Lamina Papyracea Research Articles

Anatomy of Frontal Recess and Opening

The key to successful surgery in the frontal sinus is a complete understanding of the anatomy of the frontal recess, which is behind the beak of the frontal bone between the lamina papyracea laterally and superior portion of the middle turbinate. It is a hazardous and complex area with a range of anatomical configurations and lot of abnormalities (Figure 1).

The Nasoseptal Chondromucosal Flap: A Rigid Reconstructive Technique for Skull Base and Orbital Defects

Introduction: The pedicled mucoperichondrial nasoseptal flap serves as the predominant reconstructive option for anterior skull base defects. Its use has also been described for repair of the lamina papyracea following orbital tumor removal. Large skull base or orbital defects may benefit from a more rigid reconstruction to reduce the risk of herniation of orbital or intracranial contents into the sinonasal cavity, which could result in enophthalmos, diplopia, or an encephalocele. Objective: This study aims to test the feasibility of using a vascularized rigid composite nasoseptal chondromucosal flap for increased structural support in repairing skull base or orbital defects. Methods: The study was conducted in a cadaver model in a surgical skills laboratory. Results: We demonstrate a novel technique for harvesting and insetting a pedicled vascularized autologous rigid composite nasoseptal chondromucosal flap to repair both orbital and anterior skull base defects. The graft is harvested with intact mucosa, cartilage, and bilateral perichondrium to preserve a contiguous vascular supply. Confirmation of successful reconstruction is achieved via transcranial and transorbital access to visualize the graft from above. Conclusion: The cartilaginous support with associated perichondrium adds to the structural integrity of the reconstruction and may serve as an alternative to devascularized autologous grafts or synthetic materials, which may be particularly advantageous in patients with large defects or those requiring adjuvant radiation.

Orbital complications of infected mucocele in the paranasal sinuses

ObjectiveInfected mucocele of the paranasal sinuses can induce orbital infection, including orbital subperiosteal abscess, which may lead to life-threatening intracranial complications. Effective diagnosis is important, and treatment should be aggressive. This paper presents our experiences in endoscopic surgical management of orbital complications secondary to infected paranasal sinus mucoceles. MethodsFrom our retrospective review of the medical charts for 82 patients with 92 sides diagnosed with paranasal sinus mucoceles, we present 7 sides in 7 adult patients with orbital complications secondary to infected mucoceles. The collected data include the suggested etiology, side of sinus involvement, localization of abscess in the orbit, orbital wall bone defects caused by mucocele compression, ophthalmic symptoms, duration between symptom onset and initial visit, operation date, type of surgery performed, and follow-up. ResultsThe mucocele was located in the ethmoid-frontal region in 9.8% of the sides (9/92), in the frontal sinus in 7.6% (7/92), in the ethmoidal sinus in 9.8% (9/92), in the maxillary sinus in 67.4% (62/92), in the maxillary-ethmoidal sinus in 3.3% (3/92), and in the sphenoid sinus in 2.2% (2/92). The patients with ethmoid-frontal mucoceles had a significantly higher incidence of orbital complications (6/9) as compared with the other sub-types of mucoceles (frontal, 0/7; ethmoidal, 0/9; maxillary, 1/62; maxillary-ethmoidal, 0/3; sphenoid, 0/2). Chandler's classification showed Type I in one, Type II in three, and Type III in three. Sinus involvement was observed at the ethmoid-frontal sinuses in six cases and the maxillary sinus in one case. All seven cases had a partial defect of the orbital wall bone (lamina papyracea, or inferior orbital wall bone) by mucocele compression, and the patients underwent endoscopic marsupialization. For the cases with subperiosteal abscess, the lamina papyracea was also removed partially for draining the abscess. In all cases, symptoms were resolved without any recurrence of the mucocele. ConclusionsInfected ethmoid-frontal mucoceles with a defect of the lamina papyracea tend to induce orbital infection, so prompt surgery for the infected mucoceles should be considered early even with Types I and II, before visual acuity is impaired, because surgery is the only curative treatment for the mucoceles.

Objective and subjective assessment of astructured approach to computed tomography scans of the paranasal sinuses

HintergrundDie Voraussetzung zur Vermeidung potenziell schwerwiegender Komplikationen in der Nasennebenhöhlenchirurgie ist eine fundierte Kenntnis der individuellen Anatomie. Für die Nasennebenhöhlen stellt die Computertomographie (CT) die Bildgebung der Wahl dar, um die individuelle Anatomie und das Ausmaß der Erkrankung präoperativ darzustellen.Ziel der ArbeitDas Ziel der vorliegenden Arbeit ist die Bewertung des Nutzens einer CT-Checkliste zur Identifikation wichtiger anatomischer Normvarianten in der CT der Nasennebenhöhlen.Material und MethodenJung- und Altassistent*innen der HNO-Klinik wurden gebeten, CTs der Nasennebenhöhlen vor und nach der Einführung der CLOSE-Kriterien auf anatomische Normvarianten zu untersuchen. Der Prozentsatz der korrekt identifizierten Normvarianten wurde berechnet. Zusätzlich wurde der subjektive Nutzen anhand eines Fragebogens beurteilt.ErgebnisseSechs Jung- und 6 Altassistent*innen wurden in die Studie eingeschlossen. Die Rate der korrekt identifizierten Normvarianten verbesserte sich nach der Einführung der CLOSE-Kriterien signifikant von 23,1 auf 50,9 % bzw. von 24 auf 39,8 %. Die subjektive Beurteilung der CLOSE-Checkliste war sehr positiv.SchlussfolgerungEin strukturiertes Vorgehen zur Analyse von CTs der Nasennebenhöhlen kann die Identifikation kritischer anatomischer Strukturen verbessern und wird von Weiterbildungsassistenten als sehr hilfreich bewertet.

Nuestra experiencia en el manejo de las complicaciones orbitarias en la rinosinusitis aguda

Background and objectiveThe spread of an infection from the paranasal sinuses is rare but severe. Between 4% and 20% of all rhinosinusitis can become complicated, orbital involvement being the most frequent (60-75%). Orbital complications are more common in children but more severe in adults. We aim to analyse the epidemiological characteristics of these patients and to propose a management algorithm. Materials and methodsWe carried out a retrospective review of 21 patients with orbital complications of acute rhinosinusitis diagnosed in the same institution from 2005 to 2018. The diagnosis was based on clinical history, endoscopic examination and imaging tests. All patients received an intravenous antibiotic and were assessed by ophthalmology. An immediate surgical treatment was performed in the case of an abscess or poor response to medical management. ResultsThe average age was 24 years. Fifty-two percent were males and 48% females. According to Chandler's classification, 43% (9/21) had preseptal cellulitis (7 adults and 2 children), 10% (2/21) orbital cellulitis (one adult and one child), 43% (9/21) subperiosteal abscess (2 adults and 7 children), there was one case of orbital abscess in an adult and there were no cases of cavernous sinus thrombosis. A CT scan was performed in all patients and the cases of subperiosteal or orbital abscess were treated surgically, except 2 paediatric patients (<4 years) with a small and medial subperiosteal abscess (<4mm) who responded well to medical treatment. The surgical approach is performed by endonasal endoscopy, perforating the lamina papyracea in cases of subperiosteal abscess and also opening the periorbita in orbital abscess. It was combined with an external palpebral approach in the 4 cases that presented a superior or lateral abscess. Two young adults (10%) presented an intracranial complication concomitantly. ConclusionOrbital complications of acute rhinosinusitis are rare but potentially severe. It is important to be aware of and suspect them in order to act quickly. It is essential to define the location and extension of the infection for correct management, as well as multidisciplinary treatment. The surgical approach is performed by endonasal endoscopy. It is limited by abscesses located on the roof of the orbit or on the lateral wall, when a combined external palpebral approach is required.

Anatomical Factors that Can Predict the Structure of Lamina Papyracea for Endoscopic Sinus Surgery.

This study investigated morphological variations of lamina papyracea, the structure that should be carefully considered when opening posterior ethmoid sinus during endoscopic sinus surgery, to avoid injury. This study employed axial, coronal, and sagittal computed tomography. Using computed tomography images of 228 face-sides, various anatomical parameters were determined: distances of the anterior and posterior ethmoid arteries from the skull base, and from the third lamella; changes in the angles of the lamina papyracea at the anterior and posterior ethmoid sinuses; and presence or absence of supraorbital ethmoid cell (SECs), Onodi cell, and Haller cell. The relationship between the distances which indicate the point of maximum projection by the lamina papyracea among third lamina and posterior ethmoid artery into the posterior ethmoid sinus and these anatomical factors were analyzed statistically. The projection distance of lamina papyracea into the posterior ethmoid sinus was -2.6 mm to 3.4 mm, and in 41.2% of cases, projection in the direction of the nasal cavity was greater than that of the lamina papyracea at the anterior ethmoid sinus. This distance increased with increasing distance of the maximum projection point from the skull base and increasing floating distances of the anterior and posterior ethmoid arteries. The number of subjects with large projection distances was increased among those with floating posterior ethmoid arteries. In addition, subjects with SECs had significantly greater projection distances. Particular care should be taken to avoid injury to the lamina papyracea when opening the posterior ethmoid sinus in subjects with floating anterior or posterior ethmoid arteries, and/or SEC. 4 Laryngoscope, 131:E19-E25, 2021.

“L” shape technique for endoscopic sinus surgery: An alternative method

Several techniques for performing ethmoidectomy have been reported. We describe a safe, effective and efficient technique during functional endoscopic sinus surgery (FESS). We present text, images and videos to illustrate our preferred technique during an antero-posterior ethmoidectomy and to provide a multimedia tool for educational purpose. A description of the technique without prospective or retrospective data is reported. A complete ethmoidectomy with an L-shape approach is described step-by-step, using the backbiting circular and miniature cutting forceps, with safe exposure of the lamina papyracea (LP) and skull base. In our hands, the L-shape approach for chronic rhinosinusitis with or without polyposis, performed with punch circular cutting and miniature cutting forceps, allowed for a reliably safe and efficient ethmoidectomy. The technique described can be added to the armamentarium of the endoscopic sinus surgeon.

Analysis of Lamina Papyracea Area and Ethmoid Sinus Volume in Indonesian Patients Undergoing Paranasal Sinus CT Scan

Of the rhinosinusitis (CRS) patients, half of whom require surgical intervention. Functional endoscopic sinus surgery (FESS) is a standard treatment of CRS and sinonasal polyposis. Orbito-ocular complications can occur during FESS. The lamina papyracea (LP) is the weakest point of the medial wall of the orbit. The variability in the size and shape of the paranasal sinuses is important in the FESS procedure. The ethmoid sinus is the most complex paranasal sinuses. Preoperative evaluation using computed tomography (CT) is mandatory for all patients undergoing FESS. This study aimed to determine the lamina papyracea area and ethmoid sinuses volume in patients who underwent a CT scan of paranasal sinuses. This study was a descriptive study on 103 patients who underwent a CT scan of paranasal sinuses in the Radiology Department of Hasanuddin University General Hospital, Makassar, from January to August 2019. The lamina papyracea area and ethmoid sinus volume were measured based on age and gender. The results showed that the average of lamina papyracea size and ethmoid sinus volume was greater in males than in females. There was a correlation between age and posterior height of left lamina papyracea (p=0.02), but no correlation between ethmoid sinuses volume and age.

Anterior Ethmoidal Artery: A Computed Tomography Analysis and New Classifications.

Objective to determine the anterior ethmoidal artery (AEA) anatomy and variations by computed tomography (CT) in adult and their relations to and presents new AEA classifications. Methods One hundred and fifty paranasal CT scans (300 sides) were included. Axial images were acquired with multiplanar reformates to obtain delicate details in coronal and sagittal planes. Results One hundred and forty-four AEAs canal (48%), 293 AEAs foramen (97.7%), and 229 AEAs sulcus could be detected (76.3%). The mean AEA intranasal length was 6.7 ± 1.27 mm (range: 4.24-10.6 mm). The mean angle between AEA and lamina papyracea was 105.49 ± 9.28 degrees (range: 76.41-129.76 degrees). Of them, 95.8% AEAs had an angle with lamina >90 degrees, while 4.2% had angle <90 degrees. The mean angle between AEA and lateral lamella of cribriform plate was 103.95 ± 13.08 degrees (range: 65.57-141.36 degrees). Of them, 87.5% AEAs had an angle >90 degrees and 12.5% had an angle <90 degrees. The mean distance between AEA and skull base was 1.37 ± 1.98 mm (range: 0-8.35 mm). The AEA types in relation to skull base was type 1 (0-2 mm from skull base; 64.6%), type 2 (2-4 mm; 22.2%), type 3 (4-6 mm; 11.1%), and type 4 (>6 mm; 2.1%). The mean distance between the AEA and frontal sinus ostium was 9.17 ± 4.72 mm (range: 0-25.36 mm). AEA classification according to distance from AEA to frontal sinus ostium was 17.4% type 1 (<5 mm), 41.7% type 2 (5-10 mm), 31.9% type 3 (10-15 mm), and 9% type 4 (>15 mm). Conclusion Provided AEA details improve surgeons' awareness of AEA variations in the endoscopic field and can help residents in training.

Attempted suicide with a crossbow

IntroductionAirway management and control of bleeding are essential aspects of the management of attempted suicide involving the head and neck. Attempted suicide using a crossbow is exceptional. The patient's respiratory status, the position of the crossbow bolt in the head and neck, the type of bolt and its exit wound required airway management that has not been previously reported in the literature. Case reportThis conscious patient had attempted suicide by shooting a crossbow bolt to the head. The radiological assessment (contrast-enhanced CT scan) did not reveal any vascular, ophthalmological or neurological lesions. The submental entry wound of the bolt avoided any damage to the lingual and ethmoidal arteries, lamina papyracea, or frontal lobe. The bolt induced mechanical trismus and its position limited access to the base of the neck, preventing orotracheal intubation. Nasotracheal intubation and primary tracheotomy were also difficult in this situation. It was therefore decided to remove the bolt while the patient was still conscious, rapidly followed by intubation, with no complications. ConclusionIn attempted suicide by crossbow involving the head and neck, airway management depends on the possibility of exposure of the glottis, the bolt exit wound and safe access to the anterior neck.

Does endoscopic sinus surgery alter the biomechanics of the orbit?

ObjectiveThe purpose of this study is to determine if removal of ethmoid cell septations as commonly performed in endoscopic sinus surgery leads to a change in orbital wall fracture patterns and the force required to create them.MethodsSix fresh-frozen cadaveric heads were acquired and underwent endoscopic uncinectomy, maxillary antrostomy, and anterior and posterior ethmoidectomy on one, randomized, side. The contralateral sinuses were used as intra-specimen control. Hyaluronic acid gel globe injections were performed to simulate normal intra-ocular pressure. Post-op CT scans confirmed no orbital fractures or violation of the lamina papyracea prior to trauma testing. Orbital trauma was induced using a guided weight-drop technique. Both orbits were tested in random order, and sequentially higher drops were performed until both the test and control side demonstrated an orbital fracture on CT scan.ResultsIn all six heads, the post-sinus surgery side incurred a medial orbital wall fracture, and no orbital floor fractures were identified. On the other hand, on the control side, all six heads incurred orbital floor fractures at drop heights equal to, or higher than, the surgical side. Fisher’s exact test demonstrated a significant difference in fracture pattern (p < 0.001).ConclusionsTo our knowledge, this is the first demonstration that the structures removed during sinus surgery may act as a buttress for the medial orbital wall. The anatomic changes of sinus surgery may alter the biomechanics of the orbit and affect the pattern of subsequent traumatic blowout fractures.

Paranasal Sinus Wall Erosion and Expansion in Allergic Fungal Rhinosinusitis: An Image Scoring System

BackgroundBone erosions are common in allergic fungal rhinosinusitis (AFRS). This study aimed at developing an image-based grading and scoring system for paranasal sinus (PNS) wall erosion in AFRS.MethodsA retrospective review of all confirmed AFRS cases based on the Bent and Kuhn criteria was conducted. Preoperative computed tomography (CT) images were studied to detect PNS wall erosion with expansion. Based on our observation, we described a grading system based on the proportion of PNS wall erosion, with 1 if less thanone-third, 2 if between one-third and two-thirds, and 3 if more than two-thirds of the wall is eroded. This method provides a new scoring system ranging from 0 to 72. The inter-observer reliability of this scoring system was tested and the percent of agreement was found to be 90%.ResultsAmong 142 AFRS cases, 82 patients (57.7%) had bone erosion. Orbital extension via lamina papyracea erosion occurred in 28.2% and 17.6% of the anterior and posterior ethmoid sinuses respectively, via floor erosion in 8.3% of the frontal sinuses, and via roof erosion in 2.1% of the maxillary sinuses. Intracranial extension caused by the anterior skull base erosion occurred in 19.4%, 10.9%, and 6% of the posterior ethmoid, anterior ethmoid, and frontal sinuses, respectively. The middle and posterior cranial fossa skull base was eroded in 14.4% and 9.2% of the sphenoid sinuses, respectively. Infratemporal extension occurred via erosion of the sphenoid sinus lateral wall in 17.3% of the sphenoid sinuses and via erosion of the maxillary sinus posterior wall in 6.7% of the maxillary sinuses. The mean of bone erosion score was 9.52, and the highest score was 34/72.ConclusionThe orbit is the most common extra-sinus extension site via the lamina papyracea erosion. We propose a new grading and scoring system to assess disease severity and progress.

Dehiscence of the lamina papyracea

We report the case of a 35 year old patient presenting with acute onset of right periocular pain with palpebral edema due to nose blowing with absence of trauma. Early assessment showed periorbital emphysema without ophthalmological involvement, normal pupillary light reflex and visual acuity. Computerized tomography (CT) scan of facial and orbital bones objectified right pneumo-orbita with orbital fat herniation via a partial agenesis of the lamina papyracea, without muscle incarceration. Emphysema gradually reduced after two weeks by applying pressure dressing associated with broad spectrum antibiotic therapy as well as following the rules for cleanliness (avoiding closed glottis efforts, nose blowing…). Pneumo-orbita is defined by the presence of orbital air. It is mainly caused by a trauma but few cases of spontaneous dehiscence have been reported. The opening of the lamina papyracea, acting as an antireflux valve, prevents air outlet. CT scan is essential to confirm the diagnosis. It most often has a spontaneous resolution but the presence of hyperpression, that can be responsible for ischemic optic neuropathy or occlusion of the central artery of the retina, require a rigorous monitoring in order to implement possible urgent decompressive intervention.

Imaging characteristics and clinical outcomes of biphenotypic sinonasal sarcoma.

ObjectivesBiphenotypic sinonasal sarcoma (BSS) is a new, rare tumor characterized by concomitant neural and myogenic differentiation. The aim of this study is to describe the imaging characteristics and clinical outcomes of this neoplasm.MethodsA retrospective review of BSS patients surgically treated within a tertiary academic health care system was performed. Imaging characteristics and clinical outcomes were reviewed.ResultsFive patients underwent surgical resection of BSS tumors. Negative surgical margins were achieved in four (80%) patients. There were no deaths but two (40%) patients developed local recurrences during the postoperative follow‐up period (median follow‐up 31.4 months). Review of imaging characteristics revealed a median tumor size of 3.8 cm in greatest dimension. All tumors were unilateral and centered within the nasoethmoidal region. In all cases, the tumors extended to the nasal septum, lamina papyracea, and anterior skull base with variable degrees of erosion through these structures. On CT, involved bony structures demonstrated mixed lytic and sclerotic pattern, with definitive hyperostotic bone identified in four (80%) cases. On MRI, tumors were isointense‐to‐mixed iso/hypointense on both T1‐ and T2‐weighted sequences with one tumor demonstrating mixed T2 hyperintensity. All cases demonstrated gadolinium contrast enhancement.ConclusionsBSS is a locally aggressive tumor with a low risk of regional or distant metastases but has a significant rate of recurrence even with adequate resection. Despite its rarity, BSS should be considered in the differential diagnosis when imaging demonstrates a unilateral nasoethmoidal mass that is predominantly isointense to cerebral gray matter on T2‐weighted MRI and is hyperostotic on CT.Level of Evidence4

Intracranial actinomycosis of odontogenic origin masquerading as auto-immune orbital myositis: a fatal case and review of the literature

BackgroundActinomycetes can rarely cause intracranial infection and may cause a variety of complications. We describe a fatal case of intracranial and intra-orbital actinomycosis of odontogenic origin with a unique presentation and route of dissemination. Also, we provide a review of the current literature.Case presentationA 58-year-old man presented with diplopia and progressive pain behind his left eye. Six weeks earlier he had undergone a dental extraction, followed by clindamycin treatment for a presumed maxillary infection. The diplopia responded to steroids but recurred after cessation. The diplopia was thought to result from myositis of the left medial rectus muscle, possibly related to a defect in the lamina papyracea. During exploration there was no abnormal tissue for biopsy. The medial wall was reconstructed and the myositis responded again to steroids. Within weeks a myositis on the right side occurred, with CT evidence of muscle swelling. Several months later he presented with right hemiparesis and dysarthria. Despite treatment the patient deteriorated, developed extensive intracranial hemorrhage, and died. Autopsy showed bacterial aggregates suggestive of actinomycotic meningoencephalitis with septic thromboembolism. Retrospectively, imaging studies showed abnormalities in the left infratemporal fossa and skull base and bilateral cavernous sinus.ConclusionsIn conclusion, intracranial actinomycosis is difficult to diagnose, with potentially fatal outcome. An accurate diagnosis can often only be established by means of histology and biopsy should be performed whenever feasible. This is the first report of actinomycotic orbital involvement of odontogenic origin, presenting initially as bilateral orbital myositis rather than as orbital abscess. Infection from the upper left jaw extended to the left infratemporal fossa, skull base and meninges and subsequently to the cavernous sinus and the orbits.

Chronic rhinosinusitis with nasal polyps

Chronic rhinosinusitis (CRS) is a complex disease and can present with different stages of disease progression, depending on etiology and comorbidities. One important feature of a specific subset of CRS are nasal polyps (CRSwNP). Medical treatment options for patients with CRSwNP remain limited, often making surgery necessary. Functional endoscopic sinus surgery with navigation is the preferred treatment of CRSwNP, offering the safety of computed tomography guided navigation with minimally invasive resection of the tumors. It is paramount for the anesthesiologist to know the most commonly encountered surgical perioperative complications of functional endoscopic sinus surgery: ethmoidal artery injury (bleeding, optic nerve damage), penetration of the ethmoid roof or lamina papyracea (cerebrospinal leak), nasolacrimal duct damage or direct optic nerve damage. Anticipation of surgical (bleeding, nerve or brain injury) and anesthetic complications (lost airway, hypoxia, and anaphylaxis) is fundamental to patient safety. Anesthesia management for cases with complete nasal airway obstruction relies on a careful preoperative assessment of the patient’s anatomy and symptoms, clinical presentation, and associated comorbidities. Airway compromise can result in a dangerous cannot ventilate/cannot intubate situation, a risk complicated by patient refusal for awake intubation. A proper plan should not only be established for the intubation, but also for the extubation. Important factors in proper anesthesia management are also based on accurate preoperative assessment of the patient, evaluation of associated comorbidities (obstructive sleep apnea, morbid obesity, aspirin-exacerbated respiratory disease, IgE related CRS, fungus, etc.) as well as planning of the procedure with attention to directed management and therapy (controlled hypotension, pain control, airway management, admission status).

Tension pneumo-orbit secondary to minor blunt force trauma

IntroductionTension pneumo-orbit is a rare but eye-threatening sequelae of orbital trauma. Minimal trauma to the lamina papyracea can result in a valve effect leading to rapid-onset proptosis and optic nerve compression in the absence of a haematoma. Case reportWe describe a case of medial orbital wall fracture in a 35-year-old lady following a minor fall at home. She presented with severe proptosis of the left eye. Imaging showed marked pneumo-orbit, which was managed definitively by endoscopic orbital decompression. DiscussionTension pneumo-orbit requires prompt recognition and surgical decompression. An endonasal approach may be used to decompress the orbit via the medial wall.

Endoscopic endonasal superomedial orbitectomy: How far is safe and possible?

During the endoscopic endonasal approach (EEA) to the anterior cranial base, the lateral boundaries are the lamina papyracea (medial orbital walls) bilaterally but further extension in the coronal plane is possible by performing a superomedial orbitectomy. The aims of this study are to describe the technique of the endoscopic endonasal transethmoidal supraorbital approach to the anterior cranial base and to calculate the extension in the coronal plane added with the superomedial orbitectomy. Thirty superomedial orbitectomies via EEA were completed in 15 fresh-frozen heads. After finishing the procedure, a bifrontal craniotomy with removal of both frontal lobes was performed in order to measure the width of the supraorbital EEA in the coronal plane. We divided the anterior cranial base into five zones related to distinct anatomical segments: sinusal zone, post-sinusal zone, anterior ethmoidal, inter-ethmoidal zone, and posterior ethmoidal zone. Measurements of each segment of the anterior cranial base were taken. In all specimens, it was possible to perform a superomedial orbitectomy without excessive retraction of the orbital contents. The inter-ethmoidal zone is the segment where the lateral extension was widest. The mean total width in this area was 45.4 mm. The superomedial orbitectomy added a mean of 8 mm on each side to the total anterior skull base exposure. The endoscopic endonasal superomedial orbitectomy added important extension in the coronal plane during an EEA to the anterior cranial base. The inter-ethmoidal zone has shown the greatest lateral extension. N/A Laryngoscope, 130:1151-1157, 2020.

Orbital decompression for inverted papilloma – Case report

Abstract Inverted papilloma is a rare benign sinonasal tumor with a still unclear etiology. In the last decades, HPV implication in inverted papilloma etiopathogeny has been studied and demonstrated in some scientific research papers, but with no causality proven. Imagistic investigations and the Krouse classification establish the surgical approach. Endoscopic surgery represents the golden standard treatment for most cases of inverted papilloma, while external or combined approaches present limited indications. The authors present a case and therapeutic plan of an inverted papilloma located in the ethmoid sinus, with origin in the lamina papyracea and high-risk HPV implication.

Dehiscence of the Lamina Papyracea of the Ethmoid Bone

Dehiscence of the Lamina Papyracea of the Ethmoid Bone