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By R Casiano

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Max. & SD measurements from the antrostomy ridge (mm) 30 25 20 Mean 15 Min. Max. 10 5 0 ON CA E AA L- 3 Figure 3 Minimum instrumentation required for ESS. A = 30-degree telescope. B = 70-degree telescope (optional). C = 360-degree backbiting forceps. D = 360-degree sphenoid punch or forceps. 5-mm up-biting through-cut forceps. 5-mm straight through-cut forceps. G = 4 mm long curved suction. H = calibrated straight (Frazier) suction. I = Cottle periosteal elevator. J = ostium seeker or ball probe, which is angled at one end and curved at the other.

MT = middle turbinate. PE = posterior ethmoid. M = maxillary sinus. Arrows denote the antrostomy ridge. L- 33 Figure 33 Sagittal (a) and endoscopic (b) views after completion of sphenoethmoidectomy. The sphenoid ostium has also been enlarged medially and inferiorly toward its floor. The common wall between the sphenoid (S) and posterior ethmoid (PE) has been removed. Note the relationship of these cavities to the MOF (arrow). Most of the posterior ethmoid cavity is located above this line. Conversely, most of the sphenoid is located below this line.

The junction of the medial orbital floor (MOF) with the lamina papyracea makes up the superior margin of the maxillary sinus natural ostium (asterisk). L- 25 Figure 25 Sagittal (a) and endoscopic (b) views illustrating an inferior ethmoidectomy. In advanced cases, the surgeon initially maintains a safe distance of approximately 10 mm (solid arrows) as he or she proceeds around the antrostomy ridge (dotted arrow) toward the sphenoid sinus (S). L- 26 Figure 26 Sagittal (a) and endoscopic (b) views denoting the triangular zone of safe entry (asterisk) into the inferior posterior ethmoid through the horizontal portion of the basal lamella (solid line).

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