Usamah Hadi, M.D., F.A.C.S.
Usamah Hadi graduated from the American University of Beirut and was
granted his Doctorate in Medicine in 1980 and received his American Board
Certification in Medicine. After spending four years at the same ­institute
and completing a residency in Otorhinolaryngology, Head and Neck
­Surgery, Dr. Hadi joined the Massachusetts Eye and Ear Infirmary – Harvard
Medical School in Boston, U.S.A., in 1992, where he finished a fellowship
in Endoscopic Sinus Surgery. In 1998, he became a Fellow of the American
College of Surgeons (F.A.C.S.). In 2005, Dr. Hadi was appointed Head of
Department of Otorhinolaryngology at the Beirut Governmental Rafic Hariri
Hospital, Lebanon. In addition, in 2007, he became Clinical Professor at
the ­Department of Otorhinolaryngology, Head and Neck Surgery at the
American ­University of Beirut Medical Center, Beirut, Lebanon. In 2010, he
was a charter member of the Pan Arab Rhinology Society (PARS) which
was involved in organizing several conferences in the Arab region. In 2012,
Dr. Hadi was elected President of the Lebanese Society of ­Otolaryngo­logy,
Head and Neck Surgery. He is regularly involved in medical teaching,
gives lectures and courses for medical students and residents addressing
a wide range of topics, such as anatomy of the head and neck, in-depth
exploration of the patho­physiology of allergic rhinitis, olfactory disorders,
and various ­sinonasal diseases and their medical and surgic­al management.
He also mentors graduate-level microbiolo­gy ­students and has served as a
member of the examination committee supervising many thesises. On both
a national and regional level, Dr. Hadi conducts the Functional Endoscopic
Sinus Surgery Course including hands-on cadaver dissections. He has
published more than 50 scientific papers in the field and has given ­technical
presentations and lectures at more than 30 international and national
­meetings, serving as moderator at more than ten international conferences
and numerous others in his home country and neighbouring ­regions. His
primary research aim is on allergic rhinosinusitis and diseases related to the
nose. Among his other research work are studies that focus on pathogens
and biofilm formation. In collaboration with the microbiology department,
Dr. Hadi conducts research on the pathogenesis of chronic rhinosinusitis.
He contributes to numerous charitable institutions, including Lions Club and
human rights organizations by providing medical care and services to needy
people in Lebanon.
Dr. Hadi is married to his wife Layla, a pharmacist, for more than 20 years
and has four lovely children.
®
ENDOSCOPIC AND SINONASAL
DISSECTION MANUAL FOR
ENDOSCOPIC SINUS SURGERY
Usamah HADI, M.D., F.A.C.S.
Clinical Professor
Otorhinolaryngology, Head and Neck Surgery
Department of Otorhinolaryngology, Head and Neck Surgery
American University of Beirut Medical Center
Beirut, Lebanon
4
Illustrations:
Dr. Katja Dalkowski
Hauptstraße 64, 91054 Erlangen,
Germany
E-Mail: kdalkowski@online.de
www.med-design.info/
Important notes:
Medical knowledge is ever changing. As new
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may be required. The authors and editors of the
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at the time of publication. However, in view of the
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has been involved in the preparation of this booklet,
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every respect accurate or complete, and they are
not responsible for any errors or omissions or for the
results obtained from use of such information. The
information contained within this booklet is intended for
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material is not intended for use as a basis for treatment
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The use of this booklet as well as any implementation
of the information contained within explicitly takes place
at the reader’s own risk. No liability shall be accepted
and no guarantee is given for the work neither from
the publisher or the editor nor from the author or any
other party who has been involved in the preparation of
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mentioned within this booklet.
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
Endoscopic and Sinonasal Dissection Manual for Endoscopic Sinus Surgery
Usamah Hadi, M.D, F.A.C.S.
Clinical Professor
Otorhinolaryngology, Head and Neck Surgery
Department of Otorhinolaryngology, Head and Neck Surgery
American University of Beirut Medical Center
Beirut, Lebanon
With assistance of:
Abdo Jurjus,a Ph.D., Professor
Akaber Halawi,b M.D., Chief Resident
Alyssa Kanaan,b M.D., 3rd-year Resident
Solara Sinno,b B.S., Project Coordinator
a) Department of Human Morphology, Faculty of Medicine,
American University of Beirut, Lebanon
b) Department of Otorhinolaryngology Head and Neck Surgery,
Faculty of Medicine, American University of Beirut, Lebanon
Correspondence address of the author:
Usamah Hadi, M.D, F.A.C.S.
Clinical Professor, Otorhinolaryngology, Head and Neck Surgery
Department of Otorhinolaryngology, Head and Neck Surgery
American University of Beirut Medical Center
Beirut, Lebanon
Phone: +96 11 75 17 01
+96 13 69 00 44
+96 113 43 95 69
Fax:
+96 117 51 70
E-mail: uhadi@dm.net.lb
uh00@aub.edu.lb
All rights reserved.
1st edition 2012
®
© 2015
GmbH
P.O. Box, 78503 Tuttlingen, Germany
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05.15-0.5
ISBN 978-3-89756-198-4
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
5
Table of Contents
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Your Cadaver – Your Patient. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dissection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Anatomical Variation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Preparation and Maintenance of a Cadaver Specimen. . . . . . . .
Safety Issues in the Cadaver Lab . . . . . . . . . . . . . . . . . . . . . . . . .
Practical Hints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
8
8
8
8
9
9
1.0 Anatomy of the Lateral Nasal Wall. . . . . . . . . . . . . . . . . . . . . . . . . 10
Anatomical Reference Structures . . . . . . . . . . . . . . . . . . . . . . . . . 10
Ostiomeatal Complex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
2.0 Basal Lamella of the Middle Turbinate . . . . . . . . . . . . . . . . . . . . . 12
Middle Turbinate Dissection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Variations of the Middle Turbinate . . . . . . . . . . . . . . . . . . . . . . . . . 15
3.0 Uncinate Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Uncinate Process (UP) and Maxillary Line . . . . . . . . . . . . . . . . . .
Anatomical Variants of the Uncinate Process Insertion . . . . . . .
Radiologic Examples of Uncinate Process Variants . . . . . . . . . .
16
16
18
18
4.0 Hiatus Semilunaris and Ethmoid Infundibulum . . . . . . . . . . . . . . 19
The Ethmoid Infundibulum – A Three-Dimensional Cavity . . . . . 20
5.0 Anterior Ethmoid Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
General Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Agger Nasi Cell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Agger Nasi Cell and Frontal Recess . . . . . . . . . . . . . . . . . . . . . . .
21
21
22
23
6.0 Ethmoid Bulla. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Boundaries of the Ethmoid Bulla . . . . . . . . . . . . . . . . . . . . . . . . . .
Topographical, Morphological and Surgical Aspects . . . . . . . . .
The Variable Depth of the Olfactory Fossa
(Keros Classification) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24
24
25
26
7.0 Anterior Ethmoid Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
8.0 Posterior Fontanelle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
9.0 Middle Meatal Antrostomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sites of Bone Dehiscence in the Maxillary Sinus . . . . . . . . . . . . .
Accessory Ostia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Anatomical Relationship between Uncinate Process and
Maxillary Sinus Ostium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Size of the Middle Meatal Antrostomy Window and|Its
Impact on Treatment Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . .
Patency of Middle Meatal Antrostomy . . . . . . . . . . . . . . . . . . . . .
Classification of Middle Meatal Antrostomy (MMA) –
Size and Surgical Approaches . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Type 1 – Small-Sized Middle Meatal Antrostomy . . . . . . . . . . . . .
Small Natural Maxillary Sinus Ostium . . . . . . . . . . . . . . . . . . . . . .
Type 2 – Medium-Sized Middle Meatal Antrostomy. . . . . . . . . . .
Type 3 – Large-Sized Middle Meatal Antrostomy. . . . . . . . . . . . .
Type 4 – Extensive Middle Meatal Antrostomy and Medial
Maxillectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
31
32
33
33
34
34
35
35
36
37
37
38
6
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
10.0 Sinus lateralis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Suprabullar Recess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Retrobullar Recess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Horizontal Lamella of the Middle Turbinate . . . . . . . . . . . . . . . . .
40
40
40
41
11.0 Superior Turbinate and Meatus . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Posterior Ethmoid Cell (PE) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Lateral Lamella of Anterior and Posterior Ethmoid Partitions
(1–4). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
12.0 Frontal Sinus Beak, Frontal Sinus Ostium and Frontal Recess . .
Frontal Recess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Frontal Sinus Drainage – The Draf I Approach . . . . . . . . . . . . . . .
Frontal Sinus Drainage – The Draf IIa Approach . . . . . . . . . . . . .
Frontal Sinus Drainage – The Draf IIb Approach . . . . . . . . . . . . .
Frontal Sinus Drainage – The Draf III Approach . . . . . . . . . . . . . .
45
45
47
48
49
50
13.0 Sphenoethmoid Recess and Sphenoid|Ostium . . . . . . . . . . . . . .
Sphenoid Ostium and Sphenoid Intersinus Septum . . . . . . . . . .
Sphenoid Sinus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sphenoid Sinus and Carotid Artery . . . . . . . . . . . . . . . . . . . . . . . .
Onodi Cell (Sphenoethmoid Cell). . . . . . . . . . . . . . . . . . . . . . . . . .
51
52
53
55
56
14.0 Sphenopalatine Foramen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Anatomical-Topographical and Morphological Aspects. . . . . . . 57
15.0 Nasolacrimal Sac and Duct . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Anatomical-Topographical and Morphological Aspects. . . . . . . 59
16.0 Endoscopic Approach to Pituitary Gland and Related Tumors . 60
17.0 Orbital Decompression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
18.0 Optic Nerve Decompression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
19.0 Iatrogenic CSF Leakage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
20.0 Lateral Canthotomy and Inferior Cantholysis. . . . . . . . . . . . . . . . 65
Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Words from the Heart …
To my wife, Layla, for her love, understanding, support
and|encouragement.
To our four children, Nisrine, Nadine, Dalia and Youssef, for
their patience and tolerance with the many long hours away
from them, yet still nourishing me with the joys of fatherhood
all year long.
To my parents and family, for their love, support and
education they bestowed on me, and for which I will always
be greatly indebted to them.
To my surgical teachers and mentors, Salah Salman,
Georges|Zaytoun, Nabil Fuleihan and many others not
mentioned by name, for their constant encouragement,
inspiration and assistance throughout my professional career.
To my residents and patients, for their trust and continued
stimulation to always embark on new frontiers.
8
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
Introduction
Your Cadaver – Your Patient
The head that will be used for dissection was donated by a person who
wished to make a contribution to your education as a physician. The value
of the gift that the donor has made to you cannot be measured. However, it
can only be repaid by the proper care and use of the specimen. The cadaver
must be treated with the same respect and dignity that are usually reserved
for the living patient.
Dissection
Dissection is the careful and thoughtful separation of body parts. The
essence of good dissection is to expose each structure, fully, clearly and
cleanly. Cleaning a structure, therefore, means much more than mere
recognition of its existence. Examination of the structure of the body in
the lab gives us the opportunity to learn by direct observation. The threedimensional relationships between anatomical structures are of utmost
importance for any surgical approach. While participating in this short
dissection course, today, it is recommended to adopt the perspective above.
In return, you will be rewarded with the most memorable learning experience
of your medical career.
Anatomical Variation
All bodies have the same basic morphological plan, but no two bodies are
identical, while minor variations commonly occur and should be expected.
There are many specimen on the basis of which you can examine, identify
and learn anatomical variations.
Preparation and Maintenance of a Cadaver Specimen
Specific work routines are employed to preserve, prepare and maintain all
organic substrates of pathogenic materials in cadavers, which are usually
fixed with a mixture of the following chemical agents:
Alcohol
Glycerin
Phenol
Formaldehyde
H2 O
30%
5%
5%
5%
55%
A cadaver will usually take between 12–20 liters. Perfused cadavers are
subsequently maintained in plastic bags for at least 15 weeks prior to
dissection.
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
Safety Issues in the Cadaver Lab
While in the lab
your clothing by wearing a long laboratory coat or apron.
Do not wear sandals or open-toed shoes in the laboratory, as a dropped
scalpel can seriously injure your feet.
Disposable gloves must be worn to prevent contact with human tissue.
When cutting bones, wear glasses or goggles to protect your eyes
against flying chips.
Protect
Practical Hints
Upon
entering the laboratory, you will learn, that the cadaver head was
temporarily frozen, then put at 4°C for 2 weeks, and should now be at
room temperature for work.
The veins, in general, are sometimes full of clotted blood. Occasionally,
the arteries are injected with red dye, which is not the case here.
Desiccation of the cadaver will quickly render the specimen useless for
study or training. Therefore, cover the specimen when you finish and
keep it moist throughout the course.
All pieces of the specimen that are taken out during dissection should
be stored in a special container.
Any reusable glassware or utensils that have been contaminated
with body fluids should be placed in a disinfectant (fresh 10% bleach
solution) and later autoclaved.
Thoroughly wash your hands with soap and warm water before leaving
the laboratory.
9
10
1 Anatomy of the Lateral Nasal Wall
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
1.0 Anatomy of the Lateral Nasal Wall
Anatomical Reference Structures
Using a HOPKINS® 0°-telescope you can visualize
1. the nasal floor,
2. the inferior turbinate and meatus (IT),
3. the middle turbinate and meatus (MT),
4. the superior turbinate and meatus (ST) and
5. the Eustachian tube orifice.
1 Sagittal cadaver specimen demonstrating gross anatomy of the lateral nasal wall.
2 Endoscopic view of the inferior nasal
turbinate.
3 Endoscopic view of the middle nasal
turbinate.
4 Non-enhanced coronal CT section
showing inferior turbinate and meatus (IT),
middle turbinate and meatus (MT),
superior turbinate and meatus (ST).
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
1 Anatomy of the Lateral Nasal Wall
Ostiomeatal Complex
6 Schematic depiction of the ostiomeatal complex (green area).
5 Endoscopic view of the ostiomeatal complex.
11
12
2 Basal Lamella of the Middle Turbinate
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
2.0 Basal Lamella of the Middle Turbinate
1 Schematic drawing of the basal lamellae of the ethmoid bone.
1) Basal lamella of the uncinate process
2) Basal lamella of the ethmoid bulla
3) Basal lamella of the middle turbinate
4) Basal lamella of the superior turbinate
5) Anterior wall of the sphenoid sinus
2 Axial CT section of the ethmoid cells
showing the vertical lamella (VL) of the
middle turbinate.
3 Gross anatomy of a cadaver specimen demonstrating the basal lamella of the middle
turbinate with vertical lamella (VL), frontal lamella (FL) and horizontal lamella (HL).
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
4 Coronal CT section of the ethmoid sinus showing the horizontal lamella (HL) of the middle
turbinate.
5 Schematic three-dimensional depiction of the basal lamella of the middle turbinate.
2 Basal Lamella of the Middle Turbinate
13
14
2 Basal Lamella of the Middle Turbinate
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
Middle Turbinate Dissection
1. The vertical lamella (VL) of the middle turbinate (MT) should be
medialized gently to prevent the risk of fracturing the skull base and
causing a cerebrospinal fluid leak.
2. The basal lamella of the MT naturally contributes to the development of
the sinus lateralis (also termed supra- and retrobullar recess).
3. The basal lamella (frontal lamella, FL) may be deflected anteriorly or
posteriorly by relatively large ethmoid cells.
4. The frontal lamella may be fused with the posterior wall of the ethmoid
bulla.
5. Dissection of the frontal oblique portion of the basal lamella is initiated
inferomedially to enter the posterior ethmoid sinus.
6. The horizontal lamella should be left intact to prevent destabilizing the
middle turbinate.
6 Gross anatomy of the middle turbinate: vertical lamella (VL), frontal lamella (FL) and
horizontal lamella (HL).
a
b
7 a) Endoscopic view of the frontal lamella (FL) of the middle turbinate.
b) Sagittal CT section of paranasal sinuses showing the basal lamella of the middle
turbinate.
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
Variations of the Middle Turbinate
Paradoxical Curvature
medially rather than laterally.
Found in 11–29% of patients.
Does not obstruct the ostiomeatal complex.
Concave
Concha bullosa
Aeration of any part of middle turbinate can obstruct the ostiomeatal
complex.
a
b
8 a) Endoscopic view of a paradoxically curved middle turbinate (MT) and nasal septum (S).
b) Coronal CT section at the level of the ethmoid sinuses demonstrating a paradoxically
curved middle turbinate (MT) and nasal septum (S).
a
b
9 a) Endoscopic view of the pneumatized anterior aspect of the middle turbinate, also termed
concha bullosa (Cb)
b) Coronal CT section of the anterior ethmoid sinus area showing a bilateral concha bullosa
(CB).
2 Basal Lamella of the Middle Turbinate
15
16
3 Uncinate Process
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
3.0 Uncinate Process
Uncinate Process (UP) and Maxillary Line
The middle turbinate is medialized to visualize
1. the shape and size of the middle turbinate (MT),
2. the ethmoid bulla (BE),
3. the free margin of the uncinate process (UP),
4. the line of the frontal maxillary process (also termed ‘maxillary line’).
1 Schematic drawing of the basal lamellae
of the ethmoid bone.
1) Basal lamella of the uncinate process
2) Basal lamella of the ethmoid bulla
3) Basal lamella of the middle turbinate
4) Basal lamella of the superior turbinate
5) Anterior wall of the sphenoid sinus
2 Gross anatomy demonstrated by
a sagittal cadaveric section: the
middle turbinate (MT) is reflected upward
revealing the ethmoid bulla (BE), uncinate
process (UP) and a curved landmark
referred to as frontal maxillary process
line (d).
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
3 Uncinate Process
Identify the uncinate process (UP), which
is
a thin, curved bony plate, resembling a hook, that extends from
anterosuperior to posteroinferior along the lateral nasal wall
‘guards’ the natural maxillary ostium and
consists of three layers.
If the incision is not carried backwards posteriorly to a sufficient extent,
the remaining portion of the UP may impair vision of the maxillary sinus
ostium.
a
b
3 a) Endoscopic view of the ethmoid bulla (BE), uncinate process (UP) and frontal maxillary
process line (d).
b) Coronal CT section at the level of the ethmoid region showing the uncinate process (UP).
4 Sagittal cadaveric section: the middle
turbinate has been reflected upward
exposing the uncinate process (arrow).
17
18
3 Uncinate Process
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
a
b
5 a) Endoscopic view of the uncinate process (yellow double-tipped pointer).
b) Coronal CT section of the ethmoid sinus region. The arrow indicates the uncinate
process.
Anatomical Variants of the Uncinate Process Insertion
6 Schematic drawings demonstrating three
anatomical variations of the superior and
anterior insertion of the uncinate process.
a) Insertion on the medial orbital wall
(lamina papyracea),
b) on the skull base,
c) on the middle turbinate (adapted from
Kennedy DW, Bolger WE, Zinreich SJ.
Diseases of the Sinuses: Diagnosis and
Management. Hamilton, Canada, BC
Decker; 2001.)
These variants may obstruct the natural mucociliary drainage pathways of the nasal and
paranasal sinuses, and may thus become the pathogenic cause of disease.
Radiologic Examples of Uncinate Process Variants
a
7 UP insertion on the orbit. Coronal CT
section demonstrating the insertion of the
uncinate process on the medial orbital
wall (lamina papyracea).
b
UP insertion on the skull base. Coronal CT
section of paranasal sinuses demonstrating
the insertion of the uncinate process on the
skull base.
c
UP insertion on the middle turbinate.
Coronal CT section of paranasal sinuses
demonstrating the insertion of the uncinate
process on the left middle turbinate.
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
4 Hiatus Semilunaris and
Ethmoid Infundibulum
19
4.0 Hiatus Semilunaris and Ethmoid Infundibulum
Identify the hiatus semilunaris, which
is
a two-dimensional crescent-shaped cleft located between the free
margin of the uncinate process and the ethmoid bulla (Fig. 1, arrow),
leads to a three-dimensional space, termed ‘ethmoid infundibulum’
(dotted white line on CT image, Fig. 2b)
1 Gross anatomy of a sagittal cadaver
section demonstrating the hiatus
semilunaris, a two-dimensional, crescentshaped cleft (double-tipped arrow).
a
b
2 a) Endoscopic view of the inferior semilunar hiatus (double-tipped arrow).
b) Coronal CT section of the paranasal sinuses demonstrating the inferior semilunar hiatus,
highlighted by a double-tipped arrow and dashed lines.
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4 Hiatus Semilunaris and
Ethmoid Infundibulum
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
The Ethmoid Infundibulum – A Three-Dimensional Cavity
The ethmoid infundibulum is located lateral to the hiatus semilunaris inferior.
Perform the exercises below and focus your attention on the CT images
(Figs. 2b, 4b)
A
piece of white ribbon may be inserted in the ethmoid infundibulum.
While viewing through a 0° telescope, a palpation probe may be inserted
in the ethmoid infundibulum.
Note the arrow on the axial CT image (Fig. 4b) demonstrating the
ethmoid infundibulum.
3 Gross anatomy of a sagittal cadaver
section showing a piece of white ribbon
placed in the threedimensional space
called ethmoid infundibulum.
Note the following boundaries:
posteriorly,
the frontal wall of the ethmoid bulla
anteriorly, the uncinate process and frontal maxillary process
laterally, the lamina papyracea and the posterior fontanelle
medially, the inferior hiatus semilunaris and the uncinate process
a
b
4 a) Endoscopic view after insertion of a palpation probe into the ethmoid infundibulum.
b) Axial CT section of the paranasal sinuses demonstrating the ethmoid infundibulum (EI).
Endoscopic and Sinonasal Dissection Manual
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5 Anterior Ethmoid Cell
21
5.0 Anterior Ethmoid Cells
1 Schematic drawing of the basal lamellae
of the ethmoid bone.
1) Basal lamella of the uncinate process
2) Basal lamella of the ethmoid bulla
2a) Anterior ethmoid cells
3) Basal lamella of the middle turbinate
4) Basal lamella of the superior turbinate
5) Anterior wall of the sphenoid sinus
General Characteristics
Anterior ethmoid air cells vary in number and size according to the degree
of pneumatization.
Can reach and lie medial to the lacrimal sac, thus called lacrimal cells.
Can extend anteriorly and forms the agger nasi cell.
The agger nasi is a site, where larger air cells are found, varying in size
and position.
Haller cells, also called ‘infraorbital ethmoid air cells’, present on the
medial floor of the orbit or the roof of the maxillary sinus.
Complete anterior ethmoidectomy is required to expose the frontal
recess.
2 Gross anatomy of a sagittal cadaver
section demonstrating an anterior
ethmoid cell.
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5 Anterior Ethmoid Cell
Endoscopic and Sinonasal Dissection Manual
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a
b
3 a) Endoscopic view of anterior ethmoid air cells.
b) Sagittal CT section of the paranasal sinuses demonstrating anterior ethmoid air cells.
Agger Nasi Cell
Using a HOPKINS® 0°-telescope you may inspect the Agger| Nasi Cell
(AN), which is a structure,
presenting
as an eminence in the lateral nasal wall.
found just in front of the insertion of the uncinate process and middle
turbinate.
the posterior and superior wall of which consitutes the floor of the frontal
recess.
generally pneumatized (from the frontal recess).
found medially to the lacrimal sac.
that needs to be opened in order to visualize the frontal recess and
frontal sinus.
4 Gross anatomy of a sagittal cadaver
section demonstrating the lateral nasal
wall with agger nasi cell (AN) exposed after
reflection of the middle turbinate (MT).
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
a
5 Anterior Ethmoid Cell
23
b
5 a) Endoscopic view of a Blakesley cupped forceps pointing towards the agger nasi cell (AN).
b) Coronal CT section of the paranasal sinus region demonstrating an agger nasi cell (AN).
Agger Nasi Cell and Frontal Recess
While using a 30°-HOPKINS® telescope, place a curette behind the roof of
the agger nasi cell (AN).
Following removal of the AN, the frontal recess (FR) may be opened allowing
the frontal sinus to be exposed.
a
b
6 a) Endoscopic view of the exposed frontal sinus (FS) after removal of the agger nasi cell.
b) Endoscopic view of an agger nasi cell (AN) opened by use of a curette.
7 Gross anatomy of a sagittal cadaver specimen demonstrating the lateral nasal wall following
reflection of the middle turbinate. Shown by the red pointer is the frontal recess (FR).
8 Sagittal CT section of the paranasal
sinuses demonstrating a agger nasi cell
(AN) inferior to the frontal recess (FR).
24
6 Ethmoid Bulla
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
6.0 Ethmoid Bulla
1 Schematic drawing of the basal lamellae
of the ethmoid bone.
1) Basal lamella of the uncinate process
2) Basal lamella of the ethmoid bulla
3) Basal lamella of the middle turbinate
4) Basal lamella of the superior turbinate
5) Anterior wall of the sphenoid sinus
Boundaries of the Ethmoid Bulla
Anteriorly:
the ethmoid infundibulum.
the suprabullar recess.
Posteriorly: the retrobullar recess.
Medially: the middle turbinate.
The air space between the ethmoid bulla and the middle turbinate is
called sinus lateralis.
Superiorly:
2 Gross anatomy of a sagittal cadaveric
section showing the lateral nasal wall with
bulla ethmoidalis (BE) below the reflected
middle turbinate (MT).
Endoscopic and Sinonasal Dissection Manual
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a
6 Ethmoid Bulla
25
b
3 a) Endoscopic view of a bulla ethmoidalis (BE) in relation to the middle turbinate (MT) and
sinus lateralis (SL).
b) Coronal CT section of paranasal sinuses demonstrating the middle turbinate (MT) and
bulla ethmoidalis (BE).
Topographical, Morphological and Surgical Aspects
The Ethmoid Bulla
a consistent anatomical landmark.
may be absent at all, or may not be pneumatized.
is the largest and the most anteriorly located of the ethmoid air cells
is entered via the safest point of entry, the inferomedial part of the bulla.
has an ostium that opens posteriorly or medially.
may be attached to the skull base, thus forming the posterior wall of the
frontal recess.
forms a cavity that can be exposed with a Blakesley forceps or a sharp
curette or suction tip.
is
4 Gross anatomy of a sagittal cadaver
section, showing the lateral nasal wall with
bulla ethmoidalis (BE) and its topographical
relation to the uncinate process (UP).
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6 Ethmoid Bulla
Endoscopic and Sinonasal Dissection Manual
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a
b
5 a) Endoscopic view of the bulla ethmoidalis (BE) and its relation to the uncinate process
(UP).
b) Coronal CT section of the paranasal sinuses demonstrating the middle turbinate (MT)
and uncinate process (UP) in relation to the bulla ethmoidalis (BE).
The Variable Depth of the Olfactory Fossa
(Keros Classification)
According to Keros, there are three types of olfactory fossa. The classification
scheme, which is based on the length of the lateral lamella of the cribriform
plate, is graded from type I to type III.
6 Schematic drawings of the types of olfactory fossae (I–III), forming the basis of the Keros classification.
(KEROS P. On the practical value of differences in the level of the lamina cribrosa of the ethmoid. Z Laryngol Rhinol Otol. 1962;41:809–13).
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
a
c
6 Ethmoid Bulla
b
7 Coronal CT sections demonstrating
a) type I,
b) type II and
c) type III of the Keros classification.
d) an asymmetric type of olfactory fossa.
d
The Infraorbital Ethmoid Cell (Haller Cell)
is an ethmoid cell, that develops owing to pneumatization of the lacrimal
bone along the orbital floor.
may narrow the natural maxillary ostium.
should be opened to prevent recurrent and/or persistent sinusitis.
may be of single or multiple appearance.
a
27
b
8 Coronal CT sections of the paranasal sinuses demonstrating an infraorbital ethmoid cell (Haller cell).
28
7 Anterior Ethmoid Artery
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
7.0 Anterior Ethmoid Artery
Try to localize the Anterior Ethmoid Artery (AEA)
In
the formalin-fixed cadaver specimen, the AEA appears whiter than
the surrounding tissues.
The AEA runs from lateral to medial and obliquely forward along the
skull base.
In 40% of cases, the AEA is up to 2 mm away from the skull base, lying
free or encased in a canal, and in 60% of cases, it courses directly on
the skull base (Basak et al. 1998).
The AEA, most commonly, is located 1–2 mm behind the bulla lamella.
In front of the AEA, the skull base anteriorly joins with the posterior wall
of the frontal sinus. This point is located an average of 9 mm in front of
the artery.
In 40% of cases, the canal of the AEA is not intact, containing sites of
bone dehiscence (Stammberger 1988).
1 Schematic drawing of the basal lamellae
of the ethmoid bone.
1) Basal lamella of the uncinate process
2) Basal lamella of the ethmoid bulla
2a) Anterior ethmoid artery
3) Basal lamella of the middle turbinate
4) Basal lamella of the superior turbinate
5) Anterior wall of the sphenoid sinus
Endoscopic and Sinonasal Dissection Manual
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7 Anterior Ethmoid Artery
29
2 Gross anatomy of a sagittal cadaver
specimen demonstrating the anterior
ethmoid artery (AEA) exhibiting a lighter
color tone than that of the surrounding
formalin-fixed tissues.
a
b
3 a) Endoscopic view of the anterior ethmoid artery (AEA).
b) Coronal CT section of the paranasal sinuses with arrows indicating the ethmoid roof
where the anterior ethmoid artery (AEA) emerges in a bony canal.
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8 Posterior Fontanelle
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
8.0 Posterior Fontanelle
Try to localize the Posterior Fontanelle
The
fontanelles are an area of the lateral nasal wall, deficient in bone.
In this area, the maxillary sinus mucosa is adherent to the nasal mucosa.
The unicate process divides the fontanelle area into an anterior and
posterior part.
Fontanelles are sites of predilection for accessory sinus ostia.
1 Gross anatomy of a sagittal cadaver
section demonstrating an area of bony
dehiscence (red pointer), also called
posterior nasal fontanelle.
2 a) Endoscopic view of anterior and
posterior fontanelles, predilection sites
for accessory ostia.
b) Endoscopic view of a posterior
fontanelle.
a
b
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
9 Middle Meatal Antrostomy
9.0 Middle Meatal Antrostomy
The
posteroinferior portion of the uncinate process can articulate with
the inferior turbinate, with the bulla, and/or with the palatine bone. The
bone may also flatten out or be absent (Yoon et al. 2000)
Subdividing the ethmoid infundibulum into quarters, the maxillary ostium
is located in the last ¾.
The lacrimal duct may be injured while enlarging the natural maxillary
sinus ostium anteriorly.
Lacrimal duct injury occurs in 15% of cases, but such incidence is only
rarely associated with clinical symptoms (Ünlü et al. 1996).
The natural maxillary sinus ostium is located only 2 mm from the roof
of the maxillary sinus, which predisposes the site for iatrogenic orbital
injury during antrostomies (Meyers and Valvassori 1998).
Forty percent of the sphenoid sinus lies below a horizontal plane that
passes through the posteromedial orbital floor at its junction with the
medial orbital wall (Casiano 2001).
Accessory maxillary sinus ostia, usually located in the posterior
fontanelle, should not be confused with the natural ostium. If missed, it
will lead to persistent disease (recirculation).
During MMA, avoid stripping off the maxillary sinus mucosa.
1 Gross anatomy of a sagittal cadaver
section demonstrating the site of the
middle meatal antrostomy (MMA) in
the fourth quarter of the ethmoid
infundibulum.
31
32
9 Middle Meatal Antrostomy
Endoscopic and Sinonasal Dissection Manual
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a
b
2 a) Endoscopic view showing the proximity of the middle meatal antrostomy (MMA) to the
orbital floor.
b) Coronal CT section of the paranasal sinuses in a patient with previous history of
extensive sinus surgery including middle meatal antrostomy (MMA).
Sites of Bone Dehiscence in the Maxillary Sinus
In
the fontanelle area, accessory maxillary sinus ostia are encountered
more frequently with ageing (in up to 30% of cases).
Mostly located in the posterior fontanelle.
Along the infraorbital canal or sulcus, bone dehiscence is found in 15%
of cases (Caution! Risk of injury from blind manipulations within the
sinus cavity.
3 Gross anatomy of a sagittal cadaver
section showing an area of bony
dehiscence, also termed posterior
fontanelle.
Endoscopic and Sinonasal Dissection Manual
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9 Middle Meatal Antrostomy
33
Accessory Ostia
Enlarging
an accessory ostium, while leaving untreated the blocked,
adjacent natural ostium, may lead to persistent or recurrent sinus
disease (Parsons et al. 1996).
a
b
4 a) Endoscopic view of the lateral nasal wall showing accessory ostia.
b) Endoscopic view of the lateral nasal wall showing an accessory ostium (AO).
Anatomical Relationship between Uncinate Process and
Maxillary Sinus Ostium
The
posterior inferior portion of the uninate process is highly variable in
morphology and intimately related to the natural maxillary sinus ostia.
Delicate processes from the UP bone extend to the inferior turbinate, to
the bulla and/or to the palatine bone.
The first process divides the membranous antral wall into an anterior
and posterior fontanelle.
5 Schematic drawing of the lateral nasal
wall illustrating the anatomical relationship
of the maxillary sinus ostium and the
uncinate process.
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9 Middle Meatal Antrostomy
Endoscopic and Sinonasal Dissection Manual
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Size of the Middle Meatal Antrostomy Window and|Its
Impact on Treatment Outcome
In a group of 133 patients, a large middle meatal window (larger than 16|mm
in diameter) was created either unilaterally or bilaterally, while in a control
of the same size, patients were treated with a small middle meatal antral
window (smaller than 6 mm in diameter).
During follow-up visits, conducted from 12 to 38 months post surgery,
outcomes of treatment were assessed employing a series of criteria which
included self-evaluation of symptom change (absent, improved, unchanged,
worsened) and various endoscopic findings.
Conclusion: In terms of symptom relief and endoscopic findings, no
correlation could be demonstrated with the diameter of the surgically created
antrostomy window (Albu and Tomescu 2004).
Patency of Middle Meatal Antrostomy
Within a group of 60 patients with bilateral nasal polyps and chronic
maxillary sinusitis, large middle meatal antrostomy was performed leaving
intact the natural maxillary sinus ostium. Patients were followed up and
outcomes of treatment analyzed in a comparative review (Wadwongtham,
Aeumjaturapat 2003). The study design involved a large middle meatal
antrostomy, performed on one side, whereas uncinectomy preserving the
natural maxillary ostium, was done on the contralateral side.
Sides
were chosen randomly.
Patency rate of the large middle meatal antrostomy was higher 3 months
after surgery when compared with the untreated maxillary sinus ostium.
This difference became insignificant after 12 months (level Ib).
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
Classification of Middle Meatal Antrostomy (MMA) – Size
and Surgical Approaches
Ballon Sinusotomy and Middle Meatal Antrostomy (MMA)
Minimally
invasive technique
Technique of maxillary sinus surgery without uncinate process removal
Sphenoid sinus surgery without ethmoidectomy or partial superior
turbinate resection.
Isolated frontal sinus surgery without ethmoidectomy and frontal recess
dissection.
6 Endoscopic view of balloon sinuplasty.
Type 1 – Small-Sized Middle Meatal Antrostomy
Surgical Steps
1. Inferior attachment of uncinate process is detached exposing the
natural maxillary sinus ostium.
2. Microdebrider or down-biting antral cutting punch is used to remove
any remnant of the uncinate process.
3. Areas of polypoid or inflammatory mucosa are removed.
4. Maxillary sinus ostium is probed first using an antrum probe.
5. An opening of 5 mm x 5 mm is large enough for simple endoscopy.
6. In the presence of copious or thick secretions within the sinus, the
maxillary sinus ostium is gently dilated.
9 Middle Meatal Antrostomy
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9 Middle Meatal Antrostomy
Endoscopic and Sinonasal Dissection Manual
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Small Natural Maxillary Sinus Ostium
a
b
c
7 Endoscopic views of remnants of the uncinate process (UP) following uncinectomy.
8 Coronal CT section of a left maxillary meatal antrostomy (MMA).
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
Type 2 – Medium-Sized Middle Meatal Antrostomy
Surgical Steps
Given scenario: The natural maxillary sinus ostium cannot be identified.
1. Initial incision is made under visual control above the insertion of inferior
turbinate.
2. The incision is enlarged posteriorly.
3. Make sure integrity of the orbit is preserved.
4. An antrostomy window sized 8 –10 mm is created.
a
b
9 a) Endoscopic view of the center of a middle meatal antrostomy exposing the orbital floor.
b) CT section of the paranasal sinuses showing a bilateral middle meatal antrostomy (MMA).
Type 3 – Large-Sized Middle Meatal Antrostomy
Surgical Steps
1. The natural maxillary sinus ostium should be identified and distinguished
from any accessory ostia.
2. The maxillary sinus ostium is opened posteriorly to join with the
accessory ostium, thus creating a middle meatal antrostomy sized
10–15 mm.
3. Next, a back-biting forceps is used in open-jaw position to palpate the
tissue anteriorly.
4. If the tissue anteriorly is confirmed to be bone, no additional tissue
needs to be removed.
5. If dissection is carried further anteriorly, this can result in iatrogenic injury
to the nasolacrimal duct.
6. The microdebrider may be used very cautiously to enlarge the opening
and remove the incised tissues posteriorly.
9 Middle Meatal Antrostomy
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9 Middle Meatal Antrostomy
Endoscopic and Sinonasal Dissection Manual
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Indications of Type 3 – Large-Sized Middle Meatal Antrostomy
Surgical treatment of fungal maxillary sinusitis.
Surgical treatment of antrochoanal polyp.
Access for orbital decompression.
Access for orbital fracture repair.
Access to the pterygopalatine fossa.
Resection of benign tumors.
a
b
10 Coronal CT section (a) and endoscopic view (b) of a large middle meatal antrostomy on the
left side (double-tipped arrow).
Type 4 – Extensive Middle Meatal Antrostomy and Medial
Maxillectomy
Surgical Steps
1. For endoscopic tumor resection in the area of the maxillary sinus, a large
window is dissected in the posterior nasal fontanelle (NF).
2. Dissection of an additional window in the inferior meatus and
enlargement towards the middle meatal antrostomy.
11 Gross anatomy of a sagittal cadaver section showing the area of an extensive middle
meatal antrostomy.
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
Indications of Type 4 – Extensive MMA and Medial Maxillectomy
Excision of inverted papilloma.
Access to infratemporal fossa.
Access to lateral sphenoid wall.
Access lateral to vidian nerve.
Access for repair of orbital floor fracture.
a
b
12 a) Inverted papilloma specimen.
b) Coronal MRI section of an extensive middle meatal antrostomy.
a
b
13 a) Endoscopic view of inverted papilloma.
b) Endoscopic view of an extensive middle meatal antrostomy.
9 Middle Meatal Antrostomy
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40
10 Sinus lateralis
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
10.0 Sinus lateralis
Suprabullar Recess
Boundaries of the suprabullar recess
– ethmoid bulla
Superiorly – fovea ethmoidalis
Posteriorly – communicates with retrobullar recess
Note, there is no suprabullar recess
— if the ethmoid bulla inserts on the fovea ethmoidalis.
— In this case, a suprabullar lamella will separate the suprabullar recess
from the frontal recess (FR)
Inferiorly
Retrobullar Recess
Boundaries of the retrobullar recess
Anteriorly – ethmoid bulla
Posteriorly – basal lamella
Note, there is no retrobullar recess
— if the bulla adheres to the basal lamella of the middle turbinate.
1 Schematic drawing showing the clinical
anatomy of the anterior ethmoid in axial
section.
(Adapted from: Lusk RP, ed. Pediatric
Sinusitis. New York: Raven Press; 1992)
Endoscopic and Sinonasal Dissection Manual
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10 Sinus lateralis
41
2 Gross anatomy of a cadaver specimen
showing the suprabullar recess (1),
formerly known as ‘Sinus lateralis of
Grunwald’.
3 Gross anatomy of a cadaver specimen
showing the retrobullar recess (2).
Horizontal Lamella of the Middle Turbinate
4 Axial CT scan of the paranasal sinuses
showing uncinate process (UP), ethmoid
infundibulum (EI), ethmoid bulla (EB),
basal lamella (BL), sphenoid sinus (SS).
Red lines: inferior semilunar hiatus (1)
and superior semilunar hiatus (2).
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11 Superior Turbinate and Meatus
Endoscopic and Sinonasal Dissection Manual
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11.0 Superior Turbinate and Meatus
Anatomical and Morphological Aspects
Anatomically, the superior turbinate (ST) is the least accessible and
most neglected of the nasal turbinates.
The superior turbinate
— is a projection that emanates from the ethmoid bone.
— is approximately half the length of the middle turbinate and located
above its posterior half.
— attaches superiorly to the skull base and posteriorly to the sphenoid
and ethmoid bones.
Office nasal endoscopy does not afford access to this area.
The extent of pneumatization of the superior turbinate needs to be
evaluated by computed tomography.
Pneumatization of the superior turbinate leads to a constricted nasal
space which may impair maneuverability of instruments in endoscopic
pituitary surgery.
Obstruction of the superior meatus may theoretically lead to hyposmia
or obstruction of the sphenoid sinus ostium.
Superior turbinectomy is fraught with the inherent risk of damage to the
olfactory mucosa or inadvertent disruption of the cribriform plate which
may cause a cerebrospinal fluid leak.
1 Gross anatomy of a cadaver specimen
showing the superior turbinate (ST) on the
lateral nasal wall.
2 a) Endoscopic view demonstrating the
anatomical relationship between the
sphenoid ostium and the superior
turbinate / meatus.
b) Coronal CT scan of the paranasal
sinuses showing the superior, middle
and inferior turbinates / meatuses
along with the posterior ethmoid sinus.
a
b
Endoscopic and Sinonasal Dissection Manual
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11 Superior Turbinate and Meatus
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Posterior Ethmoid Cell (PE)
1. Slide the endoscope underneath the middle turbinate and advance
it towards the rear end of the middle turbinate, thus identifying the
horizontal portion of the basal lamella.
2. Retract the scope anteriorly until the upward sloping vertical portion of
the basal lamella comes into view.
3. Remove the vertical portion of the basal lamella of the middle turbinate
by starting inferomedially.
4. Identify the superior meatus and turbinate.
5. The cell you are about to enter is the posterior ethmoid cell, on average
one or two cells.
6. Identify the skull base.
7. Identify the posterior ethmoid artery coursing from lateral to medial.
It is found parallel to the coronal plane of the skull base, on average
12|mm behind the anterior ethmoid artery.
8. The posterior ethmoid nerve may run in a bony canal of the same name.
3 Gross anatomy of a cadaver specimen
showing a posterior ethmoid cell (PE).
a
b
4 a) Endoscopic view of the anterior and
posterior ethmoid arteries.
b) Coronal CT section showing a
posterior ethmoid cell (arrow).
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11 Superior Turbinate and Meatus
Endoscopic and Sinonasal Dissection Manual
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Lateral Lamella of Anterior and Posterior Ethmoid
Partitions (1–4)
Complete
removal of the entire anterior and posterior ethmoid air cells
will expose the lamina papyracea from the agger nasi to the lateral wall
of the sphenoid sinus demonstrating the sloping course of the skull
base, posterior frontal sinus wall and the frontal sinus beak.
5 Gross anatomy of a cadaver specimen
showing multiple lamellae of ethmoid cells
inserting on the lamina papyracea.
6 a) Endoscopic view of the lamina
papyracea following removal of
multiple ethmoid cells (1–4).
b) Sagittal CT section of the paranasal
sinuses showing multiple ethmoid air
cells.
a
b
Endoscopic and Sinonasal Dissection Manual
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12 Frontal Sinus Beak, Frontal Ostium
and Nasal Recess
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12.0 Frontal Sinus Beak, Frontal Sinus Ostium
and Frontal Recess
Frontal Recess
Boundaries of the Frontal Recess
– uncinate process (UP) and agger nasi cell
Posteriorly – bulla ethmoidalis and suprabullar rescess or suprabullar
lamella
Laterally – lamina papyracea
Medially – hiatus semilunaris or neck of the middle turbinate
Inferiorly – ethmoid infundibulum
Superiorly – fovea ethmoidalis, anterior ethmoid artery, frontal ostium
The size of the frontal recess, frontal sinus beak (FSB) and frontal sinus is
determined by the extent of pneumatization of the following structures:
— Agger nasi cell (AN)
— Frontal cells
— Supraorbital cell
— Bulla ethmoidalis (BE)
Anteriorly
1 Gross anatomy of a sagittal cadaver
specimen showing the frontal sinus (FS),
frontal sinus beak (FSB), frontal recess
(FR) and surrounding structures.
Bulla ethmoidalis (BE), middle turbinate
(MT), agger nasi (AN) and uncinate
process (UP).
a
b
2 a) Endoscopic view of the frontal sinus
(FS), frontal recess (FR), anterior
ethmoid artery and ethmoid fovea.
b) Sagittal CT section showing the frontal
sinus and frontal recess.
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12 Frontal Sinus Beak, Frontal Ostium
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Endoscopic and Sinonasal Dissection Manual
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The
frontal recess requires both axial and coronal CT sections to
understand the threedimensional anatomy of this area.
Sagittal CT reconstruction provided by intraoperative surgical navigation
has shown to be important for understanding
— the anteroposterior diameter of the frontal sinus.
— topographical relationship to the adjacent agger nasi.
— supraorbital ethmoid cells.
— frontal sinus cells.
3 Intraoperative navigation images of
coronal (a) and saggital (b) CT sections
showing the frontal recess (center of
crosshairs).
a
b
4 Endoscopic views of a curved suction tip
inserted in the frontal sinus (FS).
a
b
Endoscopic and Sinonasal Dissection Manual
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12 Frontal Sinus Beak, Frontal Ostium
and Nasal Recess
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Frontal Sinus Drainage – The Draf I Approach
If
the frontal sinus drainage pathway is only demonstrated and not
enlarged, the result is a ‘Draf I’ approach.
5 Gross anatomy of a sagittal cadaver
specimen showing the frontal sinus beak.
a
b
6 a) Coronal CT section demonstrating
opacified frontal sinuses with frontal
sinus beak (red pointer).
b) Endoscopic view of the frontal sinus
drainage pathway.
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Frontal Sinus Drainage – The Draf IIa Approach
The
procedure involves a circumscribed enlargement of the drainage
pathway without altering the vertical lamella of the anterior middle
turbinate.
7 Gross anatomy of a cadaver specimen
demonstrating the access to the frontal
sinus.
a
8 Coronal CT section of the paranasal
sinuses demonstrating the extent of
dissection in a Draf IIa procedure
(double-tipped pointer).
b
9 Endoscopic views (a–b) showing the area of enlargement of the drainage pathway (dotted
yellow demarcation line) with preservation of integrity of the vertical lamella of the anterior
middle turbinate (dotted black line).
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
12 Frontal Sinus Beak, Frontal Ostium
and Nasal Recess
49
Frontal Sinus Drainage – The Draf IIb Approach
Removal
of the median floor of the frontal sinus encompasses the area
from the lamina papyracea to the nasal septum and is combined with
removal of the anterior vertical lamella of the middle turbinate.
10 Gross anatomy of a sagittal cadaver
specimen demonstrating the frontal sinus
(FS) and frontal recess (FR).
50
12 Frontal Sinus Beak, Frontal Ostium
and Nasal Recess
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
Frontal Sinus Drainage – The Draf III Approach
In a Draf type III frontal sinus drainage approach, a bilateral Draf type II|b
procedure is combined with resection of the upper nasal septum and
portions of the interfrontal septum.
11 Coronal CT section of the paranasal
sinuses demonstrating the extent of
dissection in a Draf III procedure.
A bilateral Draf IIb procedure
(red demarcation lines) is combined
with resection of the upper nasal septum
and portions of the interfrontal septum
(yellow pointer).
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
13 Sphenoethmoid Recess
and Sphenoid Ostium
51
13.0 Sphenoethmoid Recess and
Sphenoid|Ostium
Anatomical-Topographical and Morphological Aspects
The sphenoethmoid recess lies superolateral to a vertical crus which is
formed by the basal lamella of the middle turbinate.
The sphenoid sinus is found medially to the sphenoethmoid recess.
The ostium of the sphenoid sinus and superior turbinate make up the
sphenoethmoid recess forming a common drainage pathway for the
posterior ethmoid and sphenoid sinuses.
1 Gross anatomy of a cadaver specimen
showing the sphenoethmoid recess
(curved yellow line), sphenoid ostium
(black arrow) and superior turbinate (ST).
a
b
2 a) Endoscopic view of the sphenoethmoid recess (curved yellow line).
b) Axial CT section of the paranasal
sinuses showing the sphenoethmoid
recess and sphenoid ostium (yellow
arrows).
52
13 Sphenoethmoid Recess
and Sphenoid Ostium
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
Sphenoid Ostium and Sphenoid Intersinus Septum
The shenoid sinus can be accessed via the following pathways
Transethmoidal
approach
Transnasal approach
Transeptal approach
Transmaxillary-transethmoid approach
3 Gross anatomy of a sagittal cadaver
specimen showing the sphenoid
intersinus septum.
4 Endoscopic view of the right and left sphenoid sinus ostia and the
sphenoid intersinus septum.
5 Axial CT section of the paranasal sinuses demonstrating the
trajectories used in various approaches to the sphenoid sinus
(transethmoidal, transseptal, transnasal and transmaxillarytransethmoid).
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
13 Sphenoethmoid Recess
and Sphenoid Ostium
53
Sphenoid Sinus
The anterior wall of the sphenoid sinus is fenestrated inferomedially.
Expose the sphenoid sinus by lateralizing the superior turbinate using
the transnasal route or via the posterior ethmoid sinus by perforating the
inferomedial wall and passing through the superior meatus.
The natural ostium should be identified.
— It is slitlike in 80% of cases, with an average diameter of 3 mm
(1 – 9 mm). It is located 7 mm (2 – 15 mm) above the choana and
4|mm from the midline, placing it in the upper half of the anterior wall
of the sphenoid sinus. The ostia on both sides are offset by 2 mm in
two-thirds of cases (Elwany et al. 1999):
6 Gross anatomy of a sagittal cadaver
section showing the sphenoid sinus.
a
b
7 a) Endoscopic view upon having gained
entry to the sphenoid sinuses.
b) Coronal CT section of the paranasal
sinuses showing hyperpneumatized
sphenoid sinuses.
54
13 Sphenoethmoid Recess
and Sphenoid Ostium
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
8 Gross anatomy of a cadaver specimen
showing the sphenoid sinus and vital
anatomical structures of the lateral nasal
wall;
Prominence of the optic nerve canal (PON),
‘genu’ of the internal carotid artery (GICA),
abducens nerve (AN), maxillary nerve (MN)
and prominence of the pterygoid canal
(PPC).
The sphenoid sinus can pneumatize the greater or lesser sphenoid wing,
palatine bone, vomer, pterygoid process, nasal septum, or posterior
ethmoid cells in varying degrees.
Variable recesses can develop
Recesses surround the bony eminences of
— optic nerve
— internal carotid artery
— maxillary nerve and vidian nerve (also termed pterygoid nerve).
9 Gross anatomy of a cadaver specimen
showing the recesses surrounding the
sphenoid sinus.
Optico-carotid recess (OCR), internal
carotid artery (ICA), optic nerve (ON).
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
a
13 Sphenoethmoid Recess
and Sphenoid Ostium
55
b
10 a) Endoscopic view of the internal
carotid artery, the optic nerve and the
optico-carotid recess, as visualized on
the lateral sphenoid wall.
b) Coronal CT section of the paransal
sinuses showing sphenoid pneumatization extending cranially beyond the
optic nerve.
Sphenoid Sinus and Carotid Artery
Note,
the intersphenoid septum may be attached to the carotid artery
Frequently, bone thickness over the carotid artery is less than 0.1 mm
Microdehiscences occur in 8% of cases (Kainz and Stammberger 1991,
Kennedy et al. 1990)
Multiple septae can be attached to the carotid artery
Cadaveric studies have shown that the carotid artery is clinically
dehiscent in 22% of specimens
11 Gross anatomy of a cadaver specimen
showing the anatomical relationship
between the carotid artery and sphenoid
sinus wall.
56
13 Sphenoethmoid Recess
and Sphenoid Ostium
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
a
b
12 a) Endoscopic view of a dehiscent carotid
artery in the sphenoid sinus.
b) Axial CT section of the paranasal
sinuses demonstrating that the
sphenoid intersinus septum attaches
to the carotid artery.
Onodi Cell (Sphenoethmoid Cell)
An
Onodi cell is a pneumatized posterior ethmoid cell superolateral to
the sphenoid sinus.
In the presence of an Onodi cell (OC), the sphenoid sinus wall is located
medial and inferior to it.
— The Onodi cell will be located above the spheniod sinus (SS) and
displace it inferiorly
The optic nerve (ON) or even the internal carotid artery (ICA) may pass
through the Onodi cell.
Coronal CT sections are suited best to identify Onodi cells. Axial CT
sections are usually not helpful.
13 Endoscopic view of the right (RT) and left (LT) sphenoid sinuses
(SS) with carotid artery (CA), optic nerve (ON) and Onodi cell (OC).
14 Coronal CT section of the paranasal sinuses showing Onodi cells
(OC) and their anatomical relationships to the sphenoid sinus (SS),
carotid artery (CA) and optic nerves.
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
14 Sphenopalatine Foramen
57
14.0 Sphenopalatine Foramen
Anatomical-Topographical and Morphological Aspects
In
90% of cases, the sphenopalatine foramen is located in the superior
meatus close to the posterior end of the middle turbinate.
The posterior part of the middle turbinate is attached to an ethmoid
crest formed by the perpendicular plate of the palatine bone.
The sphenopalatine artery ramifies into two larger branches.
— the septal artery branch, that runs along the anterior wall of the
sphenoid sinus to the posterior nasal septum, may become a source
of bleeding during sphenoidotomy.
— The posterior lateral nasal artery, that gives off branches to the
middle turbinate and posterior fontanelle.
1 Gross anatomy of a cadaver specimen
demonstrating the inferior turbinate (IT),
sphenopalatine foramen (red circle) and
middle turbinate (MT).
58
14 Sphenopalatine Foramen
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
2 Endoscopic view of a clip (pointer) applied to the sphenopalatine
artery.
3 Sagittal CT section of the paranasal sinuses demonstrating the
sphenopalatine foramen (red circle).
4 1 Maxillary artery
2 Sphenopalatine artery
3 Foramen rotundum
4 Maxillary nerve
5 Inferior alveolar artery and nerve
6 Ostium of sphenoid sinus
7 Pterygopalatine ganglion
8 Mandibular nerve
9 Middle meningeal artery
0 Pharyngeal arterial branch
q Optic chiasm
w Inferior turbinate
e Sphenomandibular ligament
r Medial pterygoid muscle
t Parotid gland
z Oculomotor nerve
u Pterygoid canal with nerve of pterygoid
canal (vidian nerve, from the greater
superior petrosal nerve) and artery
i Posterior septal artery (medial branch of
the sphenopalatine artery)
o Superior and inferior posterolateral
branches of the sphenopalatine artery
p Descending palatine artery
a Posterior superior alveolar artery
s Infraorbital artery
Schematic anatomical drawing showing various sections at different levels of the sphenopalatine
foramen (adapted from Janfaza et al. 2001, Lee et al. 2002, Pearson et al. 1969).
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
15 Nasolacrimal Sac and Duct
59
15.0 Nasolacrimal Sac and Duct
Anatomical-Topographical and Morphological Aspects
1. Using the endoscope, first try to demonstrate the lacrimal duct (Hasner
valve), located below the inferior turbinate. Place a probe in the lacrimal
duct opening.
2. If the first step is not possible, resect the anterior half of the inferior
turbinate to expose the area of Hasner’s valve, which is located around
1 cm from the tip.
3. Outline a mucosal flap over the lacrimal sac, place its base inferoanterior
to the uncinate process and remove the mucosa.
4. The frontal process of the maxilla is exposed anteriorly and portions of
the lacrimal bone posteriorly.
5. Remove the bone with a burr or with a Kerrison punch.
6. Then identify the medial wall of the lacrimal sac.
7. Try to pass a probe in the punctum of the lower eyelid and thread it
through until you see it pushing the sac wall.
8. Incise the sac on top of the probe and deliver it into the nose.
2 Gross anatomy of a cadaver specimen
showing the spacial orientation of the
nasolacrimal duct (palpation probe).
3 Osteologic image of the orbit showing the
lacrimal bone and the frontal maxillary
process.
1 Gross anatomy of a cadaver specimen showing a palpation probe in the lacrimal duct
opening below the inferior turbinate (IT).
4 Axial CT section of the paranasal sinuses
demonstrating the bilateral lacrimal
ducts.
60
16 Pituitary Gland and Tumors
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
16.0 Endoscopic Approach to Pituitary Gland and
Related Tumors
1. Identify the sphenoid ostium.
2. Identify the anatomy of lateral nasal wall.
3. Locate the sellar floor and remove the bone with a chisel and Kerrison
punch.
4. Identify the sellar dura.
5. Incise the dura and enter the pituitary gland.
1 Gross anatomy of a cadaver specimen
demonstrating the carotid artery and optic
nerve.
Endoscopic approaches to the pituitary gland include:
transsphenoidal.
Transnasal.
Via an external ethmoidectomy approach.
Via the upper buccal sulcus of the mouth and then transseptal,
transsphenoidal.
Via a craniotomy, e.g., an anterolateral approach, or a frontal approach.
Transseptal,
2 Sagittal gadolinium-enhanced MRI
section of the brain demonstrating
increased opacity from a pituitary gland
tumor.
3 Endoscopic image captured with a
30°-HOPKINS® rigid telescope showing
the carotid artery and optic nerve.
4 Endoscopic view of the sphenoid ostium.
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
17 Orbital Decompression
61
17.0 Orbital Decompression
1. The lamina papyracea may be dehiscent.
2. Perforate the lamina papyracea (LP) with a Cottle elevator, then
undermine the thin bone and remove it medially and inferiorly in a
piecemeal fashion.
3. Remove the lamina papyracea from the skull base to the MMA and from
the lacrimal sac to the anterior wall of the sphenoid sinus.
4. Press on the globe and see the periorbita bulging.
5. Incise the periorbita (P) from posterior to anterior.
6. Several incisions are made parallel to each other attempting at all times
to prevent injury to the medial rectus muscle.
7. Orbital fat will be exposed, apply pressure to the globe and observe fat
as it herniates.
8. Using the endoscope, this test is performed during surgery to detect
injuries to the lamina papyracea.
1 Gross anatomy of a cadaver specimen
showing a palpation probe indicating the
lamina papyracea (LP).
2 Gross anatomy of a sagittal cadaver
specimen showing the periorbita (P) that
has been incised from posterior to anterior.
62
17 Orbital Decompression
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
3 Gross anatomy of a sagittal cadaver
specimen showing the periorbita (P).
4 Endoscopic view showing the periorbital
bulge after removal of the lamina
papyracea.
7 Endoscopic view of orbital fat herniation.
The orbital fat is still covered by a thin
layer of yellowish periorbita.
5 Coronal CT section of the paranasal
sinuses showing the periorbital bulge.
6 Endoscopic view of intraoperative orbital
fat herniation.
a
b
8 a) Postoperative axial CT section of the paranasal sinuses confirming orbital decompression.
b) Postoperative axial CT section demonstrating orbital fat herniation.
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
18 Optic Nerve Decompression
18.0 Optic Nerve Decompression
The
optic canal is approximately 9 mm (5 – 10 mm) long, and its wall
thickness measures approximately 0.3 – 1 mm.
The bone is thinnest in the medial middle portion of the canal.
Dehiscences are found in 4% of cases.
Remove the posterior part of the lamina papyracea to expose the
annulus of Zinn, a tendinous ring for insertion of ocular muscles.
Next, identify the optic tubercle, which is the thickened part of the optic
canal.
After removing the bony canal, identify the optic nerve sheath and incise
it longitudinally along its medial course.
Occasionally, the ophthalmic artery runs medially. It may be inadvertently
injured during incision of the optic nerve sheath for decompression.
1 Gross anatomy of a cadaver specimen
demonstrating the optic nerve canal.
2 Gross anatomy of a cadaver specimen
demonstrating the optic nerve canal.
63
64
19 Iatrogenic CSF Leakage
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
19.0 Iatrogenic CSF Leakage
Predilection Sites of CSF Leakage:
Area
of insertion of middle turbinate onto the skull base.
Region of anterior ethmoid artery.
Lateral lamella of the lamina cribrosa.
1 Gross anatomy of a cadaver specimen
demonstrating an orbital roof defect.
a
b
2 Endoscopic view (a) and coronal CT section (b) showing an orbital roof defect.
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
20 Lateral Canthotomy and
Inferior Cantholysis
65
20.0 Lateral Canthotomy and Inferior Cantholysis
Scissors
are used to divide the lateral canthus down to the bone of the
orbital rim and to the depth of the lateral sulcus of the conjunctiva.
Protect the globe in order to avoid corneal abrasion or damage to the
conjunctiva.
Retract lower lid downward.
Angulate scissors at 45° to the horizontal axis and divide the lateral
ligament and septum.
The globe and contents of the orbit will then prolapse forward.
Do not probe into the posterior compartment of the eye.
This procedure is normally sufficient to decompress the posterior
compartment of the eye.
If inadequate, a medial decompression should be done.
This may be performed either endoscopically by removing the lamina
papyracea widely and incising the orbital periosteum or externally via a
Lynch procedure.
1 Gross anatomy of a cadaver specimen
demonstrating the lateral canthotomy
procedure for orbital decompression.
2 Gross anatomy of a cadaver specimen
showing the lateral canthotomy procedure
for orbital decompression.
66
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
Bibliography
1. ALBU S, TOMESCU E. Small and large middle meatus antrostomies in
the treatment of chronic maxillary sinusitis. Otolaryngol Head Neck Surg
2004; 131: 542 – 547
2. BASAK S, KARAMAN CZ, AKDILLI A et al. Evaluation of some important
anatomical variations and dangerous areas of the paranasal sinuses by
CT for safer endonasal surgery. Rhinology 1998; 36: 162 – 167
3. CASIANO RR. A stepwise surgical technique using the medial orbital
floor as the key landmark in performing endoscopic sinus surgery.
Laryngoscope 2001; 111: 964 – 974
4. ELWANY S, ELSAEID I, THABET H. Endoscopic anatomy of the
sphenoid sinus. J Laryngol Otol 1999; 113: 122 – 126
5. JANFAZA P, NADOL JB, GALLA RJ. Surgical Anatomy of the Head and
Neck. Cambridge, MA: Harvard University Press; 2011
6. KAINZ J, STAMMBERGER H. [The roof of the anterior ethmoid: a locus
minoris resistentiae in the skull base]. Laryngol Rhinol Otol (Stuttg) 1988;
67: 142 – 149
7. KENNEDY DW, ZINREICH SJ, HASSAB MH. The internal carotid artery
as it relates to endonasal sphenoethmoidectomy. Am J Rhinol 1990;
4: 7–12
8. KENNEDY DW, BOLGER WE, ZINREICH SJ eds. Diseases of the
Sinuses: Diagnosis and Management. Hamilton, Ont. ; Lewiston, N.Y. :
BC Decker; 2001
9. KEROS P. [On the practical value of differences in the level of the lamina
cribrosa of the ethmoid]. Z Laryngol Rhinol Otol 1962; 41: 809 – 813
10. LEE HY, KIM HU, KIM SS et al. Surgical anatomy of the sphenopalatine
artery in lateral nasal wall. Laryngoscope 2002; 112: 1813 – 1818
11. MEYERS RM, VALVASSORI G. Interpretation of anatomic variations of
computed tomography scans of the sinuses: a surgeon’s perspective.
Laryngoscope 1998; 108: 422 – 425
12. PARSONS DS, STIVERS FE, TALBOT AR. The missed ostium sequence
and the surgical approach to revision functional endoscopic sinus
surgery. Otolaryngol Clin North Am 1996; 29: 169 – 183
13. PEARSON BW, MACKENZIE RG, GOODMAN WS. The anatomical
basis of transantral ligation of the maxillary artery in severe epistaxis.
Laryngoscope 1969; 79: 969 – 984
14. STAMM A, DRAF W eds. Micro-Endoscopic Surgery of the Paranasal
Sinuses and the Skull Base. Berlin: Springer; 2000
15. UNLU HH, GOVSA F, MUTLU C et al. Anatomical guidelines for
intranasal surgery of the lacrimal drainage system. Rhinology 1997; 35:
11 – 15
16. WADWONGTHAM W, AEUMJATURAPAT S. Large middle meatal
antrostomy vs undisturbed maxillary ostium in the endoscopic sinus
surgery of nasal polyposis. J Med Assoc Thai 2003; 86 Suppl 2:
S373 – 378
17. YOON JH, KIM KS, JUNG DH et al. Fontanelle and uncinate process
in the lateral wall of the human nasal cavity. Laryngoscope 2000; 110:
281 – 285
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
Recommended Set for
Endoscopic Sinus Surgery (ESS)
HOPKINS® Telescopes and Accessories
Operating Instruments
Powered Instrumentation
Navigation Panel Unit (NPU)
Cold Light Fountains
KARL STORZ Image 1 HD Camera Systems
and Videoendoscopic Equipment
67
68
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
HOPKINS® Telescopes
for Diagnosis, Surgery and Treatment of Nose and Nasal Sinuses
Diameter 2.7 mm, length 18 cm
7229 FA
7229 AA
HOPKINS® Straight Forward Telescope 0°,
enlarged view, diameter 2.7 mm, length 18 cm,
autoclavable,
fiber optic light transmission incorporated,
color code: green
7229 FA
HOPKINS® Forward-Oblique Telescope 45°,
enlarged view, diameter 2.7 mm, length 18 cm,
autoclavable,
fiber optic light transmission incorporated,
color code: black
7229 CA
HOPKINS® Lateral Telescope 70°,
enlarged view, diameter 2.7 mm, length 18 cm,
autoclavable,
fiber optic light transmission incorporated,
color code: yellow
It is recommended to check the suitability of the product for the intended procedure prior to use.
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
HOPKINS® Telescopes
for Diagnosis, Surgery and Treatment of Nose and Nasal Sinuses
Diameter 4 mm, length 18 cm
7230 AA
7230 AA
HOPKINS® Straight Forward Telescope 0°,
enlarged view, diameter 4 mm, length 18 cm,
autoclavable,
fiber optic light transmission incorporated,
color code: green
7230 FA
HOPKINS® Forward-Oblique Telescope 45°,
enlarged view, diameter 4 mm, length 18 cm,
autoclavable,
fiber optic light transmission incorporated,
color code: black
7230 CA
HOPKINS® Lateral Telescope 70°,
enlarged view, diameter 4 mm, length 18 cm,
autoclavable,
fiber optic light transmission incorporated,
color code: yellow
7230 FLA
HOPKINS® Forward-Oblique Telescope 45°,
enlarged view, diameter 4 mm, length 18 cm,
autoclavable,
­connection for fiber optic light cable on the left,
fiber o
­ ptic light transmission incorporated,
color code: black
69
70
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
KARL STORZ CLEARVISION® II System
for intra-operative irrigation of the telescope lens
One-pedal
footswitch
20 0142 30
Silicone
tubing set*
U N I T
PATIENT
S I D E
SIDE
40 3341 40
40 3341 01 KARL STORZ CLEARVISION® II Set,
Lens irrigation system for telescopes,
power supply: 100–240 VAC, 50–60 Hz
including:
CLEARVISION® II
Mains Cord
One-pedal Footswitch
Silicone Tubing Set
)*Optional Accessories:
MTP 031229-10 Single-use tubing set.
For use with KARL STORZ CLEARVISION® II. Sterile,
10 per pack
*
Irrigation sheath
Submit your order to:
mtp medical technical promotion gmbh,
Take-Off GewerbePark 46, D-78579 Neuhausen ob Eck, Germany
7230 FS
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
71
KARL STORZ CLEARVISION® II
Irrigation Sheath for use with CLEARVISION® II System
Irrigation Sheath, proximally reinforced for use with
Adjustable Holder 28272 RKB
Detail
Compatible HOPKINS® Telescopes
Order No.
Outer
Diameter
Working
length
Order No.
View
Outer
Diameter
Working
length
7230 AS
4.8 x 6.0 mm
14 cm
7230 AA
0°
4.0 mm
18 cm
7230 BS
4.8 x 6.0 mm
14 cm
7230 BA
30°
4.0 mm
18 cm
7230 FS
4.8 x 6.0 mm
14 cm
7230 FA
45°
4.0 mm
18 cm
7230 CS
4.8 x 6.0 mm
14 cm
7230 CA
70°
4.0 mm
18 cm
7220 AS
3.7 x 4.8 mm
10 cm
7220 AA
0°
3.0 mm
14 cm
7220 BS
3.7 x 4.8 mm
10 cm
7220 BA
30°
3.0 mm
14 cm
7220 FS
3.7 x 4.8 mm
10 cm
7220 FA
45°
3.0 mm
14 cm
7220 CS
3.7 x 4.8 mm
10 cm
7220 CA
70°
3.0 mm
14 cm
7219 AS
3.5 x 4.7 mm
14 cm
7229 AA
0°
2.7 mm
18 cm
7219 BS
3.5 x 4.7 mm
14 cm
7229 BA
30°
2.7 mm
18 cm
7219 FS
3.5 x 4.7 mm
14 cm
7229 FA
45°
2.7 mm
18 cm
7219 CS
3.5 x 4.7 mm
14 cm
7229 CA
70°
2.7 mm
18 cm
7230 AES
4,8 x 6 mm
14 cm
7230 AE
15°– 90°
4 mm
18 cm
72
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
RHINOFORCE® II Nasal Forceps
28164 UA
RHINOFORCE® II Nasal Forceps,
with extra fine flat jaws,
through-cutting,
tissue sparing, width of cut 1.5 mm,
straight sheath, straight jaws,
with cleaning connector,
working length 18 cm
28164 UB
Same, jaws angled upwards 45°
28164 UE
Same, jaws angled downwards 45°
663211
Forceps, straight, not through-cutting,
extra sharp, with oval, fenestrated cupped jaws,
width 1.8 mm, working length 18 cm,
color code: one black handle
663217
Same, 45° upturned
663301
Scissors, straight, delicate,
working length 18 cm
663302
Scissors, straight, extra delicate,
working length 18 cm
28164 UA
Forceps
663211
Scissors
663304
Same, curved to right
663305
Same, curved to left
663307
Same, 45° curved upwards
663300
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
Dissectors
26164 DB
28164 DB
Dissector, sharp, tip angled 45°, round spatula,
with round handle, size 3 mm, length 25 cm
28164 DF
Dissector, sharp, tip angled 15°, flat long spatula,
with round handle, size 1.5 mm, length 25 cm
28164 DS
Dissector, sharp, tip angled 15°, with round handle,
size 2 mm, length 25 cm
28164 DM
Dissector, sharp, straight tip, slightly curved spatula,
with round handle, size 3 mm, length 25 cm
Curettes
26164 KB
28164 KA
Curette, round spoon, tip slightly angled, size 1 mm,
with round handle, length 23 cm
28164 KB
Curette, round spoon, tip slightly angled, size 2 mm,
with round handle, length 25 cm
28164 KF
Curette, round spoon, tip highly angled, size 2 mm,
with round handle, length 25 cm
28164 KG
Same, size 3 mm
73
74
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
CAPPABIANCA-de DIVITIIS Ring Curettes
28164 RN
28164 RN
CAPPABIANCA-de DIVITIIS Ring Curette,
with round wire, inner diameter 3 mm, tip angled 45°,
with round handle, length 25 cm
28164 RO
CAPPABIANCA-de DIVITIIS Ring Curette,
with round wire, inner diameter 5 mm, tip angled 45°,
with round handle, length 25 cm
28164 RG
CAPPABIANCA-de DIVITIIS Ring Curette,
with round wire, inner diameter 5 mm, tip angled 90°,
with round handle, length 25 cm
28164 RB
CAPPABIANCA-de DIVITIIS Ring Curette,
with round wire, inner diameter 3 mm,
laterally curved sheath end, with round handle,
length 25 cm
28164 RD
CAPPABIANCA-de DIVITIIS Ring Curette,
with round wire, inner diameter 5 mm,
laterally curved 90° sheath end, with round handle,
length 25 cm
28164 RR
CAPPABIANCA-de DIVITIIS Curette,
blunt, stirrup-shape, with round handle, length 25 cm
CAPPABIANCA-de DIVITIIS Suction Curettes
28164 RT
28164 RT
CAPPABIANCA-de DIVITIIS Suction Curette,
with basket, round, size 5 mm, rotatable tube, LUER,
length 25 cm
28164 RU
Same, size 6.5 mm
28164 RSA CAPPABIANCA-de DIVITIIS Suction Curette,
blunt, inner diameter 3 mm, tip angled 45°, LUER,
length 25 cm
28164 RSB Same, inner diameter 5 mm
28164 RSC Same, inner diameter 7 mm
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
de DIVITIIS-CAPPABIANCA Scalpel
28164 M
28164 M
de DIVITIIS-CAPPABIANCA Scalpel,
with retractable blade, length 23 cm,
including:
Handle
Outer Sheath
Micro Knife, pointed
Round Knife
28164 MP
28164 MP
Round Knife,
vertical, oval, with round handle,
3.5 x 2.5 mm, length 25 cm
CASTELNUOVO Hook and Suction Tube
28164 H
28164 H
CASTELNUOVO Hook,
90°, blunt, with round handle,
length 25 cm
28164 X
28164 X
CASTELNUOVO Suction Tube,
diameter 2 mm, malleable, lateral suction holes,
working length 25 cm
75
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Endoscopic and Sinonasal Dissection Manual
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Suction Tubes
722830
649183
649182 BU
649180 N
662882
662883
662885
662886
722830
Suction Tube, angular,
with grip plate and cut-off hole, LUER-Lock,
outer diameter 3 mm, working length 14 cm
649180 N
FERGUSON-CASTELNUOVO Suction Tube,
without cut-off hole, LUER, diameter 2 mm,
working length 15 cm
649182 BU FERGUSON-CASTELNUOVO Suction Tube,
with cut-off hole and stylet,
with calibration markings,
lateral opening downwards, diameter 2.5 mm,
working length 15 cm
649183
FERGUSON Suction Tube,
with cut-off hole and stylet, LUER, 10 Fr.,
working length 15 cm
662882
662883
662885
662886
FRANK-PASQUINI Suction Tube,
angular, tip curved upwards, ball end,
with grip plate and cut-off hole, LUER,
diameter 2.4 mm, working length 13 cm
Same, tip curved downwards
FRANK-PASQUINI Suction Tube,
angular, tip curved upwards, ball end,
with grip plate and cut-off hole, LUER,
diameter 3 mm, working length 13 cm
Same, tip curved downwards
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
TAKE-APART® Bipolar Ring Handle
26184 HM
TAKE-APART® Bipolar Ring Handle,
for bipolar instruments,
with LUER-Lock connection for cleaning
26184 HM
TAKE-APART® Outer Sheath
26184 HSS
26184 HSS TAKE APART® Outer Sheath,
for bipolar instruments, size 3 mm,
length 20 cm
Bipolar Forceps Insert
28164 FGL
28164 FGL Bipolar Forceps Insert,
fine, 1 mm, distally angled 45°, vertical closing,
size 3 mm, length 20 cm
Bipolar High Frequency Cord
26176 LE
Bipolar High Frequency Cord,
for AUTOCON® II 400 SCB system (111, 113, 115, 122, 125),
AUTOCON® II 200, AUTOCON® II 80, KARL STORZ Coagulator
26021 B/C/D, 860021 B/C/D, 27810 B/C/D, 28810 B/C/D,
AUTOCON® series (50, 200, 350), Erbe-Coagulator,
T and ICC series, length 300 cm
77
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Endoscopic and Sinonasal Dissection Manual
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UNIDRIVE® S III ENT SCB/UNIDRIVE® S III ECO
The multifunctional unit for ENT
UNID
ECO RIVE ® S
I
Special Features:
II
UNIDRIVE® S III ECO
UNID
ENT RIVE ® S
SCB
III
UNIDRIVE® S III ENT SCB
Touch Screen: Straightforward function selection via touch screen
l
–
Set values of the last session are stored
l
l
Optimized user control due to touch screen
l
–
Choice of user languages
l
–
Operating elements are single and clear to read due to color display
l
–
One unit – multifunctional:
– Shaver system for surgery of the paranasal sinuses and anterior skull base
– INTRA Drill Handpieces (40,000 rpm and 80,000 rpm)
– Sinus Shaver
– Micro Saw
– STAMMBERGER-SACHSE Intranasal Drill
– Dermatome
– High-Speed Handpieces (60,000 rpm and 100,000 rpm)
l
l
l
–
Two motor outputs: Two motor outputs for simultaneous connection of two motors:
For example, a shaver and micro motor
l
l
Soft start function
l
–
Textual error messages
l
–
Integrated irrigation and coolant pump:
– Absolutely homogeneous, micro-processor controlled irrigation rate throughout
the entire irrigation range
– Quick and easy connection of the tubing set
l
l
Easy program selection via automated motor recognition
l
l
Continuously adjustable revolution range
l
l
Maximum number of revolutions and motor torque: Microprocessor-controlled motor rotation
speed. Therefore the preselected parameters are maintained throughout the drilling procedure.
l
l
Maximum number of revolutions can be preset
l
l
SCB model with connections to the KARL STORZ Communication Bus
(KARL STORZ-SCB)
l
–
Irrigator rod included
l
–
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
79
Motor Systems
Specifications
System specifications
Mode
Order No.
rpm
Shaver mode
oscillating
Operation mode:
in conjunction with Handpiece:
Max. rev. (rpm):DrillCut-X® II Shaver Handpiece
DrillCut-X® II N Shaver Handpiece
40 7120 50
40 7120 55
10,000*
10,000*
Sinus burr mode
rotating
in conjunction with Handpiece:
Operation mode:
Max. rev. (rpm):DrillCut-X® II Shaver Handpiece
DrillCut-X® II N Shaver Handpiece
40 7120 50
40 7120 55
12,000
12,000
High-speed drilling mode
Operation mode:
Max. rev. (rpm):
20 7120 33
60,000/100,000
counterclockwise or clockwise
in conjunction with:
High-Speed Micro Motor
counterclockwise or clockwise
Drilling mode
Operation mode:
in conjunction with:
Max. rev. (rpm):micro motor
and connecting cable
[
20 7110 33
20 7111 73
]
40,000/80,000
Micro saw mode
in conjunction with:
Max. rev. (rpm):micro motor
and connecting cable
[
20 7110 33
20 7111 73
]
15,000/20,000
Intranasal drill mode
Max. rev. (rpm):
in conjunction with:
micro motor
and connecting cable
[
20 7110 33
20 7111 73
]
60,000
Dermatome mode
Max. rev. (rpm):
in conjunction with:
micro motor
and connecting cable
[
20 7110 33
20 7111 73
]
8,000
Power supply:
100 – 240 VAC, 50/60 Hz
Dimensions:
(w x h x d)
300 x 165 x 265 mm
Two outputs for parallel connection of two motors
Integrated irrigation pump:
Flow:
adjustable in 9 steps
* Approx. 4,000 rpm is recommended as this is the most efficient suction/performance ratio.
UNIDRIVE® S III ENT SCB
UNIDRIVE® S III ECO
Touch Screen:
6.4" / 300 cd/m2
Weight:
5.2 kg
4.7 kg
Certified to:
IEC 601-1 CE acc. to MDD
IEC 60601-1
Available languages:English, French, German,
Spanish, Italian, Portuguese,
Greek, Turkish, Polish, Russian
numerical codes
80
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
Motor Systems
Special features of high-performance EC micro motor II
and of the high-speed micro motor
Special features of high-performance EC micro motor II:
l
l
l
l
l
Self-cooling, brushless high-performance
EC micro motor
Smallest possible dimensions
Autoclavable
Reprocessable in a cleaning machine
Detachable connecting cable
## INTRA
coupling for a wide variety
of applications
## Maximum torque 4 Ncm
## Number of revolutions continuously adjustable
up to 40.000 rpm
## Provided a suitable handle is used, the number
of revolutions is continuously adjustable
up to 80,000 rpm
20 7110 33
20 7110 33
High-Performance EC Micro Motor II, for use with
UNIDRIVE® II/UNIDRIVE® ENT/OMFS/NEURO/ECO
and Connecting Cable 20 7110 73, or for use with
UNIDRIVE® S III ENT/ECO/NEURO and Connecting
Cable 20 7111 73
20 7111 73
Connecting Cable, to connect High-Performance
EC Micro Motor 20 7110 33 to UNIDRIVE® S III
ENT/ECO/NEURO
Special Features of the high-speed micro motor:
l
## Maximum
l
Brushless high-speed micro motor
Smallest possible dimensions
l Autoclavable
l Reprocessable in a cleaning machine
l Maximum torque 6 Ncm
## Number
torque 6 Ncm
of revolutions continuously adjustable
up to 60.000 rpm
## Provided a suitable handle is used, the number
of revolutions is continuously adjustable
up to 100,000 rpm
20 7120 33
20 7120 33
High-Speed Micro-Motor, max. speed 60,000 rpm,
including connecting cable, for use with UNIDRIVE® S III
ENT/NEURO
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
81
UNIDRIVE® S III ENT SCB
UNIDRIVE® S III ECO
Recommended System Configuration
UNIDRIVE® S III ENT SCB
UNIDRIVE® S III ECO
40 7016 20-1
40 7014 20
40 7016 01-1
UNIDRIVE® S III ENT SCB, motor control unit with color display,
touch screen, two motor outputs, integrated irrigation pump and
SCB module, power supply 100 – 240 VAC, 50/60 Hz
including:
Mains Cord
Irrigator Rod
Two-Pedal Footswitch, two-stage, with proportional function
Silicone Tubing Set, for irrigation, sterilizable
Clip Set, for use with silicone tubing set
SCB Connecting Cable, length 100 cm
Single Use Tubing Set*, sterile, package of 3
40 7014 01
UNIDRIVE® S III ECO, motor control unit with two motor outputs and
integrated irrigation pump, power supply 100 – 240 VAC, 50/60 Hz
including:
Mains Cord
Two-Pedal Footswitch, two-stage, with proportional function
Silicone Tubing Set, for irrigation, sterilizable
Clip Set, for use with silicone tubing set
Specifications:
Touch Screen
UNIDRIVE® S III ENT SCB: 6.4"/300 cd/m2
Dimensions w x h x d
300 x 165 x 265 mm
Flow
9 steps
Weight
5.2 kg
Power supply
100-240 VAC, 50/60 Hz
Certified to
EC 601-1, CE acc. to MDD
*
mtp medical technical promotion gmbh,
Take-Off GewerbePark 46, D-78579 Neuhausen ob Eck, Germany
82
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
UNIDRIVE® S III ENT SCB
UNIDRIVE® S III ECO
System Components
Silicone Tubing Set
Two-Pedal Footswitch
20 0166 30
20 7116 40
U N I T
S I D E
PATIENT SIDE
High-Speed Micro-Motor
High-Performance EC Micro Motor II
20 7110 33
20 7111 73
20 7120 33
High-Speed Handpiece
DrillCut-X® II Shaver Handpiece,
for use with UNIDRIVE® S III
ECO/ENT/NEURO
DrillCut-X® II N Shaver Handpiece,
optional adaptability to
Shaver Tracker, for use with
UNIDRIVE® S III ECO/ENT/NEURO
40 7120 50
40 7120 55
INTRA Drill Handpiece
Shaver Blade
41201 KN
252575 – 252590
252660 – 252692
Shaver Blade, curved
Intranasal Drill
41302 KN
Sinus Burr
660000
41305 DN
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
Optional Accessories
for UNIDRIVE® S III ENT SCB and UNIDRIVE® S III ECO
*
280053
Universal Spray, 6x 500 ml bottles – HAZARDOUS GOODS – UN 1950
including:
Spray Nozzle
280053 C
Spray Nozzle, for the reprocessing of INTRA burr handpieces,
for use with Universal Spray 280053 B
031131-10*
Tubing Set, for irrigation, for single use, sterile,
package of 10
mtp medical technical promotion gmbh,
Take-Off GewerbePark 46, D-78579 Neuhausen ob Eck, Germany
83
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Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
DrillCut-X® Shaver Handpieces
Special Features:
DrillC
40 71 ut-X ® II N
20 55
DrillC
u
40 71 t-X ® II
20 50
Special Features
Max. 10,000 rpm for shaver blades, max. 12,000 rpm for sinus shaver
l
l
Straight suction channel
l
l
Integrated irrigation channel
l
l
Powerful motor, also suitable for harder materials
l
l
Absolutely silent running, no vibration
l
l
Completely immersible and machine-washable
l
l
LOCK allows fixation of shaver blades and sinus shavers
l
l
Extremely lightweight design
l
l
Optional, ergonomic handle, detachable
l
l
Can be adapted to navigation tracker
–
l
40 7120 50
40 7120 50
DrillCut-X® II Shaver Handpiece,
for use with UNIDRIVE® S III ECO/ENT/NEURO/OMFS
40 7120 55
40 7120 55
DrillCut-X® II N Shaver Handpiece,
optional adaptability to Shaver Tracker 40 8001 22,
for use with UNIDRIVE® S III ECO/ENT/NEURO/OMFS
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
DrillCut-X® II Shaver Handpiece
Special Features:
## Powerful motor
## Absolutely silent running
## Enhanced ergonomics
## Lightweight design
## Oscillation mode for shaver blades,
max. 10,000 rpm
## Rotation mode for sinus shavers, max. 12,000 rpm
## Straight suction channel and
integrated irrigation
## The
versatile DrillCut-X® II Shaver Handpiece can
be adapted to individual needs of the user
## Easy hygienic processing, suitable for use in
washer and autoclavable at 134 °C
## Quick coupling mechanism facilitates more
rapid exchange of work inserts
## Proven DrillCut-X® blade portfolios can be used
40 7120 50
40 7120 50
DrillCut-X® II Shaver Handpiece,
for use with UNIDRIVE® S III ECO/ENT/NEURO/OMFS
40 7120 90
40 7120 90
Handle, adjustable, for use with DrillCut-X® II 40 7120 50
and DrillCut-X® II N 40 7120 55
Optional Accessory:
41250 RA
41250 RA
Cleaning Adaptor, LUER-Lock,
for cleaning DrillCut-X® shaver handpieces
85
86
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
DrillCut-X® II Shaver N Handpiece
Special Features:
## Powerful motor
## Absolutely silent running
## Enhanced ergonomics
## Lighweight design
## Oscillation mode for shaver blades,
max. 10,000 rpm
## Rotation mode for sinus shavers,
max. 12,000 rpm
## Straight suction channel and integrated irrigation
## The versatile DrillCut®-X II Shaver N Shaver
Handpiece can be adapted to the individual needs
of the user
## Easy
hygienic processing, suitable for use in
washer and autoclavable at 134 °C
## Quick coupling mechanism facilitates more rapid
exchange of working inserts
## Proven DrillCut-X® blade portfolios can be used
## Optional adaptability to Shaver Tracker 40 8001 22
## Allows shaver navigation when used with
NPU 40 8000 01
40 7120 55
40 7120 55
DrillCut-X® II N Shaver Handpiece,
optional adaptability to Shaver Tracker 40 8001 22,
for use with UNIDRIVE® S III ECO/ENT/NEURO/OMFS
40 7120 90
40 7120 90
Handle, adjustable, for use with DrillCut-X® II 40 7120 50
and DrillCut-X® II N 40 7120 55
Optional Accessory:
41250 RA
41250 RA
Cleaning Adaptor, LUER-Lock,
for cleaning DrillCut-X® shaver handpieces
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
Handle for DrillCut-X® II Shaver Handpiece
for use with DrillCut-X® II 40 7120 50 and DrillCut-X® II N 40 7120 55
Special Features:
## Ergonomic design
## Ultralight construction
## Easy handle control allows individual adjustment
## The
adjustable handle can be mounted to
DrillCut®-X II or -X II N Shaver Handpiece
## Easy fixation via rotary lock
## Sterilizable
40 7120 90
40 7120 90
Handle, adjustable, for use with DrillCut-X® II 40 7120 50
and DrillCut-X® II N 40 7120 55
87
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Endoscopic and Sinonasal Dissection Manual
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Shaver Blades, straight
for Nasal Sinuses and Skull Base Surgery
For use with DrillCut-X® II and DrillCut-X® II N
41201 GN
Shaver Blades, straight, sterilizable
for use with
Detail
40 7120 50 DrillCut-X® II Handpiece
40 7120 55 DrillCut-X® II N Handpiece
Shaver Blade
length 12 cm
41201 KN
serrated cutting edge,
diameter 4 mm,
color code: blue-red
41201 KK
double serrated cutting edge,
diameter 4 mm,
color code: blue-yellow
41201 GN
concave cutting edge,
­oval cutting window, diameter 4 mm,
color code: blue-green
41201 LN
concave cutting edge, oblique
cutting window, diameter 4 mm,
color code: blue-black
41201 SN
straight cutting edge,
diameter 4 mm,
color code: blue-blue
41201 KSA
serrated cutting edge,
diameter 3 mm,
color code: blue-red
41201 KKSA
double serrated cutting edge,
diameter 3 mm,
color code: blue-yellow
41201 KKSB
double serrated cutting edge,
diameter 2 mm,
color code: blue-yellow
41201 LSA
concave cutting edge, oblique
cutting window, diameter 3 mm,
color code: blue-black
Optional Accessory:
41200 RA
Cleaning Adaptor, LUER-Lock, for cleaning the inner
and outer blades of reusable Shaver Blades 412xx
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
89
Shaver Blades, curved
for Nasal Sinuses and Skull Base Surgery
For use with DrillCut-X® II and DrillCut-X® II N
41204 KKB
Shaver Blades, curved 35°/40°, sterilizable
for use with
Detail
40 7120 50 DrillCut-X® II Handpiece
40 7120 55 DrillCut-X® II N Handpiece
Shaver Blade
length 12 cm
41202 KN
curved 35°, ­cutting edge serrated
backwards, diameter 4 mm,
color code: blue-red
41204 KKF
curved 40°, cutting edge serrated
forwards, double serrated,
diameter 4 mm,
color code: blue-yellow
41204 KKB
curved 40°, cutting edge serrated
backwards, ­double serrated,
diameter 4 mm,
color code: blue-yellow
41204 KKFA
curved 40°, cutting edge serrated
forwards, double serrated,
diameter 3 mm,
color code: blue-yellow
41204 KKBA
curved 40°, cutting edge serrated
backwards, double serrated,
diameter 3 mm,
color code: blue-yellow
Optional Accessory:
41200 RA
Cleaning Adaptor, LUER-Lock, for cleaning the inner
and outer blades of reusable Shaver Blades 412xx
90
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
Shaver Blades, curved
for Nasal Sinuses and Skull Base Surgery
For use with DrillCut-X® II and DrillCut-X® II N
41203 KKF
Shaver Blades, curved 65°, sterilizable
for use with
Detail
40 7120 50 DrillCut-X® II Handpiece
40 7120 55 DrillCut-X® II N Handpiece
Shaver Blade
length 12 cm
41203 KNF
curved 65°, cutting edge serrated
forwards, diameter 4 mm,
color code: blue-red
41203 KNB
curved 65°, cutting edge serrated
backwards, diameter 4 mm,
color code: blue-red
41203 KKF
curved 65°, cutting edge serrated
forwards, double serrated,
diameter 4 mm,
color code: blue-yellow
41203 KKB
curved 65°, cutting edge serrated
backwards, double serrated,
diameter 4 mm,
color code: blue-yellow
41203 KKFA
curved 65°, cutting edge serrated
forwards, double serrated,
diameter 3 mm,
color code: blue-yellow
41203 KKBA
curved 65°, cutting edge serrated
backwards, double serrated,
diameter 3 mm,
color code: blue-yellow
41203 GNF
curved 65°, concave cutting edge,
oval cutting window, forward
opening, diameter 4 mm,
color code: blue-green
41203 GNB
curved 65°, concave cutting edge,
oval cutting window, backward
opening, diameter 4 mm,
color code: blue-green
Optional Accessory:
41200 RA
Cleaning Adaptor, LUER-Lock, for cleaning the inner
and outer blades of reusable Shaver Blades 412xx
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
91
Shaver Blades, straight
for Nasal Sinuses and Skull Base Surgery
For use with DrillCut-X® II and DrillCut-X® II N
41301 KK
Shaver Blades, straight, for single use , sterile, package of 5
for use with
Detail
40 7120 50 DrillCut-X® II Handpiece
40 7120 55 DrillCut-X® II N Handpiece
Shaver Blade
length 12 cm
41301 KN
serrated cutting edge,
diameter 4 mm,
color code: blue-red
41301 KK
double serrated cutting edge,
diameter 4 mm,
color code: blue-yellow
41301 GN
concave cutting edge, o
­ val cutting
window, diameter 4 mm,
color code: blue-green
41301 LN
concave cutting edge, oblique
cutting window, diameter 4 mm,
color code: blue-black
41301 SN
straight cutting edge,
diameter 4 mm,
color code: blue-blue
41301 KSA
serrated cutting edge,
diameter 3 mm,
color code: blue-red
41301 KKSA
double serrated cutting edge,
diameter 3 mm,
color code: blue-yellow
41301 KKSB
double serrated cutting edge,
diameter 2 mm,
color code: blue-yellow
41301 LSA
concave cutting edge, oblique
cutting window, diameter 3 mm,
color code: blue-black
92
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
Shaver Blades, curved
for Nasal Sinuses and Skull Base Surgery
For use with DrillCut-X® II and DrillCut-X® II N
41302 KN
Shaver Blades, curved 35°/40°, for single use , sterile, package of 5
for use with
Detail
40 7120 50 DrillCut-X® II Handpiece
40 7120 55 DrillCut-X® II N Handpiece
Shaver Blade
length 12 cm
41302 KN
curved 35°, ­cutting edge
serrated backwards,
diameter 4 mm,
color code: blue-red
41304 KKF
curved 40°, cutting edge
serrated forwards, double
serrated, diameter 4 mm,
color code: blue-yellow
41304 KKB
curved 40°, cutting edge
serrated backwards, d
­ ouble
serrated, diameter 4 mm,
color code: blue-yellow
41304 KKFA
curved 40°, cutting edge
serrated forwards, double
serrated, diameter 3 mm,
color code: blue-yellow
41304 KKBA
curved 40°, cutting edge
serrated backwards, double
serrated, diameter 3 mm,
color code: blue-yellow
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
93
Shaver Blades, curved
for Nasal Sinuses and Skull Base Surgery
For use with DrillCut-X® II and DrillCut-X® II N
41303 KKB
Shaver Blades, curved 65°, for single use , sterile, package of 5
for use with
Detail
40 7120 50 DrillCut-X® II Handpiece
40 7120 55 DrillCut-X® II N Handpiece
Shaver Blade
length 12 cm
41303 KNF
curved 65°, cutting
edge serrated forwards,
diameter 4 mm,
color code: blue-red
41303 KNB
curved 65°, cutting edge
serrated backwards,
diameter 4 mm,
color code: blue-red
41303 KKF
curved 65°, cutting edge
serrated forwards, double
serrated, diameter 4 mm,
color code: blue-yellow
41303 KKB
curved 65°, cutting edge
serrated backwards, double
serrated, diameter 4 mm,
color code: blue-yellow
41303 KKFA
curved 65°, cutting edge
serrated forwards, double
serrated, diameter 3 mm,
color code: blue-yellow
41303 KKBA
curved 65°, cutting edge
serrated backwards, double
serrated, diameter 3 mm,
color code: blue-yellow
41303 GNF
curved 65°, cutting
edge concave forwards,
oval cutting window,
diameter 4 mm,
color code: blue-green
41303 GNB
curved 65°, cutting edge
concave backwards,
oval cutting window,
diameter 4 mm,
color code: blue-green
94
Endoscopic and Sinonasal Dissection Manual
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Sinus Burrs, curved
for Nasal Sinuses and Skull Base Surgery
For use with DrillCut-X® II and DrillCut-X® II N
41305 RN
Sinus Burrs, curved 70°/55°/40°/15°, for single use , sterile, package of 5
for use with
Detail
40 7120 50 DrillCut-X® II Handpiece
40 7120 55 DrillCut-X® II N Handpiece
Sinus Burr
length 12 cm
41304 W
curved 40°, cylindric,
drill diameter 3 mm,
shaft diameter 4 mm,
color code: red-blue
41303 WN
curved 55°, cylindric,
drill diameter 3.6 mm,
shaft diameter 4 mm,
color code: red-blue
41305 RN
curved 15°, bud drill,
drill diameter 4 mm,
shaft diameter 4 mm,
color code: red-black
41305 DN
curved 15°, diamond head,
drill diameter 3 mm,
shaft diameter 4 mm,
color code: red-yellow
41305 D
curved 15°, diamond head,
drill diameter 5 mm,
shaft diameter 4 mm,
color code: red-yellow
41305 DW
curved 40°, diamond head,
drill diameter 5 mm,
shaft diameter 4 mm,
color code: red-yellow
41303 DT
curved 70°, diamond head,
drill diameter 3.6 mm,
shaft diameter 4 mm,
color code: red-yellow
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
Accessories for Shaver
39550 A
39550 A
Wire Tray, provides safe storage of accessories for
KARL STORZ paranasal sinus shaver systems during
cleaning and sterilization
for storage of:
– Up to 7 shaver attachments
– Connecting cable
Please note: The instruments displayed are not included in the sterilizing and storage tray.
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Endoscopic and Sinonasal Dissection Manual
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INTRA Drill Handpiece
for Surgery in Ethmoid and Skull Base Area
Special Features:
## Tool-free closing and opening of the drill
## Right/left rotation
## Max. rotating speed up to
40,000 rpm / 80,000 U/min
## Detachable irrigation channels
## Lightweight
construction
with little vibrations
## Low maintenance
## Reprocessable in a cleaning machine
## Safe grip
## Operates
252571INTRA Drill Handpiece, angled, length 15 cm,
transmission 1:1 (40,000 rpm), for use with
KARL STORZ high-performance EC micro
motor II and burrs
252574
Same, Transmission 1:2 (80.000 rpm)
252571
252591INTRA Drill Handpiece, straight, length 13 cm,
transmission 1:1 (40,000 rpm), for use with
KARL STORZ high-performance EC micro
motor II and burrs
252574
252591
9.5 cm
649600 – 649770 G
Detail
649600
649700
649700 G
280033
Size
Dia.
mm
Standard
Diamond
Diamond
coarse
014
1.4
649614
649714
–
018
1.8
649618
649718
–
023
2.3
649623
649723
649723 G
027
2.7
649627
649727
649727 G
031
3.1
649631
649731
649731 G
035
3.5
649635
649735
649735 G
040
4
649640
649740
649740 G
045
4.5
649645
649745
649745 G
050
5
649650
649750
649750 G
060
6
649660
649760
649760 G
070
7
649670
649770
649770 G
Standard Straight Shaft Burr, stainless, size 014 – 070,
length 9.5 cm, set of 11
Diamond Straight Shaft Burr, stainless, size 014 – 070,
length 9.5 cm, set of 11
Rapid Diamond Straight Shaft Burr, stainless, with coarse diamond
coating for precise drilling and abrasion without hand pressure and
generating minimal heat, size 023 – 070, length 9.5 cm, set of 9,
color code: gold
Rack, for 36 straight shaft burrs with a length of 9.5 cm,
foldable, sterilizable, size 22 x 14 x 2 cm
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
97
INTRA Drill Handpiece
for Surgery in Ethmoid and Skull Base Area
Special Features:
closing and opening of the drill
## Right/left rotation
## Max. rotating speed up to
40,000 rpm / 80,000 U/min
## Detachable irrigation channels
## Lightweight
construction
with little vibrations
## Low maintenance
## Reprocessable in a cleaning machine
## Safe grip
## Tool-free
## Operates
252572INTRA Drill Handpiece, angled, length 18 cm,
transmission 1:1 (40,000 rpm), for use with
KARL STORZ high-performance EC micro
motor II and burrs
252575
Same, transmission 1:2 (80,000 rpm)
252572
252575
252592INTRA Drill Handpiece, straight, length 17 cm,
transmission 1:1 (40,000 rpm), for use with
KARL STORZ high-performance EC micro
motor II and burrs
252592
12.5 cm
649600 L – 649770 GL
Detail
Standard
Diamond
Diamond
coarse
sterilizable
sterilizable
sterilizable
Size
Dia.
mm
014
1.4
649614 L
649714 L
–
018
1.8
649618 L
649718 L
–
023
2.3
649623 L
649723 L
649723 GL
027
2.7
649627 L
649727 L
649727 GL
031
3.1
649631 L
649731 L
649731 GL
035
3.5
649635 L
649735 L
649735 GL
040
4
649640 L
649740 L
649740 GL
045
4.5
649645 L
649745 L
649745 GL
050
5
649650 L
649750 L
649750 GL
060
6
649660 L
649760 L
649760 GL
070
7
649670 L
649770 L
649770 GL
649600 L
Standard Straight Shaft Burr, stainless, size 014 – 070,
length 12.5 cm, set of 11
649700 L
Diamond Straight Shaft Burr, stainless, size 014 – 070,
length 12.5 cm, set of 11
649700 GL
Rapid Diamond Straight Shaft Burr, stainless, with c
­ oarse diamond
coating for precise drilling and abrasion without hand pressure and
generating minimal heat, sizes 023 – 070, length 12.5 cm, set of 9,
color code: gold
Rack, for 36 straight shaft burrs with a length of 12.5 cm,
foldable, sterilizable, size 22 x 17 x 2 cm
280034
98
Endoscopic and Sinonasal Dissection Manual
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Accessories for Burrs
280033
280034
280043
280033
Rack, for 36 straight shaft burrs with a length of 9.5 cm,
foldable, sterilizable, size 22 x 14 x 2 cm
280034
Rack, for 36 straight shaft burrs with a length of 12.5 cm,
foldable, sterilizable, size 22 x 17 x 2 cm
n 280043
Rack, flat model, to hold 21 straight shaft burrs
with a length of 7 cm (6 pcs) and 9.5 cm (15 pcs),
folding model, sterilizable, size 17.5 x 11.5 x 1.2 cm
Please note: The burrs displayed are not included in the racks.
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
99
Accessories for Burrs
39552 B
Tray for small parts included
39552 A
Wire Tray, provides safe storage of accessories for KARL STORZ
drilling/grinding systems during cleaning and sterilization,
includes tray for small parts, for use with Rack 280030, rack not
included
for storage of:
– Up to 6 drill handpieces
– Connecting cable
– EC micro motor
– Small parts
39552 B
Wire Tray, provides safe storage of accessories for KARL STORZ
drilling/grinding systems during cleaning and sterilization, includes
tray for small parts, for use with Rack 280030, rack included
for storage of:
– Up to 6 drill handpieces
– Connecting cable
– EC micro motor
– Up to 36 drill bits and burrs
– Small parts
Please note: The instruments displayed are not included in the sterilizing and storage tray.
100
Endoscopic and Sinonasal Dissection Manual
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UNIDRIVE® S III ENT SCB
High-Speed Handpieces, angled, 100,000 rpm
For use with High-Speed Drills, shaft diameter 3.17 mm
and with High-Speed Micro Motor 20 7120 33
20 7120 33
53 mm
7.5 mm
252681
93 mm
7.5 mm
252682
252681High-Speed Handpiece, medium, angled, 100,000 rpm,
for use with High-Speed Micro-Motor 20 7120 33
252682High-Speed Handpiece, long, angled, 100,000 rpm,
for use with High-Speed Micro-Motor 20 7120 33
100,000 rpm
diameter 7.5 mm
Endoscopic and Sinonasal Dissection Manual
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101
UNIDRIVE® S III ENT SCB
High-Speed Handpieces, angled, 60,000 rpm
For use with High-Speed Drills, shaft diameter 2.35 mm
and with High-Speed Micro Motor 20 7120 33
20 7120 33
51 mm
5.5 mm
252661
71 mm
5.5 mm
252662
91 mm
5.5 mm
252663
252661High-Speed Handpiece, short, angled, 60,000 rpm,
for use with High-Speed Micro-Motor 20 7120 33
252662High-Speed Handpiece, medium, angled, 60,000 rpm,
for use with High-Speed Micro-Motor 20 7120 33
252663High-Speed Handpiece, long, angled, 60,000 rpm,
for use with High-Speed Micro-Motor 20 7120 33
60,000 rpm
diameter 5.5 mm
102
Endoscopic and Sinonasal Dissection Manual
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UNIDRIVE® S III ENT SCB
High-Speed Handpieces, straight, 60,000 rpm
For use with High-Speed Drills, shaft diameter 2.35 mm
and with High-Speed Micro Motor 20 7120 33
20 7120 33
51 mm
5.5 mm
252691
71 mm
5.5 mm
252692
252691High-Speed Handpiece, short, straight, 60,000 rpm,
for use with High-Speed Micro-Motor 20 7120 33
252692High-Speed Handpiece, medium, straight, 60,000 rpm,
for use with High-Speed Micro-Motor 20 7120 33
60,000 rpm
diameter 5.5 mm
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
103
UNIDRIVE® S III ENT SCB
High-Speed Handpieces, malleable, slim, angled, 60,000 rpm
For use with High-Speed Drills, shaft diameter 1 mm
and with High-Speed Micro Motor 20 7120 33
60,000 rpm
diameter 4.7 mm
The handpieces have malleable shafts that can be bent
up to 20° according to user requirements.
malleable
20 7120 33
108 mm
252671
4.7 mm
128 mm
4.7 mm
252672
252671High-Speed Handpiece, extra long, malleable, slim, angled,
60,000 rpm, for use with High-Speed Micro-Motor 20 7120 33
252672High-Speed Handpiece, super long, malleable, slim, angled,
60,000 rpm, for use with High-Speed Micro-Motor 20 7120 33
104
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UNIDRIVE® S III ENT SCB
High-Speed Standard Burrs, High-Speed Diamond Burrs
For use with High-Speed Handpieces, 100,000 rpm
100,000 rpm
diameter 7.5 mm
252681
252682
High-Speed Standard Burrs, 100,000 rpm, for single use ,
sterile, package of 5
Diameter in mm
medium
long
1
350110 M
–
2
350120 M
350120 L
3
350130 M
350130 L
4
350140 M
350140 L
5
350150 M
350150 L
6
350160 M
350160 L
7
350170 M
350170 L
High-Speed Diamond Burrs, 100,000 rpm, for single use ,
sterile, package of 5
Diameter in mm
medium
long
1
350210 M
–
2
350220 M
350220 L
3
350230 M
350230 L
4
350240 M
350240 L
5
350250 M
350250 L
6
350260 M
350260 L
7
350270 M
350270 L
Endoscopic and Sinonasal Dissection Manual
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105
UNIDRIVE® S III ENT SCB
High-Speed Diamond Burrs, High-Speed Acorn,
High-Speed Barrel Burrs, High-Speed Neuro Fluted Burrs
For use with High-Speed Handpieces, 100,000 rpm
100,000 rpm
diameter 7.5 mm
252681
252682
High-Speed Coarse Diamond Burrs, 100,000 rpm, for single use ,
sterile, package of 5
Diameter in mm
medium
long
3
350330 M
350330 L
4
350340 M
350340 L
5
350350 M
350350 L
6
350360 M
350360 L
7
350370 M
350370 L
High-Speed Acorn, 100,000 rpm, for single use ,
sterile, package of 5
Diameter in mm
medium
7.5
350675 M
9
350690 M
High-Speed Barrel Burrs, 100,000 rpm, for single use ,
sterile, package of 5
Diameter in mm
medium
6
350960 M
9.1
350991 M
High-Speed Neuro Fluted Burrs, 100,000 rpm, for single use ,
sterile, package of 5
Diameter in mm
medium
long
1,8
350718 M
350718 L
3
350730 M
350730 L
106
Endoscopic and Sinonasal Dissection Manual
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UNIDRIVE® S III ENT SCB
High-Speed Standard Burrs, High-Speed Diamond Burrs
60,000 rpm
For use with High-Speed Handpieces, 60,000 rpm
diameter 5.5 mm
252661
252662
252691
252692
252663
High-Speed Standard Burrs, 60,000 rpm, for single use ,
sterile, package of 5
Diameter in mm
short
medium
long
1
330110 S
330110 M
–
2
330120 S
330120 M
330120 L
3
330130 S
330130 M
330130 L
4
330140 S
330140 M
330140 L
5
330150 S
330150 M
330150 L
6
330160 S
330160 M
330160 L
7
330170 S
330170 M
330170 L
High-Speed Diamond Burrs, 60,000 rpm, for single use ,
sterile, package of 5
Diameter in mm
short
medium
long
0.6
330206 S
–
–
1
330210 S
330210 M
–
1.5
330215 S
–
–
2
330220 S
330220 M
330220 L
3
330230 S
330230 M
330230 L
4
330240 S
330240 M
330240 L
5
330250 S
330250 M
330250 L
6
330260 S
330260 M
330260 L
7
330270 S
330270 M
330270 L
Endoscopic and Sinonasal Dissection Manual
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107
UNIDRIVE® S III ENT SCB
High-Speed Diamond Burrs, High-Speed Cylinder Burrs,
LINDEMANN High-Speed Fluted Burrs
For use with High-Speed Handpieces, 60,000 rpm
60,000 rpm
diameter 5.5 mm
252661
252662
252691
252692
252663
High-Speed Coarse Diamond Burrs, 60,000 rpm, for single use ,
sterile, package of 5
Diameter in mm
short
medium
long
3
330330 S
330330 M
330330 L
4
330340 S
330340 M
330340 L
5
330350 S
330350 M
330350 L
6
330360 S
330360 M
330360 L
7
330370 S
330370 M
330370 L
High-Speed Cylinder Burrs, 60,000 rpm, for single use ,
sterile, package of 5
Diameter in mm
short
4
330440 S
6
330460 S
LINDEMANN High-Speed Fluted Burrs, 60,000 rpm, for single use ,
sterile, package of 5
Size in mm
(diameter x length)
short
Diameter 2.1/11
330511 S
Diameter 2.3/26
330526 S
108
Endoscopic and Sinonasal Dissection Manual
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UNIDRIVE® S III ENT SCB
High-Speed Diamond Burrs
For use with High-Speed Handpieces, 60,000 rpm
60,000 rpm
diameter 4.7 mm
252671
252672
High-Speed Diamond Burrs, 60,000 rpm, for single use ,
sterile, package of 5
Diameter in mm
extra long
super long
2
320220 EL
320220 SL
3
320230 EL
320230 SL
4
320240 EL
320240 SL
High-Speed Coarse Diamond Burrs, 60,000 rpm, for single use ,
sterile, package of 5
Diameter in mm
extra long
super long
2
320320 EL
320320 SL
3
320330 EL
320330 SL
4
320340 EL
320340 SL
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
KARL STORZ NAV1 electromagnetic n
KARL STORZ navigation system with advanced tracking technology
The new KARL STORZ navigation system, NAV1 electromagnetic, supports surgeons in otorhinolaryngology and
skull base surgery. It uses a sophisticated electromagnetic
tracking system.
Benefits of KARL STORZ NAV1 electromagnetic
## High precision thanks to sensor location in
instrument tip
## Navigated instruments can be autoclaved 30x
## Wide range of instruments; simultaneous tracking
of up to 3 instruments possible
## Display of complete instrument geometry in the
patient’s radiology data
Experience the excellent quality and precision of the
KARL STORZ navigation system NAV1 electromagnetic.
## Planning
and monitoring of high-risk structures
with intraoperative DistanceControl
## Better orientation through waypoint navigation
## Automatic and reliable documentation of the
navigated procedure
## Infinitely adjustable CT-MRI fusion
## Import of patient data via USB, CD or PACS
109
110
Endoscopic and Sinonasal Dissection Manual
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KARL STORZ NAV1 electromagnetic n
40 8200 01
NAV1 electromagnetic
including:
NAV1 Module
NAV1 electromagnetic Module
NAV1 electromagnetic Field Generator
Headband for Navigation, for single use
EM Patient Tracker
EM Navigation Probe
Optical Mouse
Mains Cord, length 300 cm
Module Connecting Cable, length 250 cm
DVI Connecting Cable, length 300 cm
A headrest with integrated EM field generator
is included in delivery.
Note: Equipment cart with accessories not included in the delivery
of NAV1 electromagnetic 40 8200 01.
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
KARL STORZ NAV1 electromagnetic n
Components of NAV1 electromagnetic
40 8200 01
NAV1 electromagnetic
including:
NAV1 Module
NAV1 electromagnetic Module
NAV1 electromagnetic Field Generator
Headband for Navigation, for single use
EM Patient Tracker
EM Navigation Probe
Optical Mouse
Mains Cord, length 300 cm
Module Connecting Cable, length 250 cm
DVI Connecting Cable, length 300 cm
A headrest with integrated EM field generator is included in delivery.
111
112
Endoscopic and Sinonasal Dissection Manual
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Instruments for NAV1 electromagnetic
40 8201 31
EM Navigated Curette, 0°
40 820132
EM Navigated Curette, 55°
40 820130
EM Navigated Curette, 90°
40 820111
EM Navigated Frontal Sinus Probe
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
Instruments for NAV1 electromagnetic
40 820145
EM Navigated Suction Tube, straight
40 820165
EM Navigated Suction Tube, curved
40 820110
EM Navigated Probe, malleable, straight
40 820112
EM Navigated Probe, malleable, curved
40 8201 05
EM Navigated Probe
113
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Endoscopic and Sinonasal Dissection Manual
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KARL STORZ NAV1 pico
Mobile optical navigation for ENT and skull base surgery
Special Features:
space-saving system with intuitive
handling
## Easy assembly and flexible use in the OR
## Mobile,
## Durable,
sturdy and autoclavable navigation
instruments
## Reduced costs through autoclavable
accessories
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
KARL STORZ NAV1 pico
Mobile optical navigation for ENT and skull base surgery
40 8000 01
NAV1 pico
including:
Navigation Panel
Optical Mouse
Navigation Camera
Electronic Box
Docking Adaptor
Mobile Stand
Data Cable
Video Cable
Navigation Camera cable, length 250 cm
Headband for Navigation, for single use
Patient Tracker III
Transport Case Navigation
Navigation Probe
Mains Cord
115
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Endoscopic and Sinonasal Dissection Manual
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KARL STORZ NAV1 optical
Space-saving integration in any operating room
With NAV1 optical you benefit from a seamlessly ­integrated
high-performance navigation solution. The b
­ asic unit can
easily be attached to a ceiling supply unit or integrated
into an equipment cart.
Mounted on a ceiling or an extension arm, the navigation
camera allows an easy setup and optimal visualization of
the surgical site combined with high flexibility. This results
in a “zero footprint” navigation solution.
Therefore the NAV1 optical is offered as a solution for the
f­unctional combination of all units in one place.
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
KARL STORZ NAV1 optical
Space-saving integration in any operating room
40 8100 01
NAV1 optical
including:
NAV1 Module
Optical Mouse
Navigation Camera
Mobile Stand
Navigation Camera Cable, length 750 cm
Headband for Navigation, for single use
Patient Tracker III
Transport Case Navigation
Navigation Probe
Mains Cord
Note: Equipment cart with accessories not included in the delivery
of NAV1 optical 40 8100 01.
117
118
Endoscopic and Sinonasal Dissection Manual
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Probe, Patient Tracker and Headband
for optical navigation
40 800110
40 8001 10
Navigation Probe,
with glass marker spheres incorporated,
autoclavable, dimensions: 295 x 15 x 30 mm,
for use with NAV1 pico and NAV1 optical
40 8000 88
40 8000 88 Patient Tracker III,
with verification adaptor,
3 incorporated glass marker spheres and fixation screw,
autoclavable, dimensions: 80 x 60 x 12 mm
for use with NAV1 pico and NAV1 optical
40 8000 83
40 8000 83
Headband for Navigation,
for single use, with plastic holder
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
Navigated Suction Tubes
angular, curved downwards, curved upwards
40 800140 L
40 8001 40 L Navigated Suction Tube,
straight, for left-handed use, 9 Fr.,
working length 9 cm, total length 16 cm,
for use with NAV1 pico and NAV1 optical
40 800140 R
40 8001 40 R
Navigated Suction Tube,
straight, for right-handed use, 9 Fr.,
working length 9 cm, total length 16 cm,
for use with NAV1 pico and NAV1 optical
40 800160
40 8001 60
v. EICKEN Navigated Suction Tube,
curved downwards, for right-handed use,
outer diameter 3 mm, length 16.5 cm,
for use with NAV1 pico and NAV1 optical
119
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Endoscopic and Sinonasal Dissection Manual
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Navigated Suction Tubes
angular, curved downwards, curved upwards
40 800151
40 8001 51
v. EICKEN Navigated Suction Tube,
curved upwards, for left and right-handed use,
outer diameter 3 mm, length 16.5 cm,
for use with NAV1 pico and NAV1 optical
40 800160 LM
40 8001 60 LM v. EICKEN Navigated Suction Tube,
curved to left, for left and right-handed use,
outer diameter 3 mm, length 16.5 cm,
for use with NAV1 pico and NAV1 optical
40 800160 RM
40 8001 60 RM v. EICKEN Navigated Suction Tube,
curved to right, for left and right-handed use,
outer diameter 3 mm, length 16.5 cm,
for use with NAV1 pico and NAV1 optical
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
Optical Navigated Frontal Sinus Probe n
for optical navigation
40 800111
40 800111
Optical Navigated Frontal Sinus Probe,
for use with NAV1 pico and NAV1 optical
Instrument Tracker
for optical navigation
The autoclavable instrument tracker is designed for the
navigation of various instruments. The small size of the
­instrument tracker reduces the risk of collision and ensures
Special Features:
## User-friendly handling thanks to optimized,
miniaturized design
very good instrument maneuvrability.
##
Can be used for various navigation instruments
40 800120
40 800120
Tool Tracker, for optical navigated instruments,
with 3 fix-mounted glass spheres, autoclavable,
dimensions: 70 x 50 x 14 mm,
for use with navigated instruments 40 800 14x,
40 800 15x, 40 800 16x and 40 800 17x
and Optical Navigated Frontal Sinus Probe 40 800111
121
122
Endoscopic and Sinonasal Dissection Manual
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DrillCut-X® II N Shaver Handpiece and Shaver Tracker n
Special Features:
## Powerful motor
## Absolutely silent running
## Enhanced ergonomics
## Reduced-weight design
## Oscillation mode for shaver blades,
max. 10,000 rpm
## Rotation mode for sinus shavers,
max. 12,000 rpm
## Straight suction channel and
integrated irrigation
## Variable
handle allows connection with various
handpieces and enables more comfortable work
## Easy hygienic processing, suitable for use in
washer and autoclavable at 134 °C
## Quick coupling mechanism facilitates more rapid
exchange of working inserts
## Proven DrillCut-X® blade portfolio can be used
## Adaptation possibilities for navigated
Shaver Tracker 40 8001 22
## Allows shaver navigation when used with
NAV1 pico and NAV1 optical
40 8001 22
40 8001 22
Shaver Tracker, autoclavable, with glass marker spheres
incorporated, for use with DrillCut-X® II N Shaver Handpiece
40 7120 55 and Navigation Systems NAV1 pico 40 8000 01
and NAV1 optical 40 8100 01
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
IMAGE1 S Camera System n
Economical and future-proof
## Modular concept for flexible, rigid and
3D endoscopy as well as new technologies
## Forward and backward compatibility with video
endoscopes and FULL HD camera heads
Innovative Design
## Dashboard: Complete overview with intuitive
menu guidance
## Live menu: User-friendly and customizable
## Intelligent icons: Graphic representation changes
when settings of connected devices or the entire
system are adjusted
## Sustainable
## Compatible
investment
with all light sources
## Automatic
light source control
view: Parallel display of standard
­image and the Visualization mode
## Multiple source control: IMAGE1 S a
­ llows
the simultaneous display, processing and
­documentation of image information from
two c
­ onnected image sources, e.g., for hybrid
operations
## Side-by-side
Dashboard
Live menu
Intelligent icons
Side-by-side view: Parallel display of standard image and
Visualization mode
123
124
Endoscopic and Sinonasal Dissection Manual
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IMAGE1 S Camera System n
Brillant Imaging
## Clear and razor-sharp endoscopic images in
FULL HD
## Natural color rendition
## Reflection
is minimized
IMAGE1 S technologies for homogeneous
illumination, ­contrast enhancement and color
­shifting
## Multiple
FULL HD image
CLARA
FULL HD image
CHROMA
FULL HD image
SPECTRA A *
FULL HD image
SPECTRA B **
* SPECTRA A : Not for sale in the U.S.
** SPECTRA B : Not for sale in the U.S.
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
125
IMAGE1 S Camera System n
TC 200EN
TC 200EN*
IMAGE1 S CONNECT, connect module, for use with up to
3 link modules, resolution 1920 x 1080 pixels, with integrated
KARL STORZ-SCB and digital Image Processing Module,
power supply 100 – 120 VAC/200 – 240 VAC, 50/60 Hz
including:
Mains Cord, length 300 cm
DVI-D Connecting Cable, length 300 cm
SCB Connecting Cable, length 100 cm
USB Flash Drive, 32 GB, USB silicone keyboard, with touchpad, US
* Available in the following languages: DE, ES, FR, IT, PT, RU
Specifications:
- 2x DVI-D
- 1x 3G-SDI
Power supply
100 – 120 VAC/200 – 240 VAC
Format signal outputs
Power frequency
50/60 Hz
1920 x 1080p, 50/60 Hz
I, CF-Defib
LINK video inputs
3x
Protection class
Dimensions w x h x d
305 x 54 x 320 mm
USB interface
SCB interface
4x USB, (2x front, 2x rear)
2x 6-pin mini-DIN
Weight
2.1 kg
HD video outputs
For use with IMAGE1 S
IMAGE1 S CONNECT Module TC 200EN
TC 300
TC 300
IMAGE1 S H3-LINK, link module, for use with
IMAGE1 FULL HD three-chip camera heads,
power supply 100 – 120 VAC/200 – 240 VAC, 50/60 Hz,
for use with IMAGE1 S CONNECT TC 200EN
including:
Mains Cord, length 300 cm
Link Cable, length 20 cm
Specifications:
Camera System
TC 300 (H3-Link)
Supported camera heads/video endoscopes
TH 100, TH 101, TH 102, TH 103, TH 104, TH 106
(fully compatible with IMAGE1 S)
22 2200 55-3, 22 2200 56-3, 22 2200 53-3, 22 2200 60-3, 22 2200 61-3,
22 2200 54-3, 22 2200 85-3
(compatible without IMAGE1 S ­technologies CLARA, CHROMA, SPECTRA*)
LINK video outputs
1x
Power supply
100 – 120 VAC/200 – 240 VAC
Power frequency
50/60 Hz
Protection class
I, CF-Defib
Dimensions w x h x d
305 x 54 x 320 mm
Weight
1.86 kg
* SPECTRA A : Not for sale in the U.S.
** SPECTRA B : Not for sale in the U.S.
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IMAGE1 S Camera Heads n
For use with IMAGE1 S Camera System
IMAGE1 S CONNECT Module TC 200EN, IMAGE1 S H3-LINK Module TC 300
and with all IMAGE 1 HUB™ HD Camera Control Units
TH 100
TH 100
IMAGE1 S H3-Z Three-Chip FULL HD Camera Head,
50/60 Hz, IMAGE1 S compatible, progressive scan,
soakable, gas- and plasma-sterilizable, with integrated
Parfocal Zoom Lens, focal length f = 15 – 31 mm (2x),
2 freely programmable camera head buttons,
for use with IMAGE1 S and IMAGE 1 HUB™ HD/HD
Specifications:
IMAGE1 FULL HD Camera Heads
IMAGE1 S H3-Z
Product no.
TH 100
Image sensor
3x 1/3" CCD chip
Dimensions w x h x d
39 x 49 x 114 mm
Weight
270 g
Optical interface
integrated Parfocal Zoom Lens,
f = 15 – 31 mm (2x)
Min. sensitivity
F 1.4/1.17 Lux
Grip mechanism
standard eyepiece adaptor
Cable
non-detachable
Cable length
300 cm
TH 104
TH 104
IMAGE1 S H3-ZA Three-Chip FULL HD Camera Head,
50/60 Hz, IMAGE1 S compatible, autoclavable,
progressive scan, soakable, gas- and plasma-sterilizable,
with integrated Parfocal Zoom Lens, focal length
f = 15 – 31 mm (2x), 2 freely programmable camera head
buttons, for use with IMAGE1 S and IMAGE 1 HUB™ HD/HD
Specifications:
IMAGE1 FULL HD Camera Heads
IMAGE1 S H3-ZA
Product no.
TH 104
Image sensor
3x 1/3" CCD chip
Dimensions w x h x d
39 x 49 x 100 mm
Weight
299 g
Optical interface
integrated Parfocal Zoom Lens,
f = 15 – 31 mm (2x)
Min. sensitivity
F 1.4/1.17 Lux
Grip mechanism
standard eyepiece adaptor
Cable
non-detachable
Cable length
300 cm
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
Monitors
9619 NB
9619 NB
19" HD Monitor,
color systems PAL/NTSC, max. screen
resolution 1280 x 1024, image format 4:3,
power supply 100 – 240 VAC, 50/60 Hz,
wall-mounted with VESA 100 adaption,
including:
External 24 VDC Power Supply
Mains Cord
9826 NB
9826 NB
26" FULL HD Monitor,
wall-mounted with VESA 100 adaption,
color systems PAL/NTSC,
max. screen resolution 1920 x 1080,
image fomat 16:9,
power supply 100 – 240 VAC, 50/60 Hz
including:
External 24 VDC Power Supply
Mains Cord
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Monitors
KARL STORZ HD and FULL HD Monitors
19"
26"
9619 NB
9826 NB
DVI-D
l
l
Fibre Optic
–
–
3G-SDI
–
RGBS (VGA)
l
l
l
l
l
l
l
Wall-mounted with VESA 100 adaption
Inputs:
S-Video
Composite/FBAS
Outputs:
l
RGBS (VGA)
l
l
l
l
3G-SDI
–
l
l
l
l
l
l
l
l
l
l
l
DVI-D
S-Video
Composite/FBAS
–
l
–
Signal Format Display:
4:3
5:4
16:9
Picture-in-Picture
PAL/NTSC compatible
Optional accessories:
9826 SF
Pedestal, for monitor 9826 NB
9626 SF
Pedestal, for monitor 9619 NB
Specifications:
KARL STORZ HD and FULL HD Monitors
19"
26"
Desktop with pedestal
optional
optional
Product no.
9619 NB
9826 NB
Brightness
200 cd/m2 (typ)
500 cd/m2 (typ)
Max. viewing angle
178° vertical
178° vertical
Pixel distance
0.29 mm
0.3 mm
Reaction time
5 ms
8 ms
Contrast ratio
700:1
1400:1
Mount
100 mm VESA
100 mm VESA
Weight
7.6 kg
7.7 kg
Rated power
28 W
72 W
Operating conditions
0 – 40°C
5 – 35°C
Storage
-20 – 60°C
-20 – 60°C
Rel. humidity
max. 85%
max. 85%
Dimensions w x h x d
469.5 x 416 x 75.5 mm
643 x 396 x 87 mm
Power supply
100 – 240 VAC
100 – 240 VAC
Certified to
EN 60601-1,
protection class IPX0
EN 60601-1, UL 60601-1,
MDD93/42/EEC,
protection class IPX2
Endoscopic and Sinonasal Dissection Manual
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129
Cold Light Fountains and Accessories
495 NT
495 NTW
495 NTX
Fiber Optic Light Cable,
with straight connector, diameter 2.5 mm,
length 180 cm
Fiber Optic Light Cable,
diameter 2.5 mm, length 180 cm
with 90° deflection to the light source
Same, length 230 cm
LED NOVA® 150, High-Performance LED Cold Light Fountain
20 1612 01
LED Nova 150, High-Performance
LED Cold Light Fountain
with one KARL STORZ light outlet,
power supply 100 - 240 VAC, 50/60 Hz
including:
Mains cord
20131501
Cold Light Fountain XENON NOVA® 175,
power supply:
100 –125 VAC/220 –240 VAC, 50/60 Hz
including:
Mains Cord
XENON Spare Lamp,
175 watt, 15 volt
Cold Light Fountain XENON NOVA® 175
20132026
Cold Light Fountain XENON 300 SCB
20 133101-1 Cold Light Fountain XENON 300 SCB
with built-in antifog air-pump, and integrated
KARL STORZ Communication Bus System SCB
power supply:
100 –125 VAC/220 –240 VAC, 50/60 Hz
including:
Mains Cord
SCB Connecting Cord, length 100 cm
20133027
Spare Lamp Module XENON
with heat sink, 300 watt, 15 volt
20133028
XENON Spare Lamp, only,
300 watt, 15 volt
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Endoscopic and Sinonasal Dissection Manual
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Data Management and Documentation
KARL STORZ AIDA® – Exceptional documentation
The name AIDA stands for the comprehensive implementation
of all documentation requirements arising in surgical procedures:
A tailored solution that flexibly adapts to the needs of every
specialty and thereby allows for the greatest degree of
customization.
This customization is achieved in accordance with existing
clinical standards to guarantee a reliable and safe solution.
Proven functionalities merge with the latest trends and
developments in medicine to create a fully new documentation
experience – AIDA.
AIDA seamlessly integrates into existing infrastructures and
exchanges data with other systems using common standard
interfaces.
WD 200-XX* AIDA Documentation System,
for recording still images and videos,
dual channel up to FULL HD, 2D/3D,
power supply 100-240 VAC, 50/60 Hz
including:
USB Silicone Keyboard, with touchpad
ACC Connecting Cable
DVI Connecting Cable, length 200 cm
HDMI-DVI Cable, length 200 cm
Mains Cord, length 300 cm
WD 250-XX*AIDA Documentation System,
for recording still images and videos,
dual channel up to FULL HD, 2D/3D,
including SMARTSCREEN® (touch screen),
power supply 100-240 VAC, 50/60 Hz
including:
USB Silicone Keyboard, with touchpad
ACC Connecting Cable
DVI Connecting Cable, length 200 cm
HDMI-DVI Cable, length 200 cm
Mains Cord, length 300 cm
*XX Please indicate the relevant country code
(DE, EN, ES, FR, IT, PT, RU) when placing your order.
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
Workflow-oriented use
Patient
Entering patient data has never been this easy. AIDA seamlessly
integrates into the existing infrastructure such as HIS and PACS.
Data can be entered manually or via a DICOM worklist.
ll important patient information is just a click away.
Checklist
Central administration and documentation of time-out. The checklist
simplifies the documentation of all critical steps in accordance with
clinical standards. All checklists can be adapted to individual needs
for sustainably increasing patient safety.
Record
High-quality documentation, with still images and videos being
recorded in FULL HD and 3D. The Dual Capture function allows for
the parallel (synchronous or independent) recording of two sources.
All recorded media can be marked for further processing with just
one click.
Edit
With the Edit module, simple adjustments to recorded still images
and videos can be very rapidly completed. Recordings can be quickly
optimized and then directly placed in the report.
In addition, freeze frames can be cut out of videos and edited and
saved. Existing markings from the Record module can be used for
quick selection.
Complete
Completing a procedure has never been easier. AIDA offers a large
selection of storage locations. The data exported to each storage
location can be defined. The Intelligent Export Manager (IEM) then
carries out the export in the background. To prevent data loss,
the system keeps the data until they have been successfully exported.
Reference
All important patient information is always available and easy to access.
Completed procedures including all information, still images, videos,
and the checklist report can be easily retrieved from the Reference module.
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Equipment Cart
UG 220
Equipment Cart
wide, high, rides on 4 antistatic dual wheels
equipped with locking brakes 3 shelves,
mains switch on top cover,
central beam with integrated electrical subdistributors
with 12 sockets, holder for power supplies,
potential earth connectors and cable winding
on the outside,
Dimensions:
Equipment cart: 830 x 1474 x 730 mm (w x h x d),
shelf: 630 x 510 mm (w x d),
caster diameter: 150 mm
inluding:
Base module equipment cart, wide
Cover equipment, equipment cart wide
Beam package equipment, equipment cart high
3x Shelf, wide
Drawer unit with lock, wide
2x Equipment rail, long
Camera holder
UG 540
Monitor Swifel Arm,
height and side adjustable,
can be turned to the left or the right side,
swivel range 180°, overhang 780 mm,
overhang from centre 1170 mm,
load capacity max. 15 kg,
with monitor fixation VESA 5/100,
for usage with equipment carts UG xxx
UG 220
UG 540
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery
Recommended Accessories for Equipment Cart
UG 310
Isolation Transformer,
200 V – 240 V; 2000 VA with 3 special mains socket,
expulsion fuses, 3 grounding plugs,
dimensions: 330 x 90 x 495 mm (w x h x d),
for usage with equipment carts UG xxx
UG 410
Earth Leakage Monitor,
200 V – 240 V, for mounting at equipment cart,
control panel dimensions: 44 x 80 x 29 mm (w x h x d),
for usage with isolation transformer UG 310
UG 310
UG 410
UG 510Monitor Holding Arm,
height adjustable, inclinable,
mountable on left or right,
turning radius approx. 320°, overhang 530 mm,
load capacity max. 15 kg,
monitor fixation VESA 75/100,
for usage with equipment carts UG xxx
UG 510
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Notes:
Endoscopic and Sinonasal Dissection Manual
for Endoscopic Sinus Surgery