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Exophthalmos due to Hyperthyroidism
Endoscopic Orbital Decompression
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1. Starting sphenoethmoidectomy on the left. Removal of the medial wall of the maxillary sinus. |
2. Enlarged middle antrostomy. |
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3. Removal of the bulla ethmoidalis. |
4. Entering the posterior ethmoids. The superior turbinate is seen. |
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5. Removal of the inferior portion of the superior turbinate. |
6. The sphenoid ostium. |
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7. Removal of the anterior wall of the sphenoid sinus. The prominences of the optic nerve and the carotid artery are seen. |
8. Elevating the axillary flap. |
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9. Opening the agger nasi cell. |
10. Removal of the agger nasi cell. Enlargement of the frontal sinus ostium. |
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11. Removal of remnants in the area of the suprabullar cell. The sphenoethmoidectomy is completed on the left. |
12. Starting dissection on the right. The bulla ethmoidalis is removed. A large middle antrostomy is seen below. |
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13. Entering the posterior ethmoids. The superior turbinate is seen. |
14. Removal of the anterior wall of the sphenoid sinus. The optico-carotid recess is seen. |
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15. The enlarged ostium of the frontal sinus. Sphenoethmoidectomy is completed on the right. |
16. Starting the removal of the lamina papyracea on the left. |
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17. The detachment proceeds to the skull base. |
18. The detachment proceeds to the anterior wall of the sphenoid. |
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19. Elevation and removal of the medial portion of the roof of the maxillary sinus. |
20. View after the removal of the lamina papyracea and the medial wall of the maxillary sinus. |
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21. Removal of the lamina papyracea on the right. |
22. Continuing the detachment of the lamina papyracea. |
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23. Trying to elevate the orbital periosteum from the roof of the maxillary sinus. |
24. Removal of the medial portion of the roof of the maxillary sinus. |
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25. Cutting the orbital periosteum. |
26. Elevation and removal of the orbital periosteum. |
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27. Division of septations within the orbital fat. |
28. Incision of the orbital periosteum to the right. |
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29. The incision proceeds along the skull base. |
30. Grasping and elevation of the orbital periosteum. |
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31. Division of septations within the orbital fat. |
32. Repositioning of the axillary flap. |
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33. Suturing the middle turbinates to the septum. |
