Atlas of Nose and Paranasal Surgeries

ATLAS OF NOSE AND PARANASAL SURGERIES 22 Authors: M. Trebbi, F. Mattioli, D. Soloperto, M. Bettini, L. Presutti Title: Endoscopic Dacryocystorhinostomy Book: Endoscopic Surgery of the Lacrimal Drainage System DOI: 10.1007/978-3-319-20633-2_6 © Springer International Publishing Switzerland 2016 Projection zone of the lacrimal sac. a . Draw; b. before surgery. TM middle turbinate, PU uncinate process, Atm middle turbinate axilla, Zps projection sac area zone. Before making the mucoperiosteal flaps to discover the lacrimal bone, a submucosal infiltration with adrenaline solution is made, in order to reduce bleeding. 6.5.4 Flaps Preparation To identify the lacrimal sa region, the most important structure is represented by the uncinate process, because just anterior to it there’s the pro- jection of the lacrimal sac. In our opinion the head of the middle turbinate, due to its great ana- tomic variability, is not a safe landmark. Many techniques are described to make mucoperiosteal flaps. We usually used to perform two flaps, one little posterior and one bigger superior. Until flaps are superiorly and posteriorly moved, the bony wall that recovers lacrimal sac is exposed. Mucosal incision could be produced with many instruments, such us cold knife, radiofrequency a b Fig. 6.2 Projection zone of the lacrimal sac. ( a ) Draw; ( b ) before surgery. TM middle turbinate, PU uncinate process, Atm middle turbinate axilla, Zps projection sac area zone Fig. 6.3 Infiltration of the projection zone of the lacrimal area with adrenaline solution is made, in order to reduce bleeding. The site of infiltration is local- ized to the nasal lateral wall, near the lacrimal area, anterior to the uncinate process (Figs. 6.2 , 6.3 , and 6.4 ). 6.5.4 Flaps Pr To identify the la important structure process, because ju jection of the lacri head of the middle t tomic variability, i techniques are desc flaps. We usually u little posterior and flaps are superiorl bony wall that reco Mucosal incision c instruments, such knife, and laser tec 6.5.5 Laser Currently, two tec endoscopic DCR: l b Fig. 6.2 Projection zone of the lacrimal sac. ( a ) Draw; ( b ) before surgery. TM middle turbinate, PU uncinate process, Atm middle turbinate axilla, Zps projection sac area zone Fig. 6.3 Infiltration of area (continued)... ...(continued)