approaches to the sphenoid - university of texas medical · pdf file ·...
TRANSCRIPT
![Page 1: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/1.jpg)
Approaches to the
Sphenoid
Kevin Katzenmeyer, MD
Faculty Advisor: Byron J. Bailey, MD
The University of Texas Medical Branch
Department of Otolaryngology
Grand Rounds Presentation
October 11, 2000
![Page 2: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/2.jpg)
Development
Originate in 4th fetal month from sphenoethmoidal recess
Pneumatization begins at age 3
Adult size at 18
![Page 3: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/3.jpg)
Sphenoid Sinus
Congdon
Conchal – 5%
Presellar – 23%
Sellar – 67%
![Page 4: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/4.jpg)
Sphenoid Sinus
Irregular walls
Asymmetric
Dehiscences
![Page 5: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/5.jpg)
Sphenoid Sinus
Superior
Hypophysis, olfactory tract, frontal lobe
Inferior
Nasopharynx, vidian nerve
Lateral
Cavernous sinus, carotid, cranial nerves 2/3/4/5/6
Posterior
Pons, basilar artery
![Page 6: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/6.jpg)
Sphenoid Sinus
Van Alyea
Elevations
Carotid - 65%
Optic nerve - 47%
Vidian nerve – 48%
Maxillary nerve – 42%
![Page 7: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/7.jpg)
Sphenoid Sinus
7 to anterior face
9 cm to post wall
30 degrees from floor
![Page 8: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/8.jpg)
Sphenoid sinus
![Page 9: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/9.jpg)
Sphenoid Sinus
![Page 10: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/10.jpg)
Sphenoid Sinus
![Page 11: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/11.jpg)
Sphenoid Sinus -
symptoms
Headache
retroorbital
Visual symptoms
Paresthesias/Palsies
![Page 12: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/12.jpg)
Sinusitis
Dull headache
Nasal discharge
Visual symptoms
Management Decongestants
Antibiotics
Irrigation
Surgery
![Page 13: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/13.jpg)
Mucocele
MC space occupying lesion
Headaches
Visual disturbances
Radiographs
Sinusotomy
![Page 14: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/14.jpg)
Polyps
Usually associated with ethmoidal disease
Can be confined to sphenoid
History
Hx rhinosinusitis
PND
HA
Radiographs
![Page 15: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/15.jpg)
Inverting Papilloma
Primaries from sphenoid reported
Recurrence likely
![Page 16: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/16.jpg)
Malignant lesions
SCCa
Adenocarcinoma
Lymphoepithelioma
Melanoma
Sarcoma
![Page 17: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/17.jpg)
Pituitary tumors
Basophilic, acidophilic, chromophobic
Prolactin 40-50%
GH 15-25%
ACTH 5%
TSH/GnRH 1%
Multiple 15-20%
![Page 18: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/18.jpg)
Pituitary tumors
![Page 19: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/19.jpg)
Craniopharyngiomas
Bimodal presentation
Cystic or solid
Compression
Recurrence rate high
![Page 20: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/20.jpg)
Other
Dermoids
Epidermoids
Germ cell tumors
Chordomas
Osseous lesions
Meningiomas
Encephaloceles
![Page 21: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/21.jpg)
Evaluation
History & Physical
Endoscopic exam
Radiography
CT
MRI
angiography
Endocrine evaluation
![Page 22: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/22.jpg)
Approaches
Krause – 1905 – transfrontal
Schloffer – 1907 – transnasal
Cushing – 1910 – sublabial transseptal
Cushing – 1920s - extracranial
Hardy – 1960s - transseptal
![Page 23: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/23.jpg)
Sublabial Transseptal
Transfixion incision
Mucoperiosteal tunnels elevated
Cartilage separated from max crest
Sublabial incision
Anterior wall removed
![Page 24: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/24.jpg)
Sublabial Transseptal
![Page 25: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/25.jpg)
Sublabial Transseptal
![Page 26: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/26.jpg)
Sublabial Transseptal
![Page 27: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/27.jpg)
Sublabial Transseptal
![Page 28: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/28.jpg)
Endoscopic Transseptal
Lateralize middle turbinate
Expose SER/ostium
Posterior incision on vomer
Mucoperiosteal flaps
Remove anterior wall of sinus
![Page 29: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/29.jpg)
External Rhinoplasty
No sublabial dissection
Inverted V incision
Divide intercural ligaments
Mucoperichondrial tunnels
Remove posterior septum
Anterior wall removed
![Page 30: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/30.jpg)
External Rhinoplasty
![Page 31: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/31.jpg)
External Rhinoplasty
Peters and Zitsch
Incisions at base of columella and complete transfixion incision
![Page 32: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/32.jpg)
Intranasal Transseptal
Various septal incisions
Lateral alotomy
![Page 33: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/33.jpg)
Prior septal surgery
1) Avoid problem area
2) Dissection through problem area
3) Lateral displacement of septum
![Page 34: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/34.jpg)
Lateral septal
displacement
Incision on nasal floor
Complete transfixion incision
Elevation of floor mucosa bilaterally
Dissect septum from nasal spine/crest until intact bone reached
Normal sequence
![Page 35: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/35.jpg)
Lateral septal
displacement
![Page 36: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/36.jpg)
Transantral approach
Caldwell-Luc
Medial wall of antrum removed
Ethmoidectomies
Anterior wall reached
No nasal complications
![Page 37: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/37.jpg)
Transethmoidal approach
External ethmoidectomy approach to anterior wall of sphenoid
No nasal complications
![Page 38: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/38.jpg)
Transethmoidal approach
![Page 39: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/39.jpg)
Transethmoidal approach
![Page 40: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/40.jpg)
Endoscopic sphenoid
approach
Middle turbinate medialized
Ant & post inferior turb removed
Posterior ethmoidectomy thru grand lamella
Open ostium
![Page 41: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/41.jpg)
Endoscopic sphenoid
approach
![Page 42: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/42.jpg)
Endoscopic sphenoid
approach
![Page 43: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/43.jpg)
Endoscopic sphenoid
approach
![Page 44: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/44.jpg)
Intranasal
sphenoethmoidectomy
Medialization of turbinate
Anterior – posterior ethmoidectomies
Lateralize turbinate
Ostium post-sup of post attachment of middle turbinate
Anterior wall removed
![Page 45: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/45.jpg)
Transantral
sphenoethmoidectomy
Caldwell-Luc
Medial wall of antrum removed
Ethmoidectomies
sphenoidectomy
![Page 46: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/46.jpg)
Transpalatal approach
Mouth gag
Palatal incision Midline split
U or S incisions
Hard palate removed
Closed in several layers
Complications Palatal contracture, VPI, fistulae
![Page 47: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/47.jpg)
Transpalatal approach
![Page 48: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/48.jpg)
Infratemporal approach
Sphenoid sinus neoplasms
Cavernous sinus
Pterygomaxillary space
Infratemporal fossa
Nasopharynx
+/- craniotomy
![Page 49: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/49.jpg)
Infratemporal approach
![Page 50: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/50.jpg)
Infratemporal approach
![Page 51: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/51.jpg)
Anterior approach
Facial incision Lateral rhinotomy
Weber-Fergusson incision
+/- orbital exenteration
Ant/med maxillary walls removed
Ethmoidectomies
Sphenoidectomy
Drill sphenoid sinus walls
![Page 52: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/52.jpg)
Anterior approach
![Page 53: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/53.jpg)
Neurovascular
complications
Carotid artery Laceration, spasm
Cavernous sinus
Nerve palsies
Blindness
Optic chiasm Prolapse into sella
Chiasmal compression
CSF leaks meningitis
![Page 54: Approaches to the Sphenoid - University of Texas Medical · PDF file · 2014-01-21Approaches to the Sphenoid Kevin Katzenmeyer, MD Faculty Advisor: Byron J. Bailey, MD ... Cavernous](https://reader036.vdocument.in/reader036/viewer/2022062306/5aaff4c17f8b9a3a038e1754/html5/thumbnails/54.jpg)
Rhinologic complications
50%?
Septal perforations
Epistaxis
Synechiae
Anosmia
Cosmetic deformity Columellar incision visibility
Saddle nose
Loss of tip projection/decreased nasolabial angle