The Ponticulus Ethmoidalis: A Newly Appreciated Anatomic Landmark in Endoscopic Sinus Surgery

Introduction: Ethmoid sinus anatomy is so variable it has been referred to as a “labyrinth.” Accordingly, this provides a challenge for surgeons performing ethmoidectomy. Identifying consistent anatomic features or landmarks within the ethmoid sinus can aid surgeons performing sinus surgery. The goal of this investigation was to determine if subtle anatomic features are consistently present within the retrobullar recess and could potentially serve as a reliable landmark for surgeons performing ethmoid surgery. Materials and Methods: Ethmoid sinus anatomy was studied in 60 sinonasal complexes through several methods including gross anatomic dissection, endoscopic dissection and 3-D CT stereoscopic imaging. Results: Review of gross sagittal sinonasal specimens revealed that the retrobullar recess was present in all specimens and a tissue bridge was noted emanating from the basal lamella deep within the retrobullar recess in 23/24 gross sagittal specimens; in 1/24 specimens it was quite small or difficult to appreciate. In the radiographic analysis, the tissue bridge was noted in 17/18, in 1/18 it was not appreciated. In the endoscopic dissections it was noted in 17/18, in 1/18 it was small or not appreciated. Conclusion: The small tissue bridge, or ponticulus within the retrobulbar recess was seen in nearly all ethmoid sinuses studied leading us to venture that could be used in surgery to orient surgical dissection through the basal lamella into the posterior ethmoid region.

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Surgical Instrument Force Exerted during Endoscopic Sinus Surgery: Differences within the Ethmoid Sinus Complex

American Journal of Rhinology and Allergy ◽

10.2500/ajra.2010.24.3374 ◽

2010 ◽

Vol 24 (1) ◽

pp. 76-80 ◽

Cited By ~ 5

Author(s):

Peter D. Ross ◽

Paul Joice ◽

Ramez G. Nassif ◽

Paul S. White

Keyword(s):

Endoscopic Sinus Surgery ◽

Ethmoid Sinus ◽

Sinus Surgery ◽

Surgical Instrument

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A Case of Brain Herniation and Cerebrospinal Fluid Leakage during Endoscopic Marsupialization of Ethmoid Sinus Mucocele

Korean Journal of Otorhinolaryngology - Head and Neck Surgery ◽

10.3342/kjorl-hns.2019.00542 ◽

2020 ◽

Vol 63 (9) ◽

pp. 427-431

Author(s):

Song Jae Lee ◽

Sang Gyu Park ◽

Hae Won Choi ◽

Kyung Rae Kim

Keyword(s):

Cerebrospinal Fluid ◽

Surgical Intervention ◽

Brain Parenchyma ◽

Ethmoid Sinus ◽

Sinus Surgery ◽

Cerebrospinal Fluid Leakage ◽

Brain Herniation ◽

Fluid Leakage ◽

Adjacent Structures ◽

Ethmoid Sinuses

Paranasal sinus mucocele is a slowly growing benign cystic lesion. It usually involves the frontal and ethmoid sinuses and can extend to adjacent structures, especially to the orbit, skull base and brain parenchyma. Prompt surgical intervention is needed when symptoms occur. Complete resection of mucocele is approached via endoscopic sinus surgery, while marsupialization is also widely considered. Recently, we encountered a case of spontaneous brain herniation and cerebrospinal fluid leakage during endoscopic marsupialization of ethmoid sinus mucocele. Herein, we report the case with a review of the literature.

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The Prevalence of an Onodi Cell in Adult Thai Cadavers

Ear Nose & Throat Journal ◽

10.1177/014556130308200314 ◽

2003 ◽

Vol 82 (3) ◽

pp. 200-204 ◽

Cited By ~ 30

Author(s):

Sanguansak Thanaviratananich ◽

Kowit Chaisiwamongkol ◽

Suthee Kraitrakul ◽

Watcharachai Tangsawad

Keyword(s):

Optic Nerve ◽

High Risk ◽

Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Minimum Amount ◽

Bone Thickness ◽

Optic Nerve Injury ◽

Nasal Endoscope ◽

Anatomic Dissection ◽

Onodi Cell

Endoscopic sinus surgery in patients who have an Onodi cell (sphenoethmoid cell) carries a high risk for optic nerve injury. We meticulously dissected 65 embalmed cadaver adult half-heads and attempted to identify an optic canal bulge in each with a nasal endoscope. Our aims were to determine the prevalence of an Onodi cell in adult Thai cadavers, to ascertain the prevalence of an overriding ethmoid cell, and to measure the length of an overriding ethmoid cell's superior and posterior extensions in relation to the anterior sphenoid wall. Moreover, we attempted to determine the minimum amount of bone thickness between an Onodi cell and the optic nerve. We found that an Onodi cell was present in 39 of the 65 specimens (60.0%). We also found that an overriding ethmoid cell was present in 14 specimens, which accounted for 21.5% of the total number of specimens and 36.8% of 38 Onodi cell-positive specimens (the presence or absence of an overriding ethmoid cell was not recorded in one of the 39 Onodi cell-positive specimens). The distance of the overriding ethmoid cell's superior and posterior extensions from the anterior sphenoid wall ranged from 3 to 13 mm (median: 7) and from 4 to 16 mm (median: 9.5), respectively. Measurements of the minimum amount of bone thicknesses between each Onodi cell and optic nerve ranged from 0.03 to 0.54 mm (median: 0.08). Our study demonstrated that the prevalence of an Onodi cell in adult Thai cadavers was as great as the prevalence reported in the only other gross anatomic dissection study performed in Asia and much higher than rates generally reported in Western countries.

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The Anterior Ethmoidal “Genu”: A Newly Appreciated Anatomic Landmark for Endoscopic Sinus Surgery

Clinical Anatomy ◽

10.1002/ca.23347 ◽

2019 ◽

Vol 32 (4) ◽

pp. 534-540 ◽

Cited By ~ 1

Author(s):

William E. Bolger ◽

Heinz Stammberger ◽

Masaru Ishii ◽

Jens Ponikau ◽

Meiyappan Solaiyappan ◽

...

Keyword(s):

Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Anatomic Landmark

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Bacteriology of the maxillary and ethmoid sinuses in chronic sinusitis

The Journal of Laryngology & Otology ◽

10.1017/s0022215100141866 ◽

1998 ◽

Vol 112 (9) ◽

pp. 845-848 ◽

Cited By ~ 14

Author(s):

Rong-San Jiang ◽

Chen-Yt Hsu ◽

Jinq-Wen JANG

Keyword(s):

Maxillary Sinus ◽

Staphylococcus Epidermidis ◽

Chronic Sinusitis ◽

Ethmoid Sinus ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

P Value ◽

Chi Square ◽

Chi Square Test ◽

Ethmoid Sinuses

AbstractThe bacteriology of chronic sinusitis was studied by using swab and mucosalspecimens from both the maxillary and ethmoid sinuses. The specimens of the maxillary sinus were taken through translabial antroscopy. The specimens of the ethmoid sinus were taken after removing the ethmoid bulla during functional endoscopic sinus surgery (FESS). Eighty-six samples of each type of specimen were collected. Among the maxillary sinus samples, the culture rate was 60.5 per cent from the swab specimens and 36 per cent from the mucosal specimens. Among the ethmoid sinus samples, the culture rate was 58.1 per cent from the swab specimens and 75.6 per cent from the mucosal. The p-value by the Chi-Square test is higher than 0.01 (p =0.015). As there were more isolates ofStaphylococcus epidermidisfrom the mucosal specimens, they are not a better choice of specimen for sampling the ethmoid sinus than a swab specimen.

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Endoscopic Surgery for Frontal and Ethmoid Sinus Mucoceles

American Journal of Rhinology ◽

10.2500/105065894781874386 ◽

1994 ◽

Vol 8 (3) ◽

pp. 107-112 ◽

Cited By ~ 3

Author(s):

Thomas L. Kennedy

Keyword(s):

Endoscopic Surgery ◽

Endoscopic Sinus Surgery ◽

Frontal Sinus ◽

Ethmoid Sinus ◽

Endoscopic Approach ◽

Sinus Surgery ◽

Difficult Cases

Seven patients with frontal and ethmoid mucoceles treated by endoscopic sinus surgery were reviewed. Five cases were successfully managed, with two requiring a trephine procedure in combination with the intranasal endoscopic approach. Follow-up ranged from 3 to 33 months with a mean of 17.8 months. The use of endoscopic instruments through a trephine incision is recommended in difficult cases to assure patency of the frontal sinus recess. When a large frontal sinus mucocele extends into the anterior ethmoid, the endoscopic approach becomes ideal. Sinus mucoceles can be handled safely and successfully by endoscopic surgery and may eliminate the need for more traditional external procedures.

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Measurement of Osteotomy Force during Endoscopic Sinus Surgery

Allergy & Rhinology ◽

10.2500/ar.2012.3.0032 ◽

2012 ◽

Vol 3 (2) ◽

pp. ar.2012.3.0032 ◽

Cited By ~ 4

Author(s):

Paul Joice ◽

Peter D. Ross ◽

Dong Wang ◽

Eric W. Abel ◽

Paul S. White

Keyword(s):

Endoscopic Sinus Surgery ◽

Ethmoid Sinus ◽

Sinus Surgery ◽

Osteotomy Site ◽

Indication For Surgery ◽

Independent Variables ◽

The Mean ◽

Effectiveness Of Training ◽

And Gender ◽

Live Patient

Greater understanding of the surgeon's task and skills are required to improve surgical technique and the effectiveness of training. Currently, neither the objective measurement of osteotomy forces during endoscopic sinus surgery (ESS) nor the validity of the properties of cadaver materials, are well documented. Measurement was performed of peak axial osteotomy force during ESS. A comparison was made of results with previously published cadaver data to validate the force properties of cadaver models. A prospective, consecutive cohort of 25 patients was compared with data from 15 cadaver heads. A modified Storz sinus curette measured osteotomy force from uncinate, bulla ethmoidalis, and ground lamella. Independent variables were osteotomy site, age, gender, indication for surgery, and side. Corresponding cadaver data were analyzed for the independent variables of osteotomy site, side, and gender and then compared with the live patient data. Mean osteotomy force in live patients was 9.6 N (95% CI, 8.9–10.4 N). Mean osteotomy force in the cadaver heads was 6.4 N (95% CI, 5.7–7.0 N). Ethmoid osteotomy of live patients required 3.2 N (95% CI, 2.1–4.3 N) more force than the cadaver heads (p = 0.0001). This relationship was statistically significant at the bulla ethmoidalis (p = 0.002) and the ground lamella (p = 0.0001) but not at the uncinate (p = 0.068). Osteotomy in female live subjects required 1.6 N (95% CI, 0.1–3.1 N) more force than male live subjects (p = 0.03). Cadaver tissue may underestimate the mean osteotomy force required in osteotomy of living ethmoid sinus lamellae by a factor of 1.5 times. Caution may be required in extrapolating force estimates from cadaver tissue to those required in living patients.

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Sinolith in the ethmoid sinus

The Journal of Laryngology & Otology ◽

10.1017/s0022215105000162 ◽

2006 ◽

Vol 120 (2) ◽

pp. 1-3 ◽

Cited By ~ 5

Author(s):

S Kanzaki ◽

Michiie Sakamoto

Keyword(s):

Computed Tomography ◽

Infrared Spectroscopy ◽

Calcium Carbonate ◽

Calcium Phosphate ◽

Nasal Obstruction ◽

Nasal Polyp ◽

Endoscopic Sinus Surgery ◽

Ethmoid Sinus ◽

Sinus Surgery ◽

Histopathological Analysis

We report a case of sinolith in the left ethmoid sinus of a 61-year-old man. The patient complained of nasal obstruction. Computed tomography revealed a small, calcified mass associated with a nasal polyp in the left ethmoid sinus. The antrolith and polyp were removed via endoscopic sinus surgery. Histopathological analysis of the antrolith revealed it to be bone-like in formation. The antrolith was about 1 cm in diameter. Infrared spectroscopy revealed that the antrolith contained protein (45 per cent), calcium phosphate (43 per cent) and calcium carbonate (12 per cent).

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Bacteriology of Chronic Sinusitis after Ampicillin Therapy

American Journal of Rhinology ◽

10.2500/105065897780914983 ◽

1997 ◽

Vol 11 (6) ◽

pp. 467-472 ◽

Cited By ~ 4

Author(s):

Rong-san Jiang ◽

Chen-yi Hsu

Keyword(s):

Maxillary Sinus ◽

Chronic Sinusitis ◽

Ethmoid Sinus ◽

Functional Endoscopic Sinus Surgery ◽

The Other ◽

Sinus Surgery ◽

Resistant Bacteria ◽

Bacterial Isolates ◽

Ethmoid Sinuses ◽

Previous Group

The bacteriologies of the maxillary and ethmoid sinuses were studied in 74 chronic sinusitis patients who took ampicillin (500 mg every 6 hours) for 2 weeks preoperatively. The specimens from one ipsilateral maxillary and ethmoid sinuses were obtained when undergoing functional endoscopic sinus surgery. In 74 specimens of the maxillary sinus, 38 bacterial isolates were recovered. The culture rate was 46.0%. On the other hand, 34 bacterial isolates were taken from the ethmoid sinus specimens. The culture rate was 41.9%. As compared with a previous group who did not take any antibiotic preoperatively, the culture rate significantly decreased in the maxillary as well as the ethmoid sinus specimens. Not surprisingly, a significantly decreased sensitivity to ampicillin was also found in the recovered bacteria from both the maxillary sinus (23.7%) and ethmoid sinus (5.9%) specimens. These results demonstrate that antibiotic therapy with ampicillin could eradicate most sensitive bacteria in chronic sinusitis. However, persistence of resistant bacteria was demonstrated.

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