0:01

Sometimes it's amazing how anatomy

0:05

can duplicate your diagrams or vice versa.

0:09

So on the top left,

0:10

what you have is a sagittal reconstruction from axial CT

0:15

data going through the perinasal sinuses.

0:18

And just as we saw that there was that

0:22

drainage on the diagram from the frontal sinus

0:27

through the frontal recess into the middle MEUs.

0:30

You can see that here is our frontal sinus,

0:33

and here is that drainage pathway through the frontal recess

0:37

and then going into the middle MEUs.

0:39

And similarly, you have the ethmoid sinus

0:42

draining into the middle atu,

0:45

and you have your seno ethmoidal recess,

0:48

which would normally be between this

0:50

posterior ethmoid air cell here and the sphenoid sinus.

0:54

So these anatomic drawings can be duplicated

0:58

with our actual CT scans.

1:00

As I said, most

1:01

of us look at the scans on the coronal images

1:05

rather than on the sagittal images in order

1:08

to see the OSS osteomeatal units, which are those areas

1:11

of the osteum as well as the passageways.

1:15

I do want to emphasize one other area in which you will find

1:20

surgery performed.

1:22

I had mentioned that the ethmoid air cell that is just

1:25

above the osteo mutal unit is called the ethmoidal boah.

1:30

In the beginning when functional endoscopic science surgery

1:33

was proposed,

1:36

the endoscopic surgeons were doing large ethmoid ectomies.

1:40

They were clearing out all of the ethmoid air cells

1:44

and creating a common passageway with the frontal sinus.

1:47

Again, that's not really functional.

1:50

And what you see more characteristically nowadays is

1:55

that the ethmoidal bulla, which is that air cell,

1:57

which is the most likely to narrow the passage of mucus

2:02

into the middle mitus region,

2:05

that air cell is usually taken down.

2:07

It might be called a ethmoid.

2:08

Bullectomy, or what most people just call it

2:11

as a partial ethmoidectomy.

2:14

So they're actually doing less surgery than they did when

2:16

they first started with functional endoscopic sinus surgery.

2:20

Similarly, in the past,

2:22

they would take down potentially the middle turbinate

2:25

because that also when enlarged can cause narrowing

2:29

of the passageways.

2:31

Turns out that after you've done middle turbinate ectomies

2:35

patients have an unusual sense of congestion

2:39

for some reason in their sinuses,

2:41

even though they're perfectly clear.

2:43

And it has something to do with the humidification

2:45

that these terminates allow us

2:48

to have in our paranasal sinuses.

2:51

So more and more that middle turbinectomy

2:54

that was originally done in the 1980s

2:56

and 1990s is no longer performed just

2:59

as the wide ethmoidectomy is no longer being performed.

3:03

It's actually less surgery,

3:05

but they found that it's more functional from the standpoint

3:08

of the muco ciliary clearance.