الفهرس 
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Abstract
The sphenoid sinus, the neglected one among other
paranasal sinuses is also prone to different diseases.
Although isolated sphenoid sinus lesion is rare, it’s
involvement with other paranasal sinuses is not uncommon.
Drainage and areation of the sinus cavity is the
main treatment strategy in benign non-neoplastic lesions.
Many approaches developed aiming the anterior wall
of the sphenoid sinus. Transethmoidal with external
incision, transseptal with sublabial incision endonasal
transseptal and microscopic endonasal are among them.
The endoscopic approach is the easiest, one of the safest
and is widely accepted.
Surgical ostium created in the anterior wall of the
sphenoid sinus i.e. sphenoidotomy is found to serve
dealing with irreversible mucosal lesions, also in
dependent drainage and areation of the sinus cavity.
Yet, ideally the surgery must be designed to let the
patient have a permanent opening, unfortunately this task
is not so simple because the narrow field and close
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proximity to important neurovascular structures limits
the widening of the surgical ostium, besides that the
high vascularity and high regeneration power of the
mucosal lining tend to narrow the raw surface of surgical
ostium.
In our work, 20 patients had been subjected to
endoscopic sinus surgery according to Messerklinger’s
technique including sphenoidotomy. In 13 patients, the
surgery was performed bilaterally and in 7 patients
unilaterally, marsupialization to the sphenoid sinus was
done twice among the later group.
We gave special concern to the middle turbinate, we
noticed that in spite of being an important landmark in
endoscopic sinus surgery, it’s removal by previous
surgical interference gave wider surgical field ad
facilitates the exposure of the anterior wall of the
sphenoid sinus, also facilitates the removal of
crustations and suction clearance postoperatively and
prevent adhesions formation.
Eight months postoperatively we had 3 cases (9.09%)
with occluded sphenoidotomy and 12 cases (36.36%) with
stenosed one, while as in the 2 cases of marsupialized
sinus the opening is still very wide.
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from OUR STUDV WE CAN CONCLUDE
C.T. scanning of paranasal sinuses must be reviewed
meticulously before surgical handling of the patient and
also during operation
variations is the rule.
remembering that anatomical
- The distance from the anterior wall of the sphenoid
sinus to the nasal spine (about 7cm) must be measured
before penetration of the anterior wall, also measurement
to posterior nasopharyngeal wall to approximate posterior
wall of sphenoid sinus.
- The best method for opening the sinus cavity is the
identification of te natural ostium and dilating it
inferiorly medial. If the natural ostium can not be
identified, penetration of the anterior wall must be near
the mid line close to the septum it is the thinnest and
the safest point.
- Marsupialization i.e. removal of the whole anterior
wall of the sinus is better than sphenoidotomy because it
resists the expecting stenosing process and gives better
chance for permanent patency. - Any polypoidal remnants or
sphenoidotomy must be removed
stenosis.
thickened
to avoid
mucosa around
post operative.
- Meticulous postoperative care is needed to remove any
crustations, collected secretion and newly formed fibrin.
It is advised to be asfrequent as possible especially in
the first 3 months post operatively.
Frequent usage of nasal lotion is
postoperatively to dissolve crustations and
syringe usage is more efficient in this task