Before the surgical procedure was started, the middle turbinate, uncinate, and anterior ethmoid bulla
were injected with 1% lignocaine with adrenaline 1: 100,000 concentrations.
These include overpneumatized ethmoid bulla
, extensivelly pneumatized middle turbinate, enlargement of agger nasi cells, among others.
The microdebrider then is employed to shave away the uncinate tissue and expose the ethmoid bulla
Of these, in 43% the obstruction was by agger nasi cells, in 28.5% by ethmoid bulla
or accessory cells and in 28.5% by polyps.
Anatomical obstruction to this pathway can result when the frontal recess is narrowed posteriorly by an ethmoid bulla
. Anterior obstruction occurs when an enlarged agger nasi cell attenuates the infundibulum frontale.
Nasal endoscopy can identify edema or erythema of the middle meatus or ethmoid bulla
, but a plain sinus radiograph "is helpful in confirming the diagnosis of symptomatic patients with equivocal findings, particularly when specific criteria for radiographic interpretation are applied." An example of such criteria is a Waters' view revealing mucous membrane thickening of greater than 5 mm or complete opacification of one or more sinuses, the task force said.
The identification and complete removal of the uncinate process results in a widened middle meatus and access to the ethmoid bulla
, the frontal recess, and the outflow tract of the maxillary sinus.
Of these, 8 (57%) we're on the right side and 6 (43%) were on the left side, in 43% the obstruction was by agger nassi cells, in 28.5% by ethmoid Bulla
or accessory cells and in 28.5% of polyps.
At the time of surgery a well-defined ethmoid bulla
was encountered in the left middle meatus (figure, B).
(6) The boundaries of the frontal recess are typically formed by the agger nasi cell anteriorly; the lamina papyracea laterally; the most anterior and superior portion of the middle turbinate medially; and the ethmoid bulla
, its associated bulla lamella, and the suprabullar cell (if present) posteriorly.
About 16(32%) patients had enlarged ethmoid bulla
, 12(24%) patients had polypoidal changes.
Endoscopic ethmoidotomy was carried out through the anterior face of the ethmoid bulla