Use of the superior meatus and superior turbinate in the endoscopic approach to the sphenoid sinus

Endoscopic surgery of the posterior ethmoid and sphenoid sinuses can presen t the operator with a considerable challenge. Although endoscopic training and physician experience have increased significantly in the past decade, s urgical complications such as optic nerve trauma and cerebrospinal fluid le ak still occur. Surgeons reporting such complications cite a lack of orient ation within the dissection field as a primary cause. Because endoscopic si nus surgery is now being performed more routinely, surgical strategies desi gned to reduce the risk of complications are more important than ever. An a natomic landmark that could reliably orient the dissection within the poste rior ethmoids and guide the surgeon to the sphenoid sinus could reduce the possibility of such adverse outcomes. In our experience identification of t he superior meatus and superior turbinate provides a reliable landmark with in the dissection field that can ensure surgical orientation to the operato r. This technique allows safe, reliable dissection of the posterior ethmoid s and an efficient approach to the sphenoid sinus, especially in patients u ndergoing revision surgery. In this article our technique for the identific ation and definition of the superior meatus and superior turbinate is prese nted, and the advantages of using this landmark in sinus surgery are discus sed. In our experience identification of the superior meatus, superior turb inate, posterior skull base, and medial orbital wall defines a parallelogra m-shaped box, which delineates the sphenoid face, This box provides the nec essary orientation to guide the surgeon's entrance into the sphenoid sinus through the posterior ethmoid sinus (as Messerklinger described). Technique s for identifying the superior turbinate and meatus and for entering the sp henoid are detailed.