus your attention on the CT images
(Figs. 2b, 4b)
A piece of white ribbon may be inserted in the ethmoid infundibulum.

While viewing through a 0° telescope, a palpation probe may be inserted
in the ethmoid infundibulum.
Note the arrow on the axial CT image (Fig. 4b) demonstrating the
ethmoid infundibulum.

section showing a piece of white ribbon
placed in the threedimensional space
called ethmoid infundibulum.
Note the following boundaries:

posteriorly, the frontal wall of the ethmoid bulla
anteriorly, the uncinate process and frontal maxillary process
laterally, the lamina papyracea and the posterior fontanelle
medially, the inferior hiatus semilunaris and the uncinate process
a b
4 a) Endoscopic view after insertion of a palpation probe into the ethmoid infundibulum.
b) Axial CT section of the paranasal sinuses demonstrating the ethmoid infundibulum (EI).
Endoscopic and Sinonasal Dissection Manual 5 Anterior Ethmoid Cell 21
5.0 Anterior Ethmoid Cells

2a) Anterior ethmoid cells
General Characteristics
Anterior ethmoid air cells vary in number and size according to the degree
of pneumatization.
Can reach and lie medial to the lacrimal sac, thus called lacrimal cells.
Can extend anteriorly and forms the agger nasi cell.
The agger nasi is a site, where larger air cells are found, varying in size
and position.
Haller cells, also called ‘infraorbital ethmoid air cells’, present on the
medial floor of the orbit or the roof of the maxillary sinus.
Complete anterior ethmoidectomy is required to expose the frontal
recess.

section demonstrating an anterior
ethmoid cell.
22 5 Anterior Ethmoid Cell Endoscopic and Sinonasal Dissection Manual
a b
3 a) Endoscopic view of anterior ethmoid air cells.
b) Sagittal CT section of the paranasal sinuses demonstrating anterior ethmoid air cells.
Agger Nasi Cell
Using a HOPKINS® 0°-telescope you may inspect the Agger| Nasi Cell
(AN), which is a structure,
presenting as an eminence in the lateral nasal wall.

found just in front of the insertion of the uncinate process and middle
turbinate.
the posterior and superior wall of which consitutes the floor of the frontal
recess.
generally pneumatized (from the frontal recess).
found medially to the lacrimal sac.
that needs to be opened in order to visualize the frontal recess and
frontal sinus.

section demonstrating the lateral nasal
wall with agger nasi cell (AN) exposed after
reflection of the middle turbinate (MT).
Endoscopic and Sinonasal Dissection Manual 5 Anterior Ethmoid Cell 23
a b
5 a) Endoscopic view of a Blakesley cupped forceps pointing towards the agger nasi cell (AN).
b) Coronal CT section of the paranasal sinus region demonstrating an agger nasi cell (AN).
Agger Nasi Cell and Frontal Recess

While using a 30°-HOPKINS® telescope, place a curette behind the roof of
the agger nasi cell (AN).
Following removal of the AN, the frontal recess (FR) may be opened allowing
the frontal sinus to be exposed.
a b
6 a) Endoscopic view of the exposed frontal sinus (FS) after removal of the agger nasi cell.
b) Endoscopic view of an agger nasi cell (AN) opened by use of a curette.
7 Gross anatomy of a sagittal cadaver specimen demonstrating the lateral nasal wall following 8 Sagittal CT section of the paranasal
reflection of the middle turbinate. Shown by the red pointer is the frontal recess (FR). sinuses demonstrating a agger nasi cell
(AN) inferior to the frontal recess (FR).
24 6 Ethmoid Bulla Endoscopic and Sinonasal Dissection Manual
6.0 Ethmoid Bulla

Boundaries of the Ethmoid Bulla

Anteriorly:the ethmoid infundibulum.
Superiorly: the suprabullar recess.
Posteriorly: the retrobullar recess.
Medially: the middle turbinate.
The air space between the ethmoid bulla and the middle turbinate is
called sinus lateralis.
2 Gross anatomy of a sagittal cadaveric

section showing the lateral nasal wall with
bulla ethmoidalis (BE) below the reflected
middle turbinate (MT).
Endoscopic and Sinonasal Dissection Manual 6 Ethmoid Bulla 25
a b
3 a) Endoscopic view of a bulla ethmoidalis (BE) in relation to the middle turbinate (MT) and
sinus lateralis (SL).
b) Coronal CT section of paranasal sinuses demonstrating the middle turbinate (MT) and
bulla ethmoidalis (BE).
Topographical, Morphological and Surgical Aspects

The Ethmoid Bulla
is a consistent anatomical landmark.
may be absent at all, or may not be pneumatized.
is the largest and the most anteriorly located of the ethmoid air cells
is entered via the safest point of entry, the inferomedial part of the bulla.
has an ostium that opens posteriorly or medially.
may be attached to the skull base, thus forming the posterior wall of the
frontal recess.
forms a cavity that can be exposed with a Blakesley forceps or a sharp
curette or suction tip.

section, showing the lateral nasal wall with
bulla ethmoidalis (BE) and its topographical
relation to the uncinate process (UP).
26 6 Ethmoid Bulla Endoscopic and Sinonasal Dissection Manual
a b
5 a) Endoscopic view of the bulla ethmoidalis (BE) and its relation to the uncinate process
(UP).
b) Coronal CT section of the paranasal sinuses demonstrating the middle turbinate (MT)
and uncinate process (UP) in relation to the bulla ethmoidalis (BE).
The Variable Depth of the Olfactory Fossa

(Keros Classification)
According to Keros, there are three types of olfactory fossa. The classification
scheme, which is based on the length of the lateral lamella of the cribriform
plate, is graded from type I to type III.
6 Schematic drawings of the types of olfactory fossae (I–III), forming the basis of the Keros classification.
(KEROS P. On the practical value of differences in the level of the lamina cribrosa of the ethmoid. Z Laryngol Rhinol Otol. 1962;41:809–13).
Endoscopic and Sinonasal Dissection Manual 6 Ethmoid Bulla 27
a b
7 Coronal CT sections demonstrating

a) type I,
b) type II and
c) type III of the Keros classification.
c d d) an asymmetric type of olfactory fossa.
The Infraorbital Ethmoid Cell (Haller Cell)

is an ethmoid cell, that develops owing to pneumatization of the lacrimal
bone along the orbital floor.
may narrow the natural maxillary ostium.
should be opened to prevent recurrent and/or persistent sinusitis.
may be of single or multiple appearance.
a b
8 Coronal CT sections of the paranasal sinuses demonstrating an infraorbital ethmoid cell (Haller cell).
28 7 Anterior Ethmoid Artery Endoscopic and Sinonasal Dissection Manual
7.0 Anterior Ethmoid Artery

Try to localize the Anterior Ethmoid Artery (AEA)
In the formalin-fixed cadaver specimen, the AEA appears whiter than
the surrounding tissues.
The AEA runs from lateral to medial and obliquely forward along the
skull base.
In 40% of cases, the AEA is up to 2 mm away from the skull base, lying
free or encased in a canal, and in 60% of cases, it courses directly on
the skull base (Basak et al. 1998).
The AEA, most commonly, is located 1–2 mm behind the bulla lamella.
In front of the AEA, the skull base anteriorly joins with the posterior wall
of the frontal sinus. This point is located an average of 9 mm in front of
the artery.
In 40% of cases, the canal of the AEA is not intact, containing sites of
bone dehiscence (Stammberger 1988).

2a) Anterior ethmoid artery
Endoscopic and Sinonasal Dissection Manual 7 Anterior Ethmoid Artery 29

specimen demonstrating the anterior
ethmoid artery (AEA) exhibiting a lighter
color tone than that of the surrounding
formalin-fixed tissues.
a b
3 a) Endoscopic view of the anterior ethmoid artery (AEA).
b) Coronal CT section of the paranasal sinuses with arrows indicating the ethmoid roof
where the anterior ethmoid artery (AEA) emerges in a bony canal.
30 8 Posterior Fontanelle Endoscopic and Sinonasal Dissection Manual
8.0 Posterior Fontanelle

Try to localize the Posterior Fontanelle
The fontanelles are an area of the lateral nasal wall, deficient in bone.
In this area, the maxillary sinus mucosa is adherent to the nasal mucosa.
The unicate process divides the fontanelle area into an anterior and
posterior part.
Fontanelles are sites of predilection for accessory sinus ostia.

section demonstrating an area of bony
dehiscence (red pointer), also called
posterior nasal fontanelle.
2 a) Endoscopic view of anterior and

posterior fontanelles, predilection sites
for accessory ostia.
b) Endoscopic view of a posterior
fontanelle. a b
Endoscopic and Sinonasal Dissection Manual 9 Middle Meatal Antrostomy 31
9.0 Middle Meatal Antrostomy
The posteroinferior portion of the uncinate process can articulate with

the inferior turbinate, with the bulla, and/or with the palatine bone. The
bone may also flatten out or be absent (Yoon et al. 2000)
Subdividing the ethmoid infundibulum into quarters, the maxillary ostium
is located in the last ¾.
The lacrimal duct may be injured while enlarging the natural maxillary
sinus ostium anteriorly.
Lacrimal duct injury occurs in 15% of cases, but such incidence is only
rarely associated with clinical symptoms (Ünlü et al. 1996).
The natural maxillary sinus ostium is located only 2 mm from the roof
of the maxillary sinus, which predisposes the site for iatrogenic orbital
injury during antrostomies (Meyers and Valvassori 1998).
Forty percent of the sphenoid sinus lies below a horizontal plane that
passes through the posteromedial orbital floor at its junction with the
medial orbital wall (Casiano 2001).
Accessory maxillary sinus ostia, usually located in the posterior
fontanelle, should not be confused with the natural ostium. If missed, it
will lead to persistent disease (recirculation).
During MMA, avoid stripping off the maxillary sinus mucosa.

section demonstrating the site of the
middle meatal antrostomy (MMA) in
the fourth quarter of the ethmoid
infundibulum.
32 9 Middle Meatal Antrostomy Endoscopic and Sinonasal Dissection Manual
a b
2 a) Endoscopic view showing the proximity of the middle meatal antrostomy (MMA) to the
orbital floor.
b) Coronal CT section of the paranasal sinuses in a patient with previous history of
extensive sinus surgery including middle meatal antrostomy (MMA).
Sites of Bone Dehiscence in the Maxillary Sinus
In the fontanelle area, accessory maxillary sinus ostia are encountered

more frequently with ageing (in up to 30% of cases).
Mostly located in the posterior fontanelle.
Along the infraorbital canal or sulcus, bone dehiscence is found in 15%
of cases (Caution! Risk of injury from blind manipulations within the
sinus cavity.

section showing an area of bony
dehiscence, also termed posterior
fontanelle.
Accessory Ostia
Enlarging an accessory ostium, while leaving untreated the blocked,

adjacent natural ostium, may lead to persistent or recurrent sinus
disease (Parsons et al. 1996).
a b
4 a) Endoscopic view of the lateral nasal wall showing accessory ostia.
b) Endoscopic view of the lateral nasal wall showing an accessory ostium (AO).
Anatomical Relationship between Uncinate Process and

Maxillary Sinus Ostium
The posterior inferior portion of the uninate process is highly variable in

morphology and intimately related to the natural maxillary sinus ostia.
Delicate processes from the UP bone extend to the inferior turbinate, to
the bulla and/or to the palatine bone.
The first process divides the membranous antral wall into an anterior
and posterior fontanelle.
5 Schematic drawing of the lateral nasal

wall illustrating the anatomical relationship
of the maxillary sinus ostium and the
uncinate process.
Size of the Middle Meatal Antrostomy Window and|Its

Impact on Treatment Outcome
In a group of 133 patients, a large middle meatal window (larger than 16|mm
in diameter) was created either unilaterally or bilaterally, while in a control
of the same size, patients were treated with a small middle meatal antral
window (smaller than 6 mm in diameter).
During follow-up visits, conducted from 12 to 38 months post surgery,
outcomes of treatment were assessed employing a series of criteria which
included self-evaluation of symptom change (absent, improved, unchanged,
worsened) and various endoscopic findings.
Conclusion: In terms of symptom relief and endoscopic findings, no
correlation could be demonstrated with the diameter of the surgically created
antrostomy window (Albu and Tomescu 2004).
Patency of Middle Meatal Antrostomy

Within a group of 60 patients with bilateral nasal polyps and chronic
maxillary sinusitis, large middle meatal antrostomy was performed leaving
intact the natural maxillary sinus ostium. Patients were followed up and
outcomes of treatment analyzed in a comparative review (Wadwongtham,
Aeumjaturapat 2003). The study design involved a large middle meatal
antrostomy, performed on one side, whereas uncinectomy preserving the
natural maxillary ostium, was done on the contralateral side.
Sides were chosen randomly.

Patency rate of the large middle meatal antrostomy was higher 3 months
after surgery when compared with the untreated maxillary sinus ostium.
This difference became insignificant after 12 months (level Ib).
Classification of Middle Meatal Antrostomy (MMA) – Size

and Surgical Approaches
Ballon Sinusotomy and Middle Meatal Antrostomy (MMA)
Minimally invasive technique

Technique of maxillary sinus surgery without uncinate process removal
Sphenoid sinus surgery without ethmoidectomy or partial superior
turbinate resection.
Isolated frontal sinus surgery without ethmoidectomy and frontal recess
dissection.
6 Endoscopic view of balloon sinuplasty.
Type 1 – Small-Sized Middle Meatal Antrostomy

Surgical Steps
1. Inferior attachment of uncinate process is detached exposing the
natural maxillary sinus ostium.
2. Microdebrider or down-biting antral cutting punch is used to remove
any remnant of the uncinate process.
3. Areas of polypoid or inflammatory mucosa are removed.
4. Maxillary sinus ostium is probed first using an antrum probe.
5. An opening of 5 mm x 5 mm is large enough for simple endoscopy.
6. In the presence of copious or thick secretions within the sinus, the
maxillary sinus ostium is gently dilated.
Small Natural Maxillary Sinus Ostium
a b c
7 Endoscopic views of remnants of the uncinate process (UP) following uncinectomy.
8 Coronal CT section of a left maxillary meatal antrostomy (MMA).

Type 2 – Medium-Sized Middle Meatal Antrostomy
Surgical Steps
Given scenario: The natural maxillary sinus ostium cannot be identified.
1. Initial incision is made under visual control above the insertion of inferior
turbinate.
2. The incision is enlarged posteriorly.
3. Make sure integrity of the orbit is preserved.
4. An antrostomy window sized 8 –10 mm is created.
a b
9 a) Endoscopic view of the center of a middle meatal antrostomy exposing the orbital floor.
b) CT section of the paranasal sinuses showing a bilateral middle meatal antrostomy (MMA).
Type 3 – Large-Sized Middle Meatal Antrostomy
Surgical Steps
1. The natural maxillary sinus ostium should be identified and distinguished
from any accessory ostia.
2. The maxillary sinus ostium is opened posteriorly to join with the
accessory ostium, thus creating a middle meatal antrostomy sized
10–15 mm.
3. Next, a back-biting forceps is used in open-jaw position to palpate the
tissue anteriorly.
4. If the tissue anteriorly is confirmed to be bone, no additional tissue
needs to be removed.
5. If dissection is carried further anteriorly, this can result in iatrogenic injury
to the nasolacrimal duct.
6. The microdebrider may be used very cautiously to enlarge the opening
and remove the incised tissues posteriorly.
Indications of Type 3 – Large-Sized Middle Meatal Antrostomy

Surgical treatment of fungal maxillary sinusitis.
Surgical treatment of antrochoanal polyp.
Access for orbital decompression.
Access for orbital fracture repair.
Access to the pterygopalatine fossa.
Resection of benign tumors.
a b
10 Coronal CT section (a) and endoscopic view (b) of a large middle meatal antrostomy on the
left side (double-tipped arrow).
Type 4 – Extensive Middle Meatal Antrostomy and Medial

Maxillectomy
Surgical Steps
1. For endoscopic tumor resection in the area of the maxillary sinus, a large
window is dissected in the posterior nasal fontanelle (NF).
2. Dissection of an additional window in the inferior meatus and
enlargement towards the middle meatal antrostomy.
11 Gross anatomy of a sagittal cadaver section showing the area of an extensive middle
meatal antrostomy.
Indications of Type 4 – Extensive MMA and Medial Maxillectomy

Excision of inverted papilloma.
Access to infratemporal fossa.
Access to lateral sphenoid wall.
Access lateral to vidian nerve.
Access for repair of orbital floor fracture.
a b
12 a) Inverted papilloma specimen.
b) Coronal MRI section of an extensive middle meatal antrostomy.
a b
13 a) Endoscopic view of inverted papilloma.
b) Endoscopic view of an extensive middle meatal antrostomy.
40 10 Sinus lateralis Endoscopic and Sinonasal Dissection Manual
10.0 Sinus lateralis
Suprabullar Recess
Boundaries of the suprabullar recess
Inferiorly– ethmoid bulla
Superiorly – fovea ethmoidalis
Posteriorly – communicates with retrobullar recess
Note, there is no suprabullar recess
— if the ethmoid bulla inserts on the fovea ethmoidalis.
— In this case, a suprabullar lamella will separate the suprabullar recess
from the frontal recess (FR)
Retrobullar Recess
Boundaries of the retrobullar recess
Anteriorly – ethmoid bulla
Posteriorly – basal lamella
Note, there is no retrobullar recess
— if the bulla adheres to the basal lamella of the middle turbinate.
1 Schematic drawing showing the clinical

anatomy of the anterior ethmoid in axial
section.
(Adapted from: Lusk RP, ed. Pediatric
Sinusitis. New York: Raven Press; 1992)
Endoscopic and Sinonasal Dissection Manual 10 Sinus lateralis 41
2 Gross anatomy of a cadaver specimen

showing the suprabullar recess (1),
formerly known as ‘Sinus lateralis of
Grunwald’.

showing the retrobullar recess (2).
Horizontal Lamella of the Middle Turbinate
4 Axial CT scan of the paranasal sinuses

showing uncinate process (UP), ethmoid
infundibulum (EI), ethmoid bulla (EB),
basal lamella (BL), sphenoid sinus (SS).
Red lines: inferior semilunar hiatus (1)

and superior semilunar hiatus (2).
42 11 Superior Turbinate and Meatus Endoscopic and Sinonasal Dissection Manual
11.0 Superior Turbinate and Meatus
Anatomical and Morphological Aspects

Anatomically, the superior turbinate (ST) is the least accessible and
most neglected of the nasal turbinates.
The superior turbinate
— is a projection that emanates from the ethmoid bone.
— is approximately half the length of the middle turbinate and located
above its posterior half.
— attaches superiorly to the skull base and posteriorly to the sphenoid
and ethmoid bones.
Office nasal endoscopy does not afford access to this area.
The extent of pneumatization of the superior turbinate needs to be
evaluated by computed tomography.
Pneumatization of the superior turbinate leads to a constricted nasal
space which may impair maneuverability of instruments in endoscopic
pituitary surgery.
Obstruction of the superior meatus may theoretically lead to hyposmia
or obstruction of the sphenoid sinus ostium.
Superior turbinectomy is fraught with the inherent risk of damage to the
olfactory mucosa or inadvertent disruption of the cribriform plate which
may cause a cerebrospinal fluid leak.

showing the superior turbinate (ST) on the
lateral nasal wall.
2 a) Endoscopic view demonstrating the

anatomical relationship between the
sphenoid ostium and the superior
turbinate / meatus.
b) Coronal CT scan of the paranasal
sinuses showing the superior, middle
and inferior turbinates / meatuses
along with the posterior ethmoid sinus. a b
Endoscopic and Sinonasal Dissection Manual 11 Superior Turbinate and Meatus 43
Posterior Ethmoid Cell (PE)

1. Slide the endoscope underneath the middle turbinate and advance
it towards the rear end of the middle turbinate, thus identifying the
horizontal portion of the basal lamella.
2. Retract the scope anteriorly until the upward sloping vertical portion of
the basal lamella comes into view.
3. Remove the vertical portion of the basal lamella of the middle turbinate
by starting inferomedially.
4. Identify the superior meatus and turbinate.
5. The cell you are about to enter is the posterior ethmoid cell, on average
one or two cells.
6. Identify the skull base.
7. Identify the posterior ethmoid artery coursing from lateral to medial.
It is found parallel to the coronal plane of the skull base, on average
12|mm behind the anterior ethmoid artery.
8. The posterior ethmoid nerve may run in a bony canal of the same name.

showing a posterior ethmoid cell (PE).
4 a) Endoscopic view of the anterior and

posterior ethmoid arteries.
b) Coronal CT section showing a
a b posterior ethmoid cell (arrow).
44 11 Superior Turbinate and Meatus Endoscopic and Sinonasal Dissection Manual
Lateral Lamella of Anterior and Posterior Ethmoid

Partitions (1–4)
Complete removal of the entire anterior and posterior ethmoid air cells
will expose the lamina papyracea from the agger nasi to the lateral wall
of the sphenoid sinus demonstrating the sloping course of the skull
base, posterior frontal sinus wall and the frontal sinus beak.

showing multiple lamellae of ethmoid cells
inserting on the lamina papyracea.
6 a) Endoscopic view of the lamina

papyracea following removal of
multiple ethmoid cells (1–4).
b) Sagittal CT section of the paranasal
sinuses showing multiple ethmoid air
cells. a b
Endoscopic and Sinonasal Dissection Manual 12 Frontal Sinus Beak, Frontal Ostium 45
for Endoscopic Sinus Surgery and Nasal Recess
12.0 Frontal Sinus Beak, Frontal Sinus Ostium

and Frontal Recess
Frontal Recess
Boundaries of the Frontal Recess
Anteriorly – uncinate process (UP) and agger nasi cell
Posteriorly – bulla ethmoidalis and suprabullar rescess or suprabullar
lamella
Laterally – lamina papyracea
Medially – hiatus semilunaris or neck of the middle turbinate
Inferiorly – ethmoid infundibulum
Superiorly – fovea ethmoidalis, anterior ethmoid artery, frontal ostium
The size of the frontal recess, frontal sinus beak (FSB) and frontal sinus is
determined by the extent of pneumatization of the following structures:
— Agger nasi cell (AN)
— Frontal cells
— Supraorbital cell
— Bulla ethmoidalis (BE)

specimen showing the frontal sinus (FS),
frontal sinus beak (FSB), frontal recess
(FR) and surrounding structures.
Bulla ethmoidalis (BE), middle turbinate
(MT), agger nasi (AN) and uncinate
process (UP).
2 a) Endoscopic view of the frontal sinus

(FS), frontal recess (FR), anterior
ethmoid artery and ethmoid fovea.
b) Sagittal CT section showing the frontal
a b sinus and frontal recess.
46 12 Frontal Sinus Beak, Frontal Ostium Endoscopic and Sinonasal Dissection Manual
and Nasal Recess for Endoscopic Sinus Surgery
The frontal recess requires both axial and coronal CT sections to

understand the threedimensional anatomy of this area.
Sagittal CT reconstruction provided by intraoperative surgical navigation
has shown to be important for understanding
— the anteroposterior diameter of the frontal sinus.
— topographical relationship to the adjacent agger nasi.
— supraorbital ethmoid cells.
— frontal sinus cells.
3 Intraoperative navigation images of

coronal (a) and saggital (b) CT sections
showing the frontal recess (center of
crosshairs). a b
4 Endoscopic views of a curved suction tip a b

inserted in the frontal sinus (FS).
Frontal Sinus Drainage – The Draf I Approach

If the frontal sinus drainage pathway is only demonstrated and not
enlarged, the result is a ‘Draf I’ approach.

specimen showing the frontal sinus beak.
a b
6 a) Coronal CT section demonstrating

opacified frontal sinuses with frontal
sinus beak (red pointer).
b) Endoscopic view of the frontal sinus
drainage pathway.
Frontal Sinus Drainage – The Draf IIa Approach

The procedure involves a circumscribed enlargement of the drainage
pathway without altering the vertical lamella of the anterior middle
turbinate.

demonstrating the access to the frontal
sinus.
a b
8 Coronal CT section of the paranasal 9 Endoscopic views (a–b) showing the area of enlargement of the drainage pathway (dotted
sinuses demonstrating the extent of yellow demarcation line) with preservation of integrity of the vertical lamella of the anterior
dissection in a Draf IIa procedure middle turbinate (dotted black line).
(double-tipped pointer).
Frontal Sinus Drainage – The Draf IIb Approach

Removal of the median floor of the frontal sinus encompasses the area
from the lamina papyracea to the nasal septum and is combined with
removal of the anterior vertical lamella of the middle turbinate.

specimen demonstrating the frontal sinus
(FS) and frontal recess (FR).
Frontal Sinus Drainage – The Draf III Approach

In a Draf type III frontal sinus drainage approach, a bilateral Draf type II|b
procedure is combined with resection of the upper nasal septum and
portions of the interfrontal septum.
11 Coronal CT section of the paranasal

sinuses demonstrating the extent of
dissection in a Draf III procedure.
A bilateral Draf IIb procedure
(red demarcation lines) is combined
with resection of the upper nasal septum
and portions of the interfrontal septum
(yellow pointer).
Endoscopic and Sinonasal Dissection Manual 13 Sphenoethmoid Recess 51
for Endoscopic Sinus Surgery and Sphenoid Ostium
13.0 Sphenoethmoid Recess and

Sphenoid|Ostium
Anatomical-Topographical and Morphological Aspects

The sphenoethmoid recess lies superolateral to a vertical crus which is
formed by the basal lamella of the middle turbinate.
The sphenoid sinus is found medially to the sphenoethmoid recess.
The ostium of the sphenoid sinus and superior turbinate make up the
sphenoethmoid recess forming a common drainage pathway for the
posterior ethmoid and sphenoid sinuses.

showing the sphenoethmoid recess
(curved yellow line), sphenoid ostium
(black arrow) and superior turbinate (ST).
a b
2 a) Endoscopic view of the sphenoeth-

moid recess (curved yellow line).
b) Axial CT section of the paranasal
sinuses showing the sphenoethmoid
recess and sphenoid ostium (yellow
arrows).
52 13 Sphenoethmoid Recess Endoscopic and Sinonasal Dissection Manual
and Sphenoid Ostium for Endoscopic Sinus Surgery
Sphenoid Ostium and Sphenoid Intersinus Septum

The shenoid sinus can be accessed via the following pathways
Transethmoidal approach
Transnasal approach
Transeptal approach
Transmaxillary-transethmoid approach

specimen showing the sphenoid
intersinus septum.
4 Endoscopic view of the right and left sphenoid sinus ostia and the 5 Axial CT section of the paranasal sinuses demonstrating the
sphenoid intersinus septum. trajectories used in various approaches to the sphenoid sinus
(transethmoidal, transseptal, transnasal and transmaxillary-
transethmoid).
Sphenoid Sinus
The anterior wall of the sphenoid sinus is fenestrated inferomedially.

Expose the sphenoid sinus by lateralizing the superior turbinate using
the transnasal route or via the posterior ethmoid sinus by perforating the
inferomedial wall and passing through the superior meatus.
The natural ostium should be identified.
— It is slitlike in 80% of cases, with an average diameter of 3 mm
(1 – 9 mm). It is located 7 mm (2 – 15 mm) above the choana and
4|mm from the midline, placing it in the upper half of the anterior wall
of the sphenoid sinus. The ostia on both sides are offset by 2 mm in
two-thirds of cases (Elwany et al. 1999):

section showing the sphenoid sinus.
a b
7 a) Endoscopic view upon having gained

entry to the sphenoid sinuses.
b) Coronal CT section of the paranasal
sinuses showing hyperpneumatized
sphenoid sinuses.

showing the sphenoid sinus and vital
anatomical structures of the lateral nasal
wall;
Prominence of the optic nerve canal (PON),
‘genu’ of the internal carotid artery (GICA),
abducens nerve (AN), maxillary nerve (MN)
and prominence of the pterygoid canal
(PPC).
The sphenoid sinus can pneumatize the greater or lesser sphenoid wing,
palatine bone, vomer, pterygoid process, nasal septum, or posterior
ethmoid cells in varying degrees.
Variable recesses can develop
Recesses surround the bony eminences of
— optic nerve
— internal carotid artery
— maxillary nerve and vidian nerve (also termed pterygoid nerve).

showing the recesses surrounding the
sphenoid sinus.
Optico-carotid recess (OCR), internal
carotid artery (ICA), optic nerve (ON).
a b
10 a) Endoscopic view of the internal

carotid artery, the optic nerve and the
optico-carotid recess, as visualized on
the lateral sphenoid wall.
b) Coronal CT section of the paransal
sinuses showing sphenoid pneumati-
zation extending cranially beyond the
optic nerve.
Sphenoid Sinus and Carotid Artery
Note, the intersphenoid septum may be attached to the carotid artery

Frequently, bone thickness over the carotid artery is less than 0.1 mm
Microdehiscences occur in 8% of cases (Kainz and Stammberger 1991,
Kennedy et al. 1990)
Multiple septae can be attached to the carotid artery
Cadaveric studies have shown that the carotid artery is clinically
dehiscent in 22% of specimens

showing the anatomical relationship
between the carotid artery and sphenoid
sinus wall.
a b
12 a) Endoscopic view of a dehiscent carotid

artery in the sphenoid sinus.
b) Axial CT section of the paranasal
sinuses demonstrating that the
sphenoid intersinus septum attaches
to the carotid artery.
Onodi Cell (Sphenoethmoid Cell)
An Onodi cell is a pneumatized posterior ethmoid cell superolateral to

the sphenoid sinus.
In the presence of an Onodi cell (OC), the sphenoid sinus wall is located
medial and inferior to it.
— The Onodi cell will be located above the spheniod sinus (SS) and
displace it inferiorly
The optic nerve (ON) or even the internal carotid artery (ICA) may pass
through the Onodi cell.
Coronal CT sections are suited best to identify Onodi cells. Axial CT
sections are usually not helpful.
13 Endoscopic view of the right (RT) and left (LT) sphenoid sinuses 14 Coronal CT section of the paranasal sinuses showing Onodi cells
(SS) with carotid artery (CA), optic nerve (ON) and Onodi cell (OC). (OC) and their anatomical relationships to the sphenoid sinus (SS),
carotid artery (CA) and optic nerves.
Endoscopic and Sinonasal Dissection Manual 14 Sphenopalatine Foramen 57
14.0 Sphenopalatine Foramen
In 90% of cases, the sphenopalatine foramen is located in the superior

meatus close to the posterior end of the middle turbinate.
The posterior part of the middle turbinate is attached to an ethmoid
crest formed by the perpendicular plate of the palatine bone.
The sphenopalatine artery ramifies into two larger branches.
— the septal artery branch, that runs along the anterior wall of the
sphenoid sinus to the posterior nasal septum, may become a source
of bleeding during sphenoidotomy.
— The posterior lateral nasal artery, that gives off branches to the
middle turbinate and posterior fontanelle.

demonstrating the inferior turbinate (IT),
sphenopalatine foramen (red circle) and
middle turbinate (MT).
58 14 Sphenopalatine Foramen Endoscopic and Sinonasal Dissection Manual
2 Endoscopic view of a clip (pointer) applied to the sphenopalatine 3 Sagittal CT section of the paranasal sinuses demonstrating the
artery. sphenopalatine foramen (red circle).
4 1 Maxillary artery
2 Sphenopalatine artery
3 Foramen rotundum
4 Maxillary nerve
5 Inferior alveolar artery and nerve
6 Ostium of sphenoid sinus
7 Pterygopalatine ganglion
8 Mandibular nerve
9 Middle meningeal artery
0 Pharyngeal arterial branch
q Optic chiasm
w Inferior turbinate
e Sphenomandibular ligament
r Medial pterygoid muscle
t Parotid gland
z Oculomotor nerve
u Pterygoid canal with nerve of pterygoid
canal (vidian nerve, from the greater
superior petrosal nerve) and artery
i Posterior septal artery (medial branch of
the sphenopalatine artery)
o Superior and inferior posterolateral
branches of the sphenopalatine artery
p Descending palatine artery
a Posterior superior alveolar artery
s Infraorbital artery
Schematic anatomical drawing showing various sections at different levels of the sphenopalatine
foramen (adapted from Janfaza et al. 2001, Lee et al. 2002, Pearson et al. 1969).
Endoscopic and Sinonasal Dissection Manual 15 Nasolacrimal Sac and Duct 59
15.0 Nasolacrimal Sac and Duct
1. Using the endoscope, first try to demonstrate the lacrimal duct (Hasner
valve), located below the inferior turbinate. Place a probe in the lacrimal
duct opening.
2. If the first step is not possible, resect the anterior half of the inferior
turbinate to expose the area of Hasner’s valve, which is located around
1 cm from the tip.
3. Outline a mucosal flap over the lacrimal sac, place its base inferoanterior
to the uncinate process and remove the mucosa.
4. The frontal process of the maxilla is exposed anteriorly and portions of showing the spacial orientation of the
the lacrimal bone posteriorly. nasolacrimal duct (palpation probe).
5. Remove the bone with a burr or with a Kerrison punch.

6. Then identify the medial wall of the lacrimal sac.
7. Try to pass a probe in the punctum of the lower eyelid and thread it
through until you see it pushing the sac wall.
8. Incise the sac on top of the probe and deliver it into the nose.
3 Osteologic image of the orbit showing the

lacrimal bone and the frontal maxillary
process.
1 Gross anatomy of a cadaver specimen showing a palpation probe in the lacrimal duct 4 Axial CT section of the paranasal sinuses
opening below the inferior turbinate (IT). demonstrating the bilateral lacrimal
ducts.
60 16 Pituitary Gland and Tumors Endoscopic and Sinonasal Dissection Manual
16.0 Endoscopic Approach to Pituitary Gland and

Related Tumors
1. Identify the sphenoid ostium.

2. Identify the anatomy of lateral nasal wall.
3. Locate the sellar floor and remove the bone with a chisel and Kerrison
punch.
4. Identify the sellar dura.
5. Incise the dura and enter the pituitary gland.

demonstrating the carotid artery and optic
nerve.
Endoscopic approaches to the pituitary gland include:

Transseptal, transsphenoidal.
Transnasal.
Via an external ethmoidectomy approach.
Via the upper buccal sulcus of the mouth and then transseptal,
transsphenoidal.
Via a craniotomy, e.g., an anterolateral approach, or a frontal approach.
2 Sagittal gadolinium-enhanced MRI 3 Endoscopic image captured with a 4 Endoscopic view of the sphenoid ostium.
section of the brain demonstrating 30°-HOPKINS® rigid telescope showing
increased opacity from a pituitary gland the carotid artery and optic nerve.
tumor.
Endoscopic and Sinonasal Dissection Manual 17 Orbital Decompression 61
17.0 Orbital Decompression
1. The lamina papyracea may be dehiscent.

2. Perforate the lamina papyracea (LP) with a Cottle elevator, then
undermine the thin bone and remove it medially and inferiorly in a
piecemeal fashion.
3. Remove the lamina papyracea from the skull base to the MMA and from
the lacrimal sac to the anterior wall of the sphenoid sinus.
4. Press on the globe and see the periorbita bulging.
5. Incise the periorbita (P) from posterior to anterior.
6. Several incisions are made parallel to each other attempting at all times
to prevent injury to the medial rectus muscle.
7. Orbital fat will be exposed, apply pressure to the globe and observe fat
as it herniates.
8. Using the endoscope, this test is performed during surgery to detect
injuries to the lamina papyracea.

showing a palpation probe indicating the
lamina papyracea (LP).

specimen showing the periorbita (P) that
has been incised from posterior to anterior.
62 17 Orbital Decompression Endoscopic and Sinonasal Dissection Manual

specimen showing the periorbita (P).
4 Endoscopic view showing the periorbital 5 Coronal CT section of the paranasal 6 Endoscopic view of intraoperative orbital
bulge after removal of the lamina sinuses showing the periorbital bulge. fat herniation.
papyracea.
a b
7 Endoscopic view of orbital fat herniation. 8 a) Postoperative axial CT section of the paranasal sinuses confirming orbital decompression.
The orbital fat is still covered by a thin b) Postoperative axial CT section demonstrating orbital fat herniation.
layer of yellowish periorbita.
Endoscopic and Sinonasal Dissection Manual 18 Optic Nerve Decompression 63
18.0 Optic Nerve Decompression
The optic canal is approximately 9 mm (5 – 10 mm) long, and its wall

thickness measures approximately 0.3 – 1 mm.
The bone is thinnest in the medial middle portion of the canal.
Dehiscences are found in 4% of cases.
Remove the posterior part of the lamina papyracea to expose the
annulus of Zinn, a tendinous ring for insertion of ocular muscles.
Next, identify the optic tubercle, which is the thickened part of the optic
canal.
After removing the bony canal, identify the optic nerve sheath and incise
it longitudinally along its medial course.
Occasionally, the ophthalmic artery runs medially. It may be inadvertently
injured during incision of the optic nerve sheath for decompression.

demonstrating the optic nerve canal.

demonstrating the optic nerve canal.
64 19 Iatrogenic CSF Leakage Endoscopic and Sinonasal Dissection Manual
19.0 Iatrogenic CSF Leakage
Predilection Sites of CSF Leakage:

Area of insertion of middle turbinate onto the skull base.
Region of anterior ethmoid artery.
Lateral lamella of the lamina cribrosa.

demonstrating an orbital roof defect.
a b
2 Endoscopic view (a) and coronal CT section (b) showing an orbital roof defect.
Endoscopic and Sinonasal Dissection Manual 20 Lateral Canthotomy and 65
for Endoscopic Sinus Surgery Inferior Cantholysis
20.0 Lateral Canthotomy and Inferior Cantholysis
Scissors are used to divide the lateral canthus down to the bone of the
orbital rim and to the depth of the lateral sulcus of the conjunctiva.
Protect the globe in order to avoid corneal abrasion or damage to the
conjunctiva.
Retract lower lid downward.
Angulate scissors at 45° to the horizontal axis and divide the lateral
ligament and septum.
The globe and contents of the orbit will then prolapse forward.
Do not probe into the posterior compartment of the eye.
This procedure is normally sufficient to decompress the posterior
compartment of the eye.
If inadequate, a medial decompression should be done.
This may be performed either endoscopically by removing the lamina
papyracea widely and incising the orbital periosteum or externally via a
Lynch procedure.

demonstrating the lateral canthotomy
procedure for orbital decompression.

showing the lateral canthotomy procedure
for orbital decompression.
Bibliography
1. ALBU S, TOMESCU E. Small and large middle meatus antrostomies in
the treatment of chronic maxillary sinusitis. Otolaryngol Head Neck Surg
2004; 131: 542 – 547
2. BASAK S, KARAMAN CZ, AKDILLI A et al. Evaluation of some important
anatomical variations and dangerous areas of the paranasal sinuses by
CT for safer endonasal surgery. Rhinology 1998; 36: 162 – 167
3. CASIANO RR. A stepwise surgical technique using the medial orbital
floor as the key landmark in performing endoscopic sinus surgery.
Laryngoscope 2001; 111: 964 – 974
4. ELWANY S, ELSAEID I, THABET H. Endoscopic anatomy of the
sphenoid sinus. J Laryngol Otol 1999; 113: 122 – 126
5. JANFAZA P, NADOL JB, GALLA RJ. Surgical Anatomy of the Head and
Neck. Cambridge, MA: Harvard University Press; 2011
6. KAINZ J, STAMMBERGER H. [The roof of the anterior ethmoid: a locus
minoris resistentiae in the skull base]. Laryngol Rhinol Otol (Stuttg) 1988;
67: 142 – 149
7. KENNEDY DW, ZINREICH SJ, HASSAB MH. The internal carotid artery
as it relates to endonasal sphenoethmoidectomy. Am J Rhinol 1990;
4: 7–12
8. KENNEDY DW, BOLGER WE, ZINREICH SJ eds. Diseases of the
Sinuses: Diagnosis and Management. Hamilton, Ont. ; Lewiston, N.Y. :
BC Decker; 2001
9. KEROS P. [On the practical value of differences in the level of the lamina
cribrosa of the ethmoid]. Z Laryngol Rhinol Otol 1962; 41: 809 – 813
10. LEE HY, KIM HU, KIM SS et al. Surgical anatomy of the sphenopalatine
artery in lateral nasal wall. Laryngoscope 2002; 112: 1813 – 1818
11. MEYERS RM, VALVASSORI G. Interpretation of anatomic variations of
computed tomography scans of the sinuses: a surgeon’s perspective.
Laryngoscope 1998; 108: 422 – 425
12. PARSONS DS, STIVERS FE, TALBOT AR. The missed ostium sequence
and the surgical approach to revision functional endoscopic sinus
surgery. Otolaryngol Clin North Am 1996; 29: 169 – 183
13. PEARSON BW, MACKENZIE RG, GOODMAN WS. The anatomical
basis of transantral ligation of the maxillary artery in severe epistaxis.
Laryngoscope 1969; 79: 969 – 984
14. STAMM A, DRAF W eds. Micro-Endoscopic Surgery of the Paranasal
Sinuses and the Skull Base. Berlin: Springer; 2000
15. UNLU HH, GOVSA F, MUTLU C et al. Anatomical guidelines for
intranasal surgery of the lacrimal drainage system. Rhinology 1997; 35:
11 – 15
16. WADWONGTHAM W, AEUMJATURAPAT S. Large middle meatal
antrostomy vs undisturbed maxillary ostium in the endoscopic sinus
surgery of nasal polyposis. J Med Assoc Thai 2003; 86 Suppl 2:
S373 – 378
17. YOON JH, KIM KS, JUNG DH et al. Fontanelle and uncinate process
in the lateral wall of the human nasal cavity. Laryngoscope 2000; 110:
281 – 285
Recommended Set for

Endoscopic Sinus Surgery (ESS)
HOPKINS® Telescopes and Accessories

Operating Instruments
Powered Instrumentation
Navigation Panel Unit (NPU)
Cold Light Fountains
KARL STORZ Image 1 HD Camera Systems
and Videoendoscopic Equipment
HOPKINS® Telescopes
for Diagnosis, Surgery and Treatment of Nose and Nasal Sinuses
Diameter 2.7 mm, length 18 cm
7229 FA
7229 AA HOPKINS® Straight Forward Telescope 0°,

enlarged view, diameter 2.7 mm, length 18 cm,
autoclavable,
fiber optic light transmission incorporated,
color code: green
7229 FA HOPKINS® Forward-Oblique Telescope 45°,

autoclavable,
color code: black
7229 CA HOPKINS® Lateral Telescope 70°,

autoclavable,
color code: yellow
It is recommended to check the suitability of the product for the intended procedure prior to use.
HOPKINS® Telescopes
for Diagnosis, Surgery and Treatment of Nose and Nasal Sinuses
Diameter 4 mm, length 18 cm
7230 AA
7230 AA HOPKINS® Straight Forward Telescope 0°,

enlarged view, diameter 4 mm, length 18 cm,
autoclavable,
color code: green
7230 FA HOPKINS® Forward-Oblique Telescope 45°,

autoclavable,
color code: black
7230 CA HOPKINS® Lateral Telescope 70°,

autoclavable,
color code: yellow
7230 FLA HOPKINS® Forward-Oblique Telescope 45°,

autoclavable,
connection for fiber optic light cable on the left,
fiber o
ptic light transmission incorporated,
color code: black
KARL STORZ CLEARVISION® II System

for intra-operative irrigation of the telescope lens
One-pedal
footswitch
20 0142 30
Silicone
tubing set*
U N I T S I D E
PATIENT SIDE
40 3341 40
40 3341 01 KARL STORZ CLEARVISION® II Set,

Lens irrigation system for telescopes,
power supply: 100–240 VAC, 50–60 Hz
including:
CLEARVISION® II
Mains Cord
One-pedal Footswitch
Silicone Tubing Set
Irrigation sheath
)*Optional Accessories:
MTP 031229-10 Single-use tubing set.
For use with KARL STORZ CLEARVISION® II. Sterile, 7230 FS
10 per pack
* Submit your order to:

mtp medical technical promotion gmbh,
Take-Off GewerbePark 46, D-78579 Neuhausen ob Eck, Germany
KARL STORZ CLEARVISION® II

Irrigation Sheath for use with CLEARVISION® II System
Irrigation Sheath, proximally reinforced for use with Compatible HOPKINS® Telescopes
Adjustable Holder 28272 RKB
Outer Working Outer Working

Detail Order No. Order No. View
Diameter length Diameter length
7230 AS 4.8 x 6.0 mm 14 cm 7230 AA 0° 4.0 mm 18 cm
7230 BS 4.8 x 6.0 mm 14 cm 7230 BA 30° 4.0 mm 18 cm
7230 FS 4.8 x 6.0 mm 14 cm 7230 FA 45° 4.0 mm 18 cm
7230 CS 4.8 x 6.0 mm 14 cm 7230 CA 70° 4.0 mm 18 cm
7220 AS 3.7 x 4.8 mm 10 cm 7220 AA 0° 3.0 mm 14 cm
7220 BS 3.7 x 4.8 mm 10 cm 7220 BA 30° 3.0 mm 14 cm
7220 FS 3.7 x 4.8 mm 10 cm 7220 FA 45° 3.0 mm 14 cm
7220 CS 3.7 x 4.8 mm 10 cm 7220 CA 70° 3.0 mm 14 cm
7219 AS 3.5 x 4.7 mm 14 cm 7229 AA 0° 2.7 mm 18 cm
7219 BS 3.5 x 4.7 mm 14 cm 7229 BA 30° 2.7 mm 18 cm
7219 FS 3.5 x 4.7 mm 14 cm 7229 FA 45° 2.7 mm 18 cm
7219 CS 3.5 x 4.7 mm 14 cm 7229 CA 70° 2.7 mm 18 cm
7230 AES 4,8 x 6 mm 14 cm 7230 AE 15°– 90° 4 mm 18 cm

RHINOFORCE® II Nasal Forceps
28164 UA RHINOFORCE® II Nasal Forceps,

with extra fine flat jaws,
through-cutting,
tissue sparing, width of cut 1.5 mm,
straight sheath, straight jaws,
with cleaning connector, 28164 UA
working length 18 cm
28164 UB Same, jaws angled upwards 45°
28164 UE Same, jaws angled downwards 45°
Forceps
663211 Forceps, straight, not through-cutting,

extra sharp, with oval, fenestrated cupped jaws,
width 1.8 mm, working length 18 cm,
color code: one black handle
663211
663217 Same, 45° upturned
Scissors
663301 Scissors, straight, delicate,

663302 Scissors, straight, extra delicate,

663300
663304 Same, curved to right
663305 Same, curved to left
663307 Same, 45° curved upwards

Dissectors
26164 DB
28164 DB Dissector, sharp, tip angled 45°, round spatula,

with round handle, size 3 mm, length 25 cm
28164 DF Dissector, sharp, tip angled 15°, flat long spatula,

with round handle, size 1.5 mm, length 25 cm
28164 DS Dissector, sharp, tip angled 15°, with round handle,

size 2 mm, length 25 cm
28164 DM Dissector, sharp, straight tip, slightly curved spatula,

with round handle, size 3 mm, length 25 cm
Curettes
26164 KB
28164 KA Curette, round spoon, tip slightly angled, size 1 mm,

with round handle, length 23 cm
28164 KB Curette, round spoon, tip slightly angled, size 2 mm,

28164 KF Curette, round spoon, tip highly angled, size 2 mm,

28164 KG Same, size 3 mm

CAPPABIANCA-de DIVITIIS Ring Curettes
28164 RN
28164 RN CAPPABIANCA-de DIVITIIS Ring Curette,

with round wire, inner diameter 3 mm, tip angled 45°,
28164 RO CAPPABIANCA-de DIVITIIS Ring Curette,

28164 RG CAPPABIANCA-de DIVITIIS Ring Curette,

28164 RB CAPPABIANCA-de DIVITIIS Ring Curette,

with round wire, inner diameter 3 mm,
laterally curved sheath end, with round handle,
length 25 cm
28164 RD CAPPABIANCA-de DIVITIIS Ring Curette,

with round wire, inner diameter 5 mm,
laterally curved 90° sheath end, with round handle,
length 25 cm
28164 RR CAPPABIANCA-de DIVITIIS Curette,

blunt, stirrup-shape, with round handle, length 25 cm
CAPPABIANCA-de DIVITIIS Suction Curettes
28164 RT
28164 RT CAPPABIANCA-de DIVITIIS Suction Curette,

with basket, round, size 5 mm, rotatable tube, LUER,
length 25 cm
28164 RU Same, size 6.5 mm
28164 RSA CAPPABIANCA-de DIVITIIS Suction Curette,

blunt, inner diameter 3 mm, tip angled 45°, LUER,
length 25 cm
28164 RSB Same, inner diameter 5 mm
28164 RSC Same, inner diameter 7 mm

de DIVITIIS-CAPPABIANCA Scalpel
28164 M
de DIVITIIS-CAPPABIANCA Scalpel,
28164 M
with retractable blade, length 23 cm,
including:
Handle
Outer Sheath
Micro Knife, pointed
Round Knife
28164 MP
28164 MP Round Knife,

vertical, oval, with round handle,
3.5 x 2.5 mm, length 25 cm
CASTELNUOVO Hook and Suction Tube
28164 H
28164 H CASTELNUOVO Hook,

90°, blunt, with round handle,
length 25 cm
28164 X
28164 X CASTELNUOVO Suction Tube,

diameter 2 mm, malleable, lateral suction holes,
Suction Tubes
722830
649183
649182 BU
649180 N
662882
662883
662885
662886
722830 Suction Tube, angular, 662882 FRANK-PASQUINI Suction Tube,

with grip plate and cut-off hole, LUER-Lock, angular, tip curved upwards, ball end,
outer diameter 3 mm, working length 14 cm with grip plate and cut-off hole, LUER,
diameter 2.4 mm, working length 13 cm
649180 N FERGUSON-CASTELNUOVO Suction Tube,
without cut-off hole, LUER, diameter 2 mm, 662883 Same, tip curved downwards
working length 15 cm 662885 FRANK-PASQUINI Suction Tube,
649182 BU FERGUSON-CASTELNUOVO Suction Tube, angular, tip curved upwards, ball end,
with cut-off hole and stylet, with grip plate and cut-off hole, LUER,
with calibration markings, diameter 3 mm, working length 13 cm
lateral opening downwards, diameter 2.5 mm, 662886 Same, tip curved downwards
649183 FERGUSON Suction Tube,
with cut-off hole and stylet, LUER, 10 Fr.,
TAKE-APART® Bipolar Ring Handle
26184 HM TAKE-APART® Bipolar Ring Handle,

for bipolar instruments,
with LUER-Lock connection for cleaning
26184 HM
TAKE-APART® Outer Sheath
26184 HSS
26184 HSS TAKE APART® Outer Sheath,

for bipolar instruments, size 3 mm,
length 20 cm
Bipolar Forceps Insert
28164 FGL
28164 FGL Bipolar Forceps Insert,

fine, 1 mm, distally angled 45°, vertical closing,
size 3 mm, length 20 cm
Bipolar High Frequency Cord
26176 LE Bipolar High Frequency Cord,

for AUTOCON® II 400 SCB system (111, 113, 115, 122, 125),
AUTOCON® II 200, AUTOCON® II 80, KARL STORZ Coagulator
26021 B/C/D, 860021 B/C/D, 27810 B/C/D, 28810 B/C/D,
AUTOCON® series (50, 200, 350), Erbe-Coagulator,
T and ICC series, length 300 cm
UNIDRIVE® S III ENT SCB/UNIDRIVE® S III ECO

The multifunctional unit for ENT
UNIDRIVE® S III ENT SCB UNIDRIVE® S III ECO
II
III
I
ECO RIVE ® S
ENT RIVE ® S
SCB
UNID
UNID
Special Features:
Touch Screen: Straightforward function selection via touch screen l –
Set values of the last session are stored l l
Optimized user control due to touch screen l –
Choice of user languages l –
Operating elements are single and clear to read due to color display l –
One unit – multifunctional:

– Shaver system for surgery of the paranasal sinuses and anterior skull base
– INTRA Drill Handpieces (40,000 rpm and 80,000 rpm)
– Sinus Shaver l l
– Micro Saw
– STAMMBERGER-SACHSE Intranasal Drill
– Dermatome
– High-Speed Handpieces (60,000 rpm and 100,000 rpm) l –
Two motor outputs: Two motor outputs for simultaneous connection of two motors:
l l
For example, a shaver and micro motor
Soft start function l –
Textual error messages l –
Integrated irrigation and coolant pump:

– Absolutely homogeneous, micro-processor controlled irrigation rate throughout
l l
the entire irrigation range
– Quick and easy connection of the tubing set
Easy program selection via automated motor recognition l l
Continuously adjustable revolution range l l

Maximum number of revolutions and motor torque: Microprocessor-controlled motor rotation
l l
speed. Therefore the preselected parameters are maintained throughout the drilling procedure.
Maximum number of revolutions can be preset l l
SCB model with connections to the KARL STORZ Communication Bus
l –
(KARL STORZ-SCB)
Irrigator rod included l –
Motor Systems
Specifications
System specifications
Mode Order No. rpm
Shaver mode oscillating

Operation mode: in conjunction with Handpiece:
Max. rev. (rpm): DrillCut-X® II Shaver Handpiece 40 7120 50 10,000*
DrillCut-X® II N Shaver Handpiece 40 7120 55 10,000*
Sinus burr mode rotating

Operation mode: in conjunction with Handpiece:
Max. rev. (rpm): DrillCut-X® II Shaver Handpiece 40 7120 50 12,000
DrillCut-X® II N Shaver Handpiece 40 7120 55 12,000
High-speed drilling mode counterclockwise or clockwise

Operation mode: in conjunction with:
Max. rev. (rpm): High-Speed Micro Motor 20 7120 33 60,000/100,000
Drilling mode counterclockwise or clockwise

Operation mode: in conjunction with:
Max. rev. (rpm): micro motor
and connecting cable [ 20 7111 73]
20 7110 33 40,000/80,000
Micro saw mode in conjunction with:

Max. rev. (rpm): micro motor
20 7110 33 15,000/20,000
Intranasal drill mode in conjunction with:

Max. rev. (rpm):

micro motor
20 7110 33 60,000
Dermatome mode in conjunction with:

Max. rev. (rpm):

micro motor
20 7110 33 8,000
Power supply: 100 – 240 VAC, 50/60 Hz
Dimensions: 300 x 165 x 265 mm

(w x h x d)
Two outputs for parallel connection of two motors
Integrated irrigation pump:

Flow: adjustable in 9 steps
* Approx. 4,000 rpm is recommended as this is the most efficient suction/performance ratio.
Touch Screen: 6.4" / 300 cd/m2
Weight: 5.2 kg 4.7 kg
Certified to: IEC 601-1 CE acc. to MDD IEC 60601-1
Available languages: English, French, German, numerical codes

Spanish, Italian, Portuguese,
Greek, Turkish, Polish, Russian
Motor Systems
Special features of high-performance EC micro motor II
and of the high-speed micro motor
Special features of high-performance EC micro motor II:

l Self-cooling,
brushless high-performance ## INTRA coupling for a wide variety
EC micro motor of applications
l Smallest possible dimensions ## Maximum torque 4 Ncm
l Autoclavable ## Number of revolutions continuously adjustable
l Reprocessable in a cleaning machine up to 40.000 rpm
l Detachable connecting cable ## Provided a suitable handle is used, the number
of revolutions is continuously adjustable
up to 80,000 rpm
20 7110 33
20 7110 33 High-Performance EC Micro Motor II, for use with

UNIDRIVE® II/UNIDRIVE® ENT/OMFS/NEURO/ECO
and Connecting Cable 20 7110 73, or for use with
UNIDRIVE® S III ENT/ECO/NEURO and Connecting
Cable 20 7111 73
20 7111 73 Connecting Cable, to connect High-Performance

EC Micro Motor 20 7110 33 to UNIDRIVE® S III
ENT/ECO/NEURO
Special Features of the high-speed micro motor:

l Brushlesshigh-speed micro motor ## Maximum torque 6 Ncm
l Smallestpossible dimensions ## Number of revolutions continuously adjustable
l Autoclavable up to 60.000 rpm
l Reprocessable in a cleaning machine ## Provided a suitable handle is used, the number
of revolutions is continuously adjustable
l Maximum torque 6 Ncm
up to 100,000 rpm
20 7120 33
20 7120 33
High-Speed Micro-Motor, max. speed 60,000 rpm,
including connecting cable, for use with UNIDRIVE® S III
ENT/NEURO
UNIDRIVE® S III ENT SCB

UNIDRIVE® S III ECO
Recommended System Configuration
40 7016 20-1 40 7014 20
40 7016 01-1
UNIDRIVE® S III ENT SCB, motor control unit with color display,
touch screen, two motor outputs, integrated irrigation pump and
SCB module, power supply 100 – 240 VAC, 50/60 Hz
including:
Mains Cord
Irrigator Rod
Two-Pedal Footswitch, two-stage, with proportional function
Silicone Tubing Set, for irrigation, sterilizable
Clip Set, for use with silicone tubing set
SCB Connecting Cable, length 100 cm
Single Use Tubing Set*, sterile, package of 3
40 7014 01
UNIDRIVE® S III ECO, motor control unit with two motor outputs and
integrated irrigation pump, power supply 100 – 240 VAC, 50/60 Hz
including:
Mains Cord
Two-Pedal Footswitch, two-stage, with proportional function
Silicone Tubing Set, for irrigation, sterilizable
Clip Set, for use with silicone tubing set
Specifications:
Touch Screen UNIDRIVE® S III ENT SCB: 6.4"/300 cd/m2 Dimensions w x h x d 300 x 165 x 265 mm
Flow 9 steps Weight 5.2 kg
Power supply 100-240 VAC, 50/60 Hz Certified to EC 601-1, CE acc. to MDD
* mtp medical technical promotion gmbh,


UNIDRIVE® S III ECO
System Components
Silicone Tubing Set
Two-Pedal Footswitch
20 0166 30
20 7116 40
U N I T S I D E
PATIENT SIDE
High-Speed Micro-Motor High-Performance EC Micro Motor II DrillCut-X® II Shaver Handpiece, DrillCut-X® II N Shaver Handpiece,
for use with UNIDRIVE® S III optional adaptability to
ECO/ENT/NEURO Shaver Tracker, for use with
UNIDRIVE® S III ECO/ENT/NEURO
20 7110 33
20 7120 33 20 7111 73 40 7120 50 40 7120 55
High-Speed Handpiece INTRA Drill Handpiece

Shaver Blade
41201 KN
252660 – 252692 252575 – 252590
Shaver Blade, curved
Intranasal Drill
41302 KN
Sinus Burr
660000
41305 DN
Optional Accessories
for UNIDRIVE® S III ENT SCB and UNIDRIVE® S III ECO
280053 Universal Spray, 6x 500 ml bottles – HAZARDOUS GOODS – UN 1950

including:
Spray Nozzle
280053 C Spray Nozzle, for the reprocessing of INTRA burr handpieces,

for use with Universal Spray 280053 B
031131-10* Tubing Set, for irrigation, for single use, sterile,

package of 10
* mtp medical technical promotion gmbh,

DrillCut-X® Shaver Handpieces

Special Features
40 71 ut-X ® II N
40 71 t-X ® II
20 55
20 50
u
DrillC
DrillC
Special Features:
Max. 10,000 rpm for shaver blades, max. 12,000 rpm for sinus shaver l l
Straight suction channel l l
Integrated irrigation channel l l
Powerful motor, also suitable for harder materials l l
Absolutely silent running, no vibration l l
Completely immersible and machine-washable l l
LOCK allows fixation of shaver blades and sinus shavers l l
Extremely lightweight design l l
Optional, ergonomic handle, detachable l l
Can be adapted to navigation tracker – l
40 7120 50
40 7120 50 DrillCut-X® II Shaver Handpiece,

for use with UNIDRIVE® S III ECO/ENT/NEURO/OMFS
40 7120 55
40 7120 55 DrillCut-X® II N Shaver Handpiece,

optional adaptability to Shaver Tracker 40 8001 22,
DrillCut-X® II Shaver Handpiece
Special Features:
## Powerful motor ## The versatile DrillCut-X® II Shaver Handpiece can
## Absolutely silent running be adapted to individual needs of the user
## Enhanced ergonomics ## Easy hygienic processing, suitable for use in
washer and autoclavable at 134 °C
## Lightweight design
## Quick coupling mechanism facilitates more
## Oscillation mode for shaver blades,
rapid exchange of work inserts
max. 10,000 rpm
## Proven DrillCut-X® blade portfolios can be used
## Rotation mode for sinus shavers, max. 12,000 rpm
## Straight suction channel and
integrated irrigation
40 7120 50
40 7120 50 DrillCut-X® II Shaver Handpiece,

40 7120 90
40 7120 90 Handle, adjustable, for use with DrillCut-X® II 40 7120 50

and DrillCut-X® II N 40 7120 55
Optional Accessory:
41250 RA
41250 RA Cleaning Adaptor, LUER-Lock,

for cleaning DrillCut-X® shaver handpieces
DrillCut-X® II Shaver N Handpiece
Special Features:
## Powerful motor ## Easy hygienic processing, suitable for use in
## Absolutely silent running washer and autoclavable at 134 °C
## Enhanced ergonomics ## Quick coupling mechanism facilitates more rapid
exchange of working inserts
## Lighweight design
## Proven DrillCut-X® blade portfolios can be used
## Optional adaptability to Shaver Tracker 40 8001 22
max. 10,000 rpm
## Rotation mode for sinus shavers, ## Allows shaver navigation when used with
max. 12,000 rpm NPU 40 8000 01
## Straight suction channel and integrated irrigation
## The versatile DrillCut®-X II Shaver N Shaver
Handpiece can be adapted to the individual needs
of the user
40 7120 55
40 7120 55 DrillCut-X® II N Shaver Handpiece,

optional adaptability to Shaver Tracker 40 8001 22,
40 7120 90

Optional Accessory:
41250 RA
41250 RA Cleaning Adaptor, LUER-Lock,

for cleaning DrillCut-X® shaver handpieces
Handle for DrillCut-X® II Shaver Handpiece

for use with DrillCut-X® II 40 7120 50 and DrillCut-X® II N 40 7120 55
Special Features:
## Ergonomic design ## The adjustable handle can be mounted to
## Ultralight construction DrillCut®-X II or -X II N Shaver Handpiece
## Easy handle control allows individual adjustment ## Easy fixation via rotary lock
## Sterilizable
40 7120 90

Shaver Blades, straight

for Nasal Sinuses and Skull Base Surgery
For use with DrillCut-X® II and DrillCut-X® II N
41201 GN
Shaver Blades, straight, sterilizable

for use with
Shaver Blade
Detail 40 7120 50 DrillCut-X® II Handpiece length 12 cm
40 7120 55 DrillCut-X® II N Handpiece
serrated cutting edge,

41201 KN diameter 4 mm,
color code: blue-red
double serrated cutting edge,

41201 KK diameter 4 mm,
color code: blue-yellow
concave cutting edge,

41201 GN oval cutting window, diameter 4 mm,
color code: blue-green
concave cutting edge, oblique

41201 LN cutting window, diameter 4 mm,
color code: blue-black
straight cutting edge,

41201 SN diameter 4 mm,
color code: blue-blue

41201 KSA diameter 3 mm,

41201 KKSA diameter 3 mm,

41201 KKSB diameter 2 mm,

41201 LSA cutting window, diameter 3 mm,
Optional Accessory:
41200 RA Cleaning Adaptor, LUER-Lock, for cleaning the inner
and outer blades of reusable Shaver Blades 412xx
Shaver Blades, curved

41204 KKB
Shaver Blades, curved 35°/40°, sterilizable

for use with
Shaver Blade
curved 35°, cutting edge serrated

41202 KN backwards, diameter 4 mm,

forwards, double serrated,
41204 KKF
diameter 4 mm,

backwards, double serrated,
41204 KKB
diameter 4 mm,

41204 KKFA
diameter 3 mm,

41204 KKBA
diameter 3 mm,
Optional Accessory:

41203 KKF
Shaver Blades, curved 65°, sterilizable

for use with
Shaver Blade

41203 KNF forwards, diameter 4 mm,

41203 KNB backwards, diameter 4 mm,

41203 KKF
diameter 4 mm,

41203 KKB
diameter 4 mm,

41203 KKFA
diameter 3 mm,

41203 KKBA
diameter 3 mm,
curved 65°, concave cutting edge,

oval cutting window, forward
41203 GNF
opening, diameter 4 mm,
curved 65°, concave cutting edge,

oval cutting window, backward
41203 GNB
opening, diameter 4 mm,
Optional Accessory:
Shaver Blades, straight

41301 KK
Shaver Blades, straight, for single use , sterile, package of 5

for use with
Shaver Blade

41301 KN diameter 4 mm,

41301 KK diameter 4 mm,
concave cutting edge, o val cutting

41301 GN window, diameter 4 mm,

41301 LN cutting window, diameter 4 mm,
straight cutting edge,

41301 SN diameter 4 mm,
color code: blue-blue

41301 KSA diameter 3 mm,

41301 KKSA diameter 3 mm,

41301 KKSB diameter 2 mm,

41301 LSA cutting window, diameter 3 mm,

41302 KN
Shaver Blades, curved 35°/40°, for single use , sterile, package of 5

for use with
Shaver Blade
curved 35°, cutting edge

serrated backwards,
41302 KN
diameter 4 mm,

serrated forwards, double
41304 KKF
serrated, diameter 4 mm,

serrated backwards, d ouble
41304 KKB

41304 KKFA

serrated backwards, double
41304 KKBA

41303 KKB
Shaver Blades, curved 65°, for single use , sterile, package of 5

for use with
Shaver Blade
curved 65°, cutting

edge serrated forwards,
41303 KNF
diameter 4 mm,

serrated backwards,
41303 KNB
diameter 4 mm,

41303 KKF

41303 KKB

41303 KKFA

41303 KKBA
curved 65°, cutting

edge concave forwards,
41303 GNF oval cutting window,
diameter 4 mm,

concave backwards,
41303 GNB oval cutting window,
diameter 4 mm,
Sinus Burrs, curved

41305 RN
Sinus Burrs, curved 70°/55°/40°/15°, for single use , sterile, package of 5

for use with
Sinus Burr
curved 40°, cylindric,

drill diameter 3 mm,
41304 W
shaft diameter 4 mm,
color code: red-blue
curved 55°, cylindric,

drill diameter 3.6 mm,
41303 WN
color code: red-blue
curved 15°, bud drill,

41305 RN
color code: red-black
curved 15°, diamond head,

41305 DN
color code: red-yellow

41305 D

41305 DW

drill diameter 3.6 mm,
41303 DT
Accessories for Shaver
39550 A
39550 A Wire Tray, provides safe storage of accessories for

KARL STORZ paranasal sinus shaver systems during
cleaning and sterilization
for storage of:
– Up to 7 shaver attachments
– Connecting cable
Please note: The instruments displayed are not included in the sterilizing and storage tray.
INTRA Drill Handpiece

for Surgery in Ethmoid and Skull Base Area
Special Features:
## Tool-free closing and opening of the drill ## Lightweight construction
## Right/left rotation ## Operates with little vibrations
## Max. rotating speed up to ## Low maintenance
40,000 rpm / 80,000 U/min ## Reprocessable in a cleaning machine
## Detachable irrigation channels ## Safe grip
252571 INTRA Drill Handpiece, angled, length 15 cm,

transmission 1:1 (40,000 rpm), for use with
252571 KARL STORZ high-performance EC micro
motor II and burrs
252574 Same, Transmission 1:2 (80.000 rpm)
252574 252591 INTRA Drill Handpiece, straight, length 13 cm,
KARL STORZ high-performance EC micro
motor II and burrs
252591
9.5 cm
649600 – 649770 G
Dia. Diamond
Detail Size Standard Diamond
mm coarse
014 1.4 649614 649714 –
018 1.8 649618 649718 –
023 2.3 649623 649723 649723 G
027 2.7 649627 649727 649727 G
031 3.1 649631 649731 649731 G
035 3.5 649635 649735 649735 G
040 4 649640 649740 649740 G
045 4.5 649645 649745 649745 G
050 5 649650 649750 649750 G
060 6 649660 649760 649760 G
070 7 649670 649770 649770 G
649600 Standard Straight Shaft Burr, stainless, size 014 – 070,

length 9.5 cm, set of 11
649700 Diamond Straight Shaft Burr, stainless, size 014 – 070,
649700 G Rapid Diamond Straight Shaft Burr, stainless, with coarse diamond
coating for precise drilling and abrasion without hand pressure and
generating minimal heat, size 023 – 070, length 9.5 cm, set of 9,
color code: gold
280033 Rack, for 36 straight shaft burrs with a length of 9.5 cm,
foldable, sterilizable, size 22 x 14 x 2 cm
INTRA Drill Handpiece

for Surgery in Ethmoid and Skull Base Area
Special Features:
## Tool-free closing and opening of the drill ## Lightweight construction
## Right/left rotation ## Operates with little vibrations
## Max. rotating speed up to ## Low maintenance
40,000 rpm / 80,000 U/min ## Reprocessable in a cleaning machine
## Detachable irrigation channels ## Safe grip
252572 INTRA Drill Handpiece, angled, length 18 cm,

252572 KARL STORZ high-performance EC micro
motor II and burrs
252575 Same, transmission 1:2 (80,000 rpm)
252575 252592 INTRA Drill Handpiece, straight, length 17 cm,
KARL STORZ high-performance EC micro
252592 motor II and burrs
12.5 cm
649600 L – 649770 GL
Diamond
Standard Diamond
Dia. coarse
Detail Size
mm
sterilizable sterilizable sterilizable
014 1.4 649614 L 649714 L –
018 1.8 649618 L 649718 L –

023 2.3 649623 L 649723 L 649723 GL
027 2.7 649627 L 649727 L 649727 GL
031 3.1 649631 L 649731 L 649731 GL
035 3.5 649635 L 649735 L 649735 GL
040 4 649640 L 649740 L 649740 GL
045 4.5 649645 L 649745 L 649745 GL
050 5 649650 L 649750 L 649750 GL
060 6 649660 L 649760 L 649760 GL
070 7 649670 L 649770 L 649770 GL
649600 L Standard Straight Shaft Burr, stainless, size 014 – 070,

649700 L Diamond Straight Shaft Burr, stainless, size 014 – 070,
649700 GL Rapid Diamond Straight Shaft Burr, stainless, with c oarse diamond
coating for precise drilling and abrasion without hand pressure and
generating minimal heat, sizes 023 – 070, length 12.5 cm, set of 9,
color code: gold
Accessories for Burrs
280033
280034
280043

n 280043 Rack, flat model, to hold 21 straight shaft burrs

with a length of 7 cm (6 pcs) and 9.5 cm (15 pcs),
folding model, sterilizable, size 17.5 x 11.5 x 1.2 cm
Please note: The burrs displayed are not included in the racks.
Accessories for Burrs
39552 B
Tray for small parts included
39552 A Wire Tray, provides safe storage of accessories for KARL STORZ

drilling/grinding systems during cleaning and sterilization,
includes tray for small parts, for use with Rack 280030, rack not
included
for storage of:
– Up to 6 drill handpieces
– EC micro motor
– Small parts
39552 B Wire Tray, provides safe storage of accessories for KARL STORZ
drilling/grinding systems during cleaning and sterilization, includes
tray for small parts, for use with Rack 280030, rack included
for storage of:
– Up to 6 drill handpieces
– EC micro motor
– Up to 36 drill bits and burrs
– Small parts
Please note: The instruments displayed are not included in the sterilizing and storage tray.

High-Speed Handpieces, angled, 100,000 rpm
For use with High-Speed Drills, shaft diameter 3.17 mm

100,000 rpm
and with High-Speed Micro Motor 20 7120 33
diameter 7.5 mm
20 7120 33
53 mm
7.5 mm
252681
93 mm
7.5 mm
252682
252681 High-Speed Handpiece, medium, angled, 100,000 rpm,

for use with High-Speed Micro-Motor 20 7120 33
252682 High-Speed Handpiece, long, angled, 100,000 rpm,

High-Speed Handpieces, angled, 60,000 rpm

60,000 rpm
diameter 5.5 mm
20 7120 33
51 mm
5.5 mm
252661
71 mm
5.5 mm
252662
91 mm
5.5 mm
252663
252661 High-Speed Handpiece, short, angled, 60,000 rpm,

252662 High-Speed Handpiece, medium, angled, 60,000 rpm,
252663 High-Speed Handpiece, long, angled, 60,000 rpm,

High-Speed Handpieces, straight, 60,000 rpm

60,000 rpm
diameter 5.5 mm
20 7120 33
51 mm
5.5 mm
252691
71 mm
5.5 mm
252692
252691 High-Speed Handpiece, short, straight, 60,000 rpm,

252692 High-Speed Handpiece, medium, straight, 60,000 rpm,

High-Speed Handpieces, malleable, slim, angled, 60,000 rpm
For use with High-Speed Drills, shaft diameter 1 mm

60,000 rpm
diameter 4.7 mm
The handpieces have malleable shafts that can be bent

up to 20° according to user requirements.
malleable
20 7120 33
108 mm
4.7 mm 252671
128 mm
252672
4.7 mm
252671 High-Speed Handpiece, extra long, malleable, slim, angled,

60,000 rpm, for use with High-Speed Micro-Motor 20 7120 33
252672 High-Speed Handpiece, super long, malleable, slim, angled,
60,000 rpm, for use with High-Speed Micro-Motor 20 7120 33

High-Speed Standard Burrs, High-Speed Diamond Burrs
For use with High-Speed Handpieces, 100,000 rpm

100,000 rpm
diameter 7.5 mm
252681 252682
High-Speed Standard Burrs, 100,000 rpm, for single use ,

sterile, package of 5
Diameter in mm medium long
1 350110 M –
2 350120 M 350120 L
3 350130 M 350130 L
4 350140 M 350140 L
5 350150 M 350150 L
6 350160 M 350160 L
7 350170 M 350170 L
High-Speed Diamond Burrs, 100,000 rpm, for single use ,

1 350210 M –
2 350220 M 350220 L
3 350230 M 350230 L
4 350240 M 350240 L
5 350250 M 350250 L
6 350260 M 350260 L
7 350270 M 350270 L

High-Speed Diamond Burrs, High-Speed Acorn,
High-Speed Barrel Burrs, High-Speed Neuro Fluted Burrs

100,000 rpm
diameter 7.5 mm
252681 252682
High-Speed Coarse Diamond Burrs, 100,000 rpm, for single use ,

3 350330 M 350330 L
4 350340 M 350340 L
5 350350 M 350350 L
6 350360 M 350360 L
7 350370 M 350370 L
High-Speed Acorn, 100,000 rpm, for single use ,

Diameter in mm medium
7.5 350675 M
9 350690 M
High-Speed Barrel Burrs, 100,000 rpm, for single use ,

Diameter in mm medium
6 350960 M
9.1 350991 M
High-Speed Neuro Fluted Burrs, 100,000 rpm, for single use ,

1,8 350718 M 350718 L
3 350730 M 350730 L

High-Speed Standard Burrs, High-Speed Diamond Burrs
60,000 rpm
diameter 5.5 mm
252661 252662 252663
252691 252692
High-Speed Standard Burrs, 60,000 rpm, for single use ,

Diameter in mm short medium long
1 330110 S 330110 M –
2 330120 S 330120 M 330120 L
3 330130 S 330130 M 330130 L
4 330140 S 330140 M 330140 L
5 330150 S 330150 M 330150 L
6 330160 S 330160 M 330160 L
7 330170 S 330170 M 330170 L

0.6 330206 S – –
1 330210 S 330210 M –
1.5 330215 S – –
2 330220 S 330220 M 330220 L
3 330230 S 330230 M 330230 L
4 330240 S 330240 M 330240 L
5 330250 S 330250 M 330250 L
6 330260 S 330260 M 330260 L
7 330270 S 330270 M 330270 L


High-Speed Diamond Burrs, High-Speed Cylinder Burrs,
LINDEMANN High-Speed Fluted Burrs

60,000 rpm
diameter 5.5 mm
252661 252662 252663
252691 252692

3 330330 S 330330 M 330330 L
4 330340 S 330340 M 330340 L
5 330350 S 330350 M 330350 L
6 330360 S 330360 M 330360 L
7 330370 S 330370 M 330370 L
High-Speed Cylinder Burrs, 60,000 rpm, for single use ,

Diameter in mm short
4 330440 S
6 330460 S
LINDEMANN High-Speed Fluted Burrs, 60,000 rpm, for single use ,

Size in mm
short
(diameter x length)
Diameter 2.1/11 330511 S
Diameter 2.3/26 330526 S


High-Speed Diamond Burrs

60,000 rpm
diameter 4.7 mm
252671 252672

Diameter in mm extra long super long
2 320220 EL 320220 SL
3 320230 EL 320230 SL
4 320240 EL 320240 SL

Diameter in mm extra long super long
2 320320 EL 320320 SL
3 320330 EL 320330 SL
4 320340 EL 320340 SL
KARL STORZ NAV1 electromagnetic n
KARL STORZ navigation system with advanced tracking technology

The new KARL STORZ navigation system, NAV1 electro- Experience the excellent quality and precision of the
magnetic, supports surgeons in otorhinolaryngology and KARL STORZ navigation system NAV1 electromagnetic.
skull base surgery. It uses a sophisticated electromagnetic
tracking system.
Benefits of KARL STORZ NAV1 electromagnetic

## High precision thanks to sensor location in ## Planning and monitoring of high-risk structures
instrument tip with intraoperative DistanceControl
## Navigated instruments can be autoclaved 30x ## Better orientation through waypoint navigation
## Wide range of instruments; simultaneous tracking ## Automatic and reliable documentation of the
of up to 3 instruments possible navigated procedure
## Display of complete instrument geometry in the ## Infinitely adjustable CT-MRI fusion
patient’s radiology data ## Import of patient data via USB, CD or PACS
40 8200 01 NAV1 electromagnetic

including:
NAV1 Module
NAV1 electromagnetic Module
NAV1 electromagnetic Field Generator
Headband for Navigation, for single use
EM Patient Tracker
EM Navigation Probe
Optical Mouse
Mains Cord, length 300 cm
Module Connecting Cable, length 250 cm
DVI Connecting Cable, length 300 cm
A headrest with integrated EM field generator

is included in delivery.
Note: Equipment cart with accessories not included in the delivery

of NAV1 electromagnetic 40 8200 01.

Components of NAV1 electromagnetic
40 8200 01 NAV1 electromagnetic

including:
NAV1 Module
NAV1 electromagnetic Module
NAV1 electromagnetic Field Generator
EM Patient Tracker
EM Navigation Probe
Optical Mouse
Module Connecting Cable, length 250 cm
A headrest with integrated EM field generator is included in delivery.

Instruments for NAV1 electromagnetic
40 8201 31 EM Navigated Curette, 0°
40 820132 EM Navigated Curette, 55°
40 820130 EM Navigated Curette, 90°
40 820111 EM Navigated Frontal Sinus Probe

Instruments for NAV1 electromagnetic
40 820145 EM Navigated Suction Tube, straight
40 820165 EM Navigated Suction Tube, curved
40 820110 EM Navigated Probe, malleable, straight
40 820112 EM Navigated Probe, malleable, curved
40 8201 05 EM Navigated Probe

KARL STORZ NAV1 pico

Mobile optical navigation for ENT and skull base surgery
Special Features:
## Mobile,space-saving system with intuitive ## Durable,sturdy and autoclavable navigation
handling instruments
## Easy assembly and flexible use in the OR ## Reduced costs through autoclavable
accessories
KARL STORZ NAV1 pico

Mobile optical navigation for ENT and skull base surgery
40 8000 01 NAV1 pico

including:
Navigation Panel
Optical Mouse
Navigation Camera
Electronic Box
Docking Adaptor
Mobile Stand
Data Cable
Video Cable
Navigation Camera cable, length 250 cm
Patient Tracker III
Transport Case Navigation
Navigation Probe
Mains Cord
KARL STORZ NAV1 optical

Space-saving integration in any operating room
With NAV1 optical you benefit from a seamlessly integrated Mounted on a ceiling or an extension arm, the navigation
high-performance navigation solution. The b asic unit can camera allows an easy setup and optimal visualization of
easily be attached to a ceiling supply unit or integrated the surgical site combined with high flexibility. This results
into an equipment cart. in a “zero footprint” navigation solution.
Therefore the NAV1 optical is offered as a solution for the
functional combination of all units in one place.
KARL STORZ NAV1 optical

Space-saving integration in any operating room
40 8100 01 NAV1 optical

including:
NAV1 Module
Optical Mouse
Navigation Camera
Mobile Stand
Navigation Camera Cable, length 750 cm
Patient Tracker III
Transport Case Navigation
Navigation Probe
Mains Cord
Note: Equipment cart with accessories not included in the delivery

of NAV1 optical 40 8100 01.
Probe, Patient Tracker and Headband

for optical navigation
40 800110
40 8001 10
Navigation Probe,
with glass marker spheres incorporated,
autoclavable, dimensions: 295 x 15 x 30 mm,
for use with NAV1 pico and NAV1 optical
40 8000 88
40 8000 88 Patient Tracker III,

with verification adaptor,
3 incorporated glass marker spheres and fixation screw,
autoclavable, dimensions: 80 x 60 x 12 mm
40 8000 83
40 8000 83 Headband for Navigation,

for single use, with plastic holder
Navigated Suction Tubes

angular, curved downwards, curved upwards
40 800140 L
40 8001 40 L Navigated Suction Tube,

straight, for left-handed use, 9 Fr.,
working length 9 cm, total length 16 cm,
40 800140 R
40 8001 40 R Navigated Suction Tube,

straight, for right-handed use, 9 Fr.,
working length 9 cm, total length 16 cm,
40 800160
40 8001 60 v. EICKEN Navigated Suction Tube,

curved downwards, for right-handed use,
outer diameter 3 mm, length 16.5 cm,
Navigated Suction Tubes

angular, curved downwards, curved upwards
40 800151
40 8001 51 v. EICKEN Navigated Suction Tube,

curved upwards, for left and right-handed use,
40 800160 LM
40 8001 60 LM v. EICKEN Navigated Suction Tube,

curved to left, for left and right-handed use,
40 800160 RM
40 8001 60 RM v. EICKEN Navigated Suction Tube,

curved to right, for left and right-handed use,
Optical Navigated Frontal Sinus Probe n

40 800111
40 800111 Optical Navigated Frontal Sinus Probe,

Instrument Tracker
The autoclavable instrument tracker is designed for the very good instrument maneuvrability.
navigation of various instruments. The small size of the
instrument tracker reduces the risk of collision and ensures
Special Features:
## User-friendly handling thanks to optimized, ## Can be used for various navigation instruments
miniaturized design
40 800120
40 800120 Tool Tracker, for optical navigated instruments,

with 3 fix-mounted glass spheres, autoclavable,
dimensions: 70 x 50 x 14 mm,
for use with navigated instruments 40 800 14x,
40 800 15x, 40 800 16x and 40 800 17x
and Optical Navigated Frontal Sinus Probe 40 800111
DrillCut-X® II N Shaver Handpiece and Shaver Tracker n
Special Features:
## Powerful motor ## Variablehandle allows connection with various
## Absolutely silent running handpieces and enables more comfortable work
## Enhanced ergonomics ## Easy hygienic processing, suitable for use in
washer and autoclavable at 134 °C
## Reduced-weight design
## Quick coupling mechanism facilitates more rapid
exchange of working inserts
max. 10,000 rpm
## Proven DrillCut-X® blade portfolio can be used
## Rotation mode for sinus shavers,
## Adaptation possibilities for navigated
max. 12,000 rpm
Shaver Tracker 40 8001 22
## Straight suction channel and
## Allows shaver navigation when used with
integrated irrigation
NAV1 pico and NAV1 optical
40 8001 22
40 8001 22 Shaver Tracker, autoclavable, with glass marker spheres

incorporated, for use with DrillCut-X® II N Shaver Handpiece
40 7120 55 and Navigation Systems NAV1 pico 40 8000 01
and NAV1 optical 40 8100 01
IMAGE1 S Camera System n

Economical and future-proof
## Modular concept for flexible, rigid and ## Sustainable investment
3D endoscopy as well as new technologies ## Compatible with all light sources
## Forward and backward compatibility with video
endoscopes and FULL HD camera heads
Innovative Design
## Dashboard: Complete overview with intuitive ## Automatic light source control
menu guidance ## Side-by-side view: Parallel display of standard
## Live menu: User-friendly and customizable image and the Visualization mode
## Intelligent icons: Graphic representation changes ## Multiple source control: IMAGE1 S a llows
when settings of connected devices or the entire the simultaneous display, processing and
system are adjusted documentation of image information from
two c onnected image sources, e.g., for hybrid
operations
Dashboard Live menu
Intelligent icons Side-by-side view: Parallel display of standard image and

Visualization mode

Brillant Imaging
## Clear and razor-sharp endoscopic images in ## Reflection is minimized
FULL HD ## Multiple IMAGE1 S technologies for homogeneous
## Natural color rendition illumination, contrast enhancement and color
shifting
FULL HD image CLARA
FULL HD image CHROMA
FULL HD image SPECTRA A *
FULL HD image SPECTRA B **
* SPECTRA A : Not for sale in the U.S.

** SPECTRA B : Not for sale in the U.S.
TC 200EN
IMAGE1 S CONNECT, connect module, for use with up to

TC 200EN*
3 link modules, resolution 1920 x 1080 pixels, with integrated
KARL STORZ-SCB and digital Image Processing Module,
power supply 100 – 120 VAC/200 – 240 VAC, 50/60 Hz
including:
DVI-D Connecting Cable, length 300 cm
SCB Connecting Cable, length 100 cm
USB Flash Drive, 32 GB, USB silicone keyboard, with touchpad, US
* Available in the following languages: DE, ES, FR, IT, PT, RU
Specifications:
HD video outputs - 2x DVI-D Power supply 100 – 120 VAC/200 – 240 VAC
- 1x 3G-SDI Power frequency 50/60 Hz
Format signal outputs 1920 x 1080p, 50/60 Hz Protection class I, CF-Defib
LINK video inputs 3x Dimensions w x h x d 305 x 54 x 320 mm
USB interface 4x USB, (2x front, 2x rear) Weight 2.1 kg
SCB interface 2x 6-pin mini-DIN
For use with IMAGE1 S

IMAGE1 S CONNECT Module TC 200EN
TC 300
TC 300 IMAGE1 S H3-LINK, link module, for use with

IMAGE1 FULL HD three-chip camera heads,
power supply 100 – 120 VAC/200 – 240 VAC, 50/60 Hz,
for use with IMAGE1 S CONNECT TC 200EN
including:
Link Cable, length 20 cm
Specifications:
Camera System TC 300 (H3-Link)
Supported camera heads/video endoscopes TH 100, TH 101, TH 102, TH 103, TH 104, TH 106
(fully compatible with IMAGE1 S)
22 2200 55-3, 22 2200 56-3, 22 2200 53-3, 22 2200 60-3, 22 2200 61-3,
22 2200 54-3, 22 2200 85-3
(compatible without IMAGE1 S technologies CLARA, CHROMA, SPECTRA*)
LINK video outputs 1x
Power supply 100 – 120 VAC/200 – 240 VAC
Power frequency 50/60 Hz
Protection class I, CF-Defib
Dimensions w x h x d 305 x 54 x 320 mm
Weight 1.86 kg
* SPECTRA A : Not for sale in the U.S.

** SPECTRA B : Not for sale in the U.S.
IMAGE1 S Camera Heads n

For use with IMAGE1 S Camera System
IMAGE1 S CONNECT Module TC 200EN, IMAGE1 S H3-LINK Module TC 300
and with all IMAGE 1 HUB™ HD Camera Control Units
TH 100 IMAGE1 S H3-Z Three-Chip FULL HD Camera Head,

50/60 Hz, IMAGE1 S compatible, progressive scan,
soakable, gas- and plasma-sterilizable, with integrated
Parfocal Zoom Lens, focal length f = 15 – 31 mm (2x),
2 freely programmable camera head buttons,
TH 100 for use with IMAGE1 S and IMAGE 1 HUB™ HD/HD
Specifications:
IMAGE1 FULL HD Camera Heads IMAGE1 S H3-Z
Product no. TH 100
Image sensor 3x 1/3" CCD chip
Weight 270 g
Optical interface integrated Parfocal Zoom Lens,
f = 15 – 31 mm (2x)
Min. sensitivity F 1.4/1.17 Lux
Grip mechanism standard eyepiece adaptor
Cable non-detachable
Cable length 300 cm
TH 104 IMAGE1 S H3-ZA Three-Chip FULL HD Camera Head,

50/60 Hz, IMAGE1 S compatible, autoclavable,
progressive scan, soakable, gas- and plasma-sterilizable,
with integrated Parfocal Zoom Lens, focal length
f = 15 – 31 mm (2x), 2 freely programmable camera head
TH 104 buttons, for use with IMAGE1 S and IMAGE 1 HUB™ HD/HD
Specifications:
IMAGE1 FULL HD Camera Heads IMAGE1 S H3-ZA
Product no. TH 104
Image sensor 3x 1/3" CCD chip
Weight 299 g
Optical interface integrated Parfocal Zoom Lens,
f = 15 – 31 mm (2x)
Min. sensitivity F 1.4/1.17 Lux
Grip mechanism standard eyepiece adaptor
Cable non-detachable
Cable length 300 cm
Monitors
9619 NB
9619 NB 19" HD Monitor,

color systems PAL/NTSC, max. screen
resolution 1280 x 1024, image format 4:3,
power supply 100 – 240 VAC, 50/60 Hz,
wall-mounted with VESA 100 adaption,
including:
External 24 VDC Power Supply
Mains Cord
9826 NB
9826 NB 26" FULL HD Monitor,

wall-mounted with VESA 100 adaption,
color systems PAL/NTSC,
max. screen resolution 1920 x 1080,
image fomat 16:9,
power supply 100 – 240 VAC, 50/60 Hz
including:
External 24 VDC Power Supply
Mains Cord
Monitors
KARL STORZ HD and FULL HD Monitors 19" 26"

Wall-mounted with VESA 100 adaption 9619 NB 9826 NB
Inputs:
DVI-D l l
Fibre Optic – –
3G-SDI – l
RGBS (VGA) l l
S-Video l l
Composite/FBAS l l
Outputs:
DVI-D l l
S-Video l –
Composite/FBAS l l
RGBS (VGA) l –
3G-SDI – l
Signal Format Display:
4:3 l l
5:4 l l
16:9 l l
Picture-in-Picture l l
PAL/NTSC compatible l l
Optional accessories:
9826 SF Pedestal, for monitor 9826 NB
9626 SF Pedestal, for monitor 9619 NB
Specifications:
KARL STORZ HD and FULL HD Monitors 19" 26"
Desktop with pedestal optional optional
Product no. 9619 NB 9826 NB
Brightness 200 cd/m2 (typ) 500 cd/m2 (typ)
Max. viewing angle 178° vertical 178° vertical
Pixel distance 0.29 mm 0.3 mm
Reaction time 5 ms 8 ms
Contrast ratio 700:1 1400:1
Mount 100 mm VESA 100 mm VESA
Weight 7.6 kg 7.7 kg
Rated power 28 W 72 W
Operating conditions 0 – 40°C 5 – 35°C
Storage -20 – 60°C -20 – 60°C
Rel. humidity max. 85% max. 85%
Dimensions w x h x d 469.5 x 416 x 75.5 mm 643 x 396 x 87 mm
Power supply 100 – 240 VAC 100 – 240 VAC
Certified to EN 60601-1, EN 60601-1, UL 60601-1,
protection class IPX0 MDD93/42/EEC,
protection class IPX2
Cold Light Fountains and Accessories
495 NT Fiber Optic Light Cable,

with straight connector, diameter 2.5 mm,
length 180 cm
495 NTW Fiber Optic Light Cable,
diameter 2.5 mm, length 180 cm
with 90° deflection to the light source
495 NTX Same, length 230 cm
LED NOVA® 150, High-Performance LED Cold Light Fountain
20 1612 01
LED Nova 150, High-Performance
LED Cold Light Fountain
with one KARL STORZ light outlet,
power supply 100 - 240 VAC, 50/60 Hz
including:
Mains cord
Cold Light Fountain XENON NOVA® 175
20131501 Cold Light Fountain XENON NOVA® 175,

power supply:
100 –125 VAC/220 –240 VAC, 50/60 Hz
including:
Mains Cord
20132026 XENON Spare Lamp,
175 watt, 15 volt
Cold Light Fountain XENON 300 SCB
20 133101-1 Cold Light Fountain XENON 300 SCB

with built-in antifog air-pump, and integrated
KARL STORZ Communication Bus System SCB
power supply:
100 –125 VAC/220 –240 VAC, 50/60 Hz
including:
Mains Cord
SCB Connecting Cord, length 100 cm
20133027 Spare Lamp Module XENON
with heat sink, 300 watt, 15 volt
20133028 XENON Spare Lamp, only,
300 watt, 15 volt
Data Management and Documentation

KARL STORZ AIDA® – Exceptional documentation
The name AIDA stands for the comprehensive implementation

of all documentation requirements arising in surgical procedures:
A tailored solution that flexibly adapts to the needs of every
specialty and thereby allows for the greatest degree of
customization.
This customization is achieved in accordance with existing
clinical standards to guarantee a reliable and safe solution.
Proven functionalities merge with the latest trends and
developments in medicine to create a fully new documentation
experience – AIDA.
AIDA seamlessly integrates into existing infrastructures and
exchanges data with other systems using common standard
interfaces.
WD 200-XX* AIDA Documentation System,

for recording still images and videos,
dual channel up to FULL HD, 2D/3D,
power supply 100-240 VAC, 50/60 Hz
including:
USB Silicone Keyboard, with touchpad
ACC Connecting Cable
HDMI-DVI Cable, length 200 cm
WD 250-XX* AIDA Documentation System,

for recording still images and videos,
dual channel up to FULL HD, 2D/3D,
including SMARTSCREEN® (touch screen),
power supply 100-240 VAC, 50/60 Hz
including:
USB Silicone Keyboard, with touchpad
ACC Connecting Cable
HDMI-DVI Cable, length 200 cm
*XX Please indicate the relevant country code

(DE, EN, ES, FR, IT, PT, RU) when placing your order.
Workflow-oriented use
Patient
Entering patient data has never been this easy. AIDA seamlessly
integrates into the existing infrastructure such as HIS and PACS.
Data can be entered manually or via a DICOM worklist.
ll important patient information is just a click away.
Checklist
Central administration and documentation of time-out. The checklist
simplifies the documentation of all critical steps in accordance with
clinical standards. All checklists can be adapted to individual needs
for sustainably increasing patient safety.
Record
High-quality documentation, with still images and videos being
recorded in FULL HD and 3D. The Dual Capture function allows for
the parallel (synchronous or independent) recording of two sources.
All recorded media can be marked for further processing with just
one click.
Edit
With the Edit module, simple adjustments to recorded still images
and videos can be very rapidly completed. Recordings can be quickly
optimized and then directly placed in the report.
In addition, freeze frames can be cut out of videos and edited and
saved. Existing markings from the Record module can be used for
quick selection.
Complete
Completing a procedure has never been easier. AIDA offers a large
selection of storage locations. The data exported to each storage
location can be defined. The Intelligent Export Manager (IEM) then
carries out the export in the background. To prevent data loss,
the system keeps the data until they have been successfully exported.
Reference
All important patient information is always available and easy to access.
Completed procedures including all information, still images, videos,
and the checklist report can be easily retrieved from the Reference module.
Equipment Cart
UG 220 Equipment Cart

wide, high, rides on 4 antistatic dual wheels
equipped with locking brakes 3 shelves,
mains switch on top cover,
central beam with integrated electrical subdistributors
with 12 sockets, holder for power supplies,
potential earth connectors and cable winding
on the outside,
Dimensions:
Equipment cart: 830 x 1474 x 730 mm (w x h x d),
shelf: 630 x 510 mm (w x d),
caster diameter: 150 mm
inluding:
Base module equipment cart, wide
Cover equipment, equipment cart wide
Beam package equipment, equipment cart high
3x Shelf, wide
Drawer unit with lock, wide
2x Equipment rail, long
Camera holder
UG 220
UG 540 Monitor Swifel Arm,

height and side adjustable,
can be turned to the left or the right side,
swivel range 180°, overhang 780 mm,
overhang from centre 1170 mm,
load capacity max. 15 kg,
with monitor fixation VESA 5/100,
for usage with equipment carts UG xxx
UG 540
Recommended Accessories for Equipment Cart
UG 310 Isolation Transformer,

200 V – 240 V; 2000 VA with 3 special mains socket,
expulsion fuses, 3 grounding plugs,
dimensions: 330 x 90 x 495 mm (w x h x d),
UG 310
UG 410 Earth Leakage Monitor,

200 V – 240 V, for mounting at equipment cart,
control panel dimensions: 44 x 80 x 29 mm (w x h x d),
for usage with isolation transformer UG 310
UG 410
UG 510 Monitor Holding Arm,

height adjustable, inclinable,
mountable on left or right,
turning radius approx. 320°, overhang 530 mm,
load capacity max. 15 kg,
monitor fixation VESA 75/100,
UG 510
Notes:

Endoscopic and Sinus CX Manual

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Endoscopic and Sinus CX Manual

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Usamah Hadi graduated from the American University of Beirut and was

ENDOSCOPIC AND SINONASAL

Medical knowledge is ever changing. As new American University of Beirut, Lebanon

1.0 Anatomy of the Lateral Nasal Wall. . . . . . . . . . . . . . . . . . . . . . . . . 10

2.0 Basal Lamella of the Middle Turbinate . . . . . . . . . . . . . . . . . . . . . 12

3.0 Uncinate Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

4.0 Hiatus Semilunaris and Ethmoid Infundibulum . . . . . . . . . . . . . . 19

5.0 Anterior Ethmoid Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

6.0 Ethmoid Bulla. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

7.0 Anterior Ethmoid Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

8.0 Posterior Fontanelle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

9.0 Middle Meatal Antrostomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

10.0 Sinus lateralis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

11.0 Superior Turbinate and Meatus . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

13.0 Sphenoethmoid Recess and Sphenoid|Ostium . . . . . . . . . . . . . . 51

14.0 Sphenopalatine Foramen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

15.0 Nasolacrimal Sac and Duct . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

16.0 Endoscopic Approach to Pituitary Gland and Related Tumors . 60

17.0 Orbital Decompression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

18.0 Optic Nerve Decompression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

19.0 Iatrogenic CSF Leakage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

20.0 Lateral Canthotomy and Inferior Cantholysis. . . . . . . . . . . . . . . . 65

To my wife, Layla, for her love, understanding, support

Your Cadaver – Your Patient

Preparation and Maintenance of a Cadaver Specimen

Alcohol Glycerin Phenol Formaldehyde H2 O

Safety Issues in the Cadaver Lab

1.0 Anatomy of the Lateral Nasal Wall

Anatomical Reference Structures

2.0 Basal Lamella of the Middle Turbinate

1 Schematic drawing of the basal lamellae of the ethmoid bone.

5 Schematic three-dimensional depiction of the basal lamella of the middle turbinate.

Middle Turbinate Dissection

Variations of the Middle Turbinate

3.0 Uncinate Process

Uncinate Process (UP) and Maxillary Line

1 Schematic drawing of the basal lamellae

2 Gross anatomy demonstrated by

Identify the uncinate process (UP), which

4 Sagittal cadaveric section: the middle

Anatomical Variants of the Uncinate Process Insertion

6 Schematic drawings demonstrating three

Radiologic Examples of Uncinate Process Variants

4.0 Hiatus Semilunaris and Ethmoid Infundibulum

1 Gross anatomy of a sagittal cadaver

The Ethmoid Infundibulum – A Three-Dimensional Cavity

The ethmoid infundibulum is located lateral to the hiatus semilunaris inferior.

A piece of white ribbon may be inserted in the ethmoid infundibulum.

3 Gross anatomy of a sagittal cadaver

Note the following boundaries:

5.0 Anterior Ethmoid Cells

1 Schematic drawing of the basal lamellae

2 Gross anatomy of a sagittal cadaver

Agger Nasi Cell

presenting as an eminence in the lateral nasal wall.

4 Gross anatomy of a sagittal cadaver

Agger Nasi Cell and Frontal Recess

6.0 Ethmoid Bulla

1 Schematic drawing of the basal lamellae

Boundaries of the Ethmoid Bulla

2 Gross anatomy of a sagittal cadaveric

Topographical, Morphological and Surgical Aspects

4 Gross anatomy of a sagittal cadaver