D- Anterior Ethmoidectomy
The anterior ethmoid is intimately related to the drainage segment of the frontal and maxillary sinuses and therefore it may act as focus for reinfection of these sinuses. The ethmoid bulla (EB, 1-4 cells) is the largest of the anterior ethmoid. Other cells are agger nasi cells (pneumatizing frontal process of maxilla and /or lacrimal bone), frontal cells, suprabullar cells and Haller cells (pneumatizing infero-medial wall of the orbit).
The bulla is opened at its anterior wall which is removed together with its medial wall. The posterior wall might be the anterior wall of sinus lateralis, if present, or part of the middle turbinate basal lamella in absence of the lateral sinus. This posterior wall is removed only if the lateral sinus is present and need to be drained. The lateral wall of EB is part of lamina papyracea (LP) and must be left intact. The inferior wall of EB is better left in place to separate anterior ethmoid drainage pathway from that of the maxillary sinus. The roof of EB is left in place as a landmark till the frontal sinus is drained.
Video24 illustrates Anterior Ethmoidectomy with cold instruments.
Video 24 "Ant. Ethmoidectomy with Cold Instruments"
Video 25 illustrates Anterior Ethmoidectomy with powered instruments.
Video 25 "Powered Ant. Ethmoidectomy"
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