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"
