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Sphenoid Sinus Access and Exposure

Microscopic Approaches

The next major consideration in the recurrent trans-sphenoidal procedure is the precise route of entry into the sphenoid sinus. For microscopic approaches, the two basic options are the endonasal approach and the sublabial approach. Selection of one over the other depends on the size of the nostril, the size of the lesion, and the preference of the surgeon. We tend to favor endonasal approaches in most instances, reserving the sublabial incision for pediatric patients or adults with small nostrils in whom the broader corridor afforded by the piriform aperture improves the visualization of the surgical field and the maneuverability of the surgical instruments. The endonasal microscopic approaches include the transseptal submucosal, the septal pushover, and the direct sphenoidotomy. These essentially differ based on the location of the initial incision. With the transseptal submucosal technique, the incision is made just within the …