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Endoscopic AnAtomy of thE LAtErAL nAsAL WALL, ostiomEAtAL compLEx

And AntErior skuLL BAsEA stEp-By-stEp GuidE

86 illustrations

reda kAmEL, m.d.

Professor of Rhinology Department of ENT, Cairo University, Egypt

Dedication

To my wife Azza and my daughters Menna, Sara and Rana.

They miss me most of the time because I am always busy in the field of endoscopic sinonasal surgery, research, teaching and clinical practice.

Reda Kamel

®

Endoscopic Anatomy of the Lateral Nasal Wall, Ostiomeatal Complex and Anterior Skull Base4

Endoscopic Anatomy of the Lateral Nasal Wall, Ostiomeatal Complex and Anterior Skull BaseA Step-by-Step GuideReda Kamel, M.D. Professor of Rhinology Department of ENT, Cairo University, Egypt

Correspondence address of the author: Prof. Reda Kamel, M.D. Professor of Rhinology, Department of ENT, Functional and Microscopic ENT Unit 61 Canal Street – Sawares Square Maadi 11431 Cairo, Egypt Phone: +20 23 80 29 55 +20 23 63 25 96 Fax: +20 23 59 6740 E-mail: [email protected]

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Endoscopic Anatomy of the Lateral Nasal Wall, Ostiomeatal Complex and Anterior Skull Base 5

Contents

Preface and Acknowledgements . . . . . . . . . . . . . . . . . . . . . . 6

1.0 Anatomical Basics

1.1 Nasal Turbinates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

1.2 Paranasal Sinuses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

1.3 The Ostiomeatal Complex . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

1.4 Uncinate Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

1.5 Bulla Ethmoidalis

1.6 Hiatus Semilunaris Inferior . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

1.7 Ethmoid Infundibulum

1.8 Hiatus Semilunaris Superior

1.9 Lateral Sinus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

1.10 Maxillary Sinus Ostium

1.11 Fontanelle Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

1.12 Frontal Recess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

1.13 Supraorbital Ethmoid Air Cell

1.14 Anterior Ethmoid Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

1.15 Frontal Sinus Ostium

1.16 Agger Nasi Cell. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

1.17 Frontal Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

1.18 Middle Turbinate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

1.19 Basal Lamella . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

1.20 Ethmoid Labyrinth

1.21 Roof of the Ethmoids

1.22 Lateral Lamella

1.23 Cribriform Plate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

1.24 Olfactory Fossa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

1.25 Posterior Ethmoid Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

1.26 Sphenoethmoidal Cell (Onodi Cell) . . . . . . . . . . . . . . . . . . . . 28

1.27 Sphenopalatine Foramen

1.28 Sphenoid Sinus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

1.29 Neurovascular Relationships of the Sphenoid Sinus

1.30 Sphenoid Sinus Ostium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

1.31 Nasopharynx

1.32 Nasal Choana. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

1.33 Anatomic Variations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

1.34 Conclusion

Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Instrument Sets for Endoscopic Diagnosis and Surgery of the Lateral Nasal Wall, Ostiomeatal Complex and Anterior Skull Base as recommended by Prof. Reda Kamel, M.D. . . . 35


PrefaceTransnasal endoscopic sinonasal surgery has become a widely accepted technique over the past decade. Though the technique usually is applied in the case of relatively minor diseases, it can involve major compli-cations. It can be said with certainty that incomplete surgery is safe but ineffective, whereas complete surgery is effective but unsafe. The surgeon requires a sound background knowledge of the anatomical details of the sinonasal area in order to perform safe and effective surgery.

This booklet is an anatomic guide based on 14 years of academic and clinical experience gained by the author in transnasal endoscopic sinonasal surgery.

The aim of this volume is to impart basic information of the anatomy of the lateral nasal wall and Ostiomeatal area in a step-by-step manner. As such, it may serve as a ready reference for residents in training and practitioners of continuing medical education courses. For this reason, details of particular significance for dissection or actual surgical proced ures are illustrated by schematic drawings. The author hopes that this manual will be a source of valuable information to its readers.

Reda Kamel, M.D. Professor of Rhinology

Cairo University, Egypt, 2005

AcknowledgementsI would like to acknowledge the continuous support and encouragement I have received from the KARL STORZ company and especially from Mrs. Sybill Storz. I would also like to thank Professor Heinz Stammberger who put me on the right track during his visit to Cairo, Egypt in 1986 and my visit to Graz, Austria in 1987. He aroused my interest in endoscopic sinus surgery and gave me continuous inspiration. I am grateful to Professor David Kennedy who offered me invaluable support during my fellowship at the Johns Hopkins University, USA in 1989-1990. He was an excellent guide in both research and clinical fields.

I would also like to thank my senior professors at Cairo University as well as my colleagues for their continuous support, encouragement, and guidance. Moreover, I have to confess that I owe much to those dear colleagues who attended my instructive sinonasal endoscopic courses. Whilst I did my best to teach them with sincerity, their fruitful questions and discus-sions also taught me a lot in return.

I have to thank Dr. Tarek Kandiel, Dr. Ashraf Khaled, Dr. Hany El Gamal, Dr. Hesham Abd El-Wahed and Dr. Mohammad Makhdoum for their help in editing and reviewing this book.

Reda Kamel


1.0 Anatomical BasicsBefore commencing to study the detailed anatomy of the lateral nasal wall, one must be aware that there is a very wide range of possible anatomic variations, both between different people and even between the two sides of the same individual’s nose. It is crucial for the surgeon to be able to identify any anatomic variation and/or pathological anomaly in the individual patient to ensure that the endoscopic sinus surgery is both efficacious and safe, and affords the desired optimal benefit for the patient. The identification of variations and pathologies must be based on a very detailed and thorough understanding of the usual anatomy of the ostiomeatal complex, lateral nasal wall and anterior skull base.

1.1 Nasal Turbinates

The lateral nasal wall is characterized by three turbi-nates (inferior, middle, and superior), each of which has its own meatus (inferior, middle and superior meatus) running below the structure. The spheno-ethmoidal recess is located just above, posterior and medial to the superior turbinate (Figs. 1a, b).

Fig. 1aLateral nasal wall – nasal turbinates (schematic depiction, coronal plane)

Sphenoethmoidal recess

Superior meatus

Inferior meatus

Superior turbinate

Middle turbinate

Inferior turbinate

Middle meatus

Fig. 1bLateral nasal wall – nasal turbinates (schematic depiction, sagittal plane).


Middle turbinate

Inferior turbinate

Superior meatus

Superior turbinate

Middle meatus

Inferior meatus


1.2 Paranasal Sinuses

The frontal sinus, maxillary sinus and anterior ethmoid sinuses constitute the anterior group of the paranasal sinuses, all of which open into the middle meatus, while the posterior ethmoid cells and sphenoid sinus form the posterior group of the paranasal sinuses. The posterior ethmoids open into the superior meatus and the sphenoid sinus opens into the spheno-ethmoidal recess (Figs. 2a, b).

Fig. 2aDrainage of the anterior paranasal sinuses (schematic depiction, coronal plane).

Frontal sinus

Anterior ethmoids

Maxillary sinus

Middle meatus

Fig. 2bDrainage of the posterior paranasal sinuses (schematic depiction, sagittal plane).

Sphenoid sinus

Posterior ethmoids


1.3 The Ostiomeatal Complex

The Ostiomeatal Complex (OMC) is also termed Anterior Ethmoid Middle Meatus Complex. The ostio-meatal complex consists of the air cells of the anterior ethmoid and their ostia, ethmoidal infundibulum, maxillary ostium, frontal ostium, and middle meatus. As a functional entity, the OMC represents the final section of the common drainage and ventilation pathway of the frontal, maxillary and anterior ethmoid sinuses (Figs. 3a–c).

Fig. 3aLeft Ostiomeatal Complex (schematic depiction, coronal plane).

Ostiomeatal Complex

Fig. 3bRight Ostiomeatal Complex (schematic depiction, sagittal plane).

Ostiomeatal Complex

Fig. 3cLeft Ostiomeatal Complex (schematic depiction, coronal plane).

Middle turbinate

Ethmoid infundibulum

Bulla ethmoidalisFrontal sinus ostium

Middle meatus

Maxillary sinus ostium


The following structures can be identified under the endoscope as parts of the Ostiomeatal Complex:

O Agger nasi cell.O Uncinate process.O Bulla ethmoidalis (Fig. 3d).O Hiatus semilunaris inferior between the uncinate

process and bulla ethmoidalis.O Middle turbinate.O Location of the maxillary sinus ostium posterior

and inferior to the angle formed between bulla ethmoidalis and uncinate process.

O Location of the frontal sinus ostium anterior and superior to the angle formed between bulla ethmoidalis and uncinate process (Fig. 3e).

Fig. 3eLeft Ostiomeatal Complex (30°-endoscope).

Frontal sinus ostium


Fig. 3dLeft Ostiomeatal Complex (0°-endoscope).

Agger nasi cell

Uncinate process

Bulla ethmoidalis

Middle turbinate

Inferior turbinate

Nasal septum

Middle meatus


Proceed by insinuating the endoscope posteriorly between the middle turbinate and the ethmoidal bulla to identify the following structures (Figs. 3f–h):

O Basal lamella (second part of the middle turbi nate, oblique part).

O Hiatus semilunaris superior and lateral sinus posterior and superior to the ethmoidal bulla.

The following structures can be identified by gently pushing medially the middle turbinate (Fig. 3i):

O Uncinate process.O Agger nasi cell, anterior and superior to the

uncinate process.O Bulla ethmoidalis.O Basal lamella.

Fig. 3fBasal lamella, (yellow area) lateral sinus and hiatus semilunaris superior (red arrow) (endoscopic view).

Middle turbinate

Basal lamella

Bulla ethmoidalis

Fig. 3gLeft Ostiomeatal Complex (schematic depiction, axial plane).

Hiatus semilunaris superior

Hiatus semilunaris inferior

Lateral sinus

Ethmoid Infundibulum

Fig. 3iLeft ostiomeatal complex (schematic depiction, sagittal plane).

Agger nasi

Uncinate process

Bulla ethmoidalis

Basal lamella

Fig. 3hLeft ostiomeatal complex (schematic depiction, coronal plane).

Lateral sinus



Ethmoid Infundibulum


Its free posterior rim constitutes the free edge of the hiatus semilunaris inferior leading to the ethmoid infundibulum (Fig. 4a).

Superior attachment of the uncinate process: the uncinate process usually is attached to the lamina papyracea, whereas the ethmoidal infundibulum ends blindly in the terminal recess. Under these circumstances, the frontal recess opens directly into the middle meatus (Fig. 4b). Alternatively, the uncinate process may be attached to the skull base or the neck of the middle turbinate, a configuration where the frontal recess opens into the ethmoidal infundi-bulum (Figs. 4c, d).

1.4 Uncinate Process

The uncinate process is a thin bone located in a sagittal orientation and shaped like a hook. The uncinate process is attached to the following struc tures:

O Inferiorly and far posterior: to the ethmoid process of the inferior turbinate.

O Anteriorly and far superior: to the lamina papyracea, skull base or middle turbinate.

O Laterally: to the lamina papyracea and fontanelle area.

Fig. 4aLeft uncinate process (schematic depiction, sagittal plane).

Lamina papyracea

Ethmoid process of inferior turbinate

Uncinate process


Hiatus semi lunaris inferior

Inferior turbinate

Fig. 4bUncinate process attached to lamina papyracea (terminal recess) (schematic depiction, coronal plane).

Lamina papyracea

Uncinate process

Terminal recess

Middle meatus

E

Fig. 4dUncinate process attached to the middle turbinate (schematic depiction, coronal plane).

Middle turbinate

Uncinate process

E Ethmoid infundibulum

Fig. 4cUncinate process attached to the skull base (schematic depiction, coronal plane).

Skull base

E Ethmoid infundibulum

Uncinate process


1.5 Bulla Ethmoidalis

The bulla ethmoidalis (Figs. 5a–c) is a part of the air cells of the anterior ethmoid. It is attached laterally to the lamina papyracea and usually opens into the lateral sinus posteriorly. The spatial relationships can be summar ized as follows:

O Anteriorly and inferiorly: the ethmoid infundi bulum separates the bulla from the uncinate process.

O Superiorly: the suprabullar recess (the anterior and superior portion of the lateral sinus) separates the bulla from the fovea ethmoidalis.

O Posteriorly: the retrobullar recess (the posterior and inferior part of the lateral sinus) separates the bulla from the basal lamella of the middle turbinate.

O Medially: the middle meatus separates the bulla from the middle turbinate. The lumen between bulla ethmoidalis and middle turbinate is termed the conchal sinus.

1.6 Hiatus Semilunaris Inferior

The hiatus semilunaris inferior is a two-dimensional passage-way between the ethmoidal bulla and the free edge of the uncinate process, and leads to a three- dimensional lumen, (i.e. the ethmoidal infundi bulum) between the anterior wall of the eth moi dal bulla and the posterior wall of the uncinate process.

Fig. 5bLeft bulla ethmoidalis (schematic depiction, axial plane).


Middle turbinateConchal sinusHiatus semilunaris inferior

Basal lamella

Lateral sinus


Uncinate process

Fig. 5aLeft bulla ethmoidalis (endoscopic view).

Nasal septum

Conchal sinus

Uncinate process

Bulla ethmoidalis

Middle turbinate

Inferior turbinate

Middle meatus

Fig. 5cBulla ethmoidalis (schematic depiction, sagittal plane).

Fovea ethmoidalis


Uncinate process

Lateral sinus

Basal lamella

Bulla ethmoidalis


Fig. 7Left hiatus semilunaris inferior and ethmoid infundibulum (schematic depiction, sagittal plane).

Frontal recess

Uncinate process


Bulla ethmoidalis

Infundibulum

Fig. 9aLateral sinus components: Suprabullar recess and retrobullar recess (schematic depiction, sagittal plane).

Retrobullar recess

Suprabullar recess

Fig. 8aLateral sinus and hiatus semilunaris superior (schematic depiction, sagittal plane).

Bulla ethmoidalis

Fovea ethmoidalis

Lateral sinus

Basal lamella

Fig. 9bLateral sinus: no suprabullar recess (schematic depiction, sagittal plane).

Retrobullar recess

Fig. 9cLateral sinus: no retrobullar recess (schematic depiction, sagittal plane).

Suprabullar recess

Fig. 8bLateral sinus and hiatus semilunaris superior (schematic depiction, sagittal plane).

Bulla ethmoidalis

Fovea ethmoidalis

Lateral sinus

Basal lamella

t

t


1.7 Ethmoid Infundibulum

The boundaries of the ethmoid infundibulum are defined as follows:

O Anteriorly: uncinate process.O Posteriorly: anterior wall of the bulla ethmoidalis.O Laterally: lamina papyracea anteriorly and

fontanelle area posteriorly.O Medially: hiatus semilunaris inferior and uncinate

process.O Anteriorly and superiorly: frontal recess area and

frontal sinus ostium.O Posteriorly and inferiorly: maxillary sinus ostium

(Fig. 7).

1.8 Hiatus Semilunaris Superior

The hiatus semilunaris superior is a two-dimensional passage-way between the ethmoidal bulla (anteri orly and inferiorly) and the skull base (superiorly) and the basal lamella (posteriorly), and leads to a three-dimen-sional lumen, i.e. the lateral sinus (Figs. 8a, b).

1.9 Lateral Sinus

The lateral sinus is divided into a suprabullar recess and a retrobullar recess. In its anterior and superior location, the suprabullar recess is a space bordered by the ethmoidal bulla (inferiorly) and the ethmoidal fovea (superiorly). In contrast, the retrobullar recess in its posterior and inferior location is bordered by the ethmoidal bulla (anteriorly) and the basal lamella (posteriorly). If the ethmoidal bulla directly adheres to the ethmoidal fovea, no suprabullar recess is formed, whereas there is no retrobullar recess, if the ethmoidal bulla adheres to the basal lamella (Figs. 9a–c).

Far anterior, the suprabullar recess of the lateral sinus is separated from the frontal recess by the suprabullar lamella. In the absence of a suprabullar lamella the suprabullar recess of the lateral sinus and the frontal recess of the infundibulum form a continuous cavity (Figs. 9d, e).

Fig. 9dLeft suprabullar lamella (schematic depiction, sagittal plane).

Fig. 9eIn the absence of a suprabullar lamella the lateral sinus and frontal recess form a continuous cavity (schematic depiction, axial plane).

Frontal recess

Suprabullar recess

Frontal recess

Suprabullar recess

Suprabullar lamella


1.10 Maxillary Sinus Ostium

The maxillary sinus ostium usually is located post erior and inferior at the angle formed by the ethmoidal bulla and the uncinate process. Size, exact location, shape, and orientation of the maxillary sinus ostium are subject to anatomic variations (Figs. 10a, b).

1.11 Fontanelle Area

The medial wall of the maxillary sinus is composed of bone with nasal mucosa medially and maxillary sinus mucosa laterally, the area of the fontanelle being an exception. In the area of the fontanelle, the bony wall is dehiscent and the nasal mucosa adheres to the maxillary sinus mucosa. The uncinate process separates the fontanelle area into the anter ior and posterior fontanelles (i.e. anterior and poster ior to the uncinate process). The natural maxillary sinus ostium is located in the posterior fontanelle. There may be one or more accessory maxillary sinus ostium /ostia in the anterior and/or posterior fon ta nelle (Fig. 11).

Fig. 10aLeft maxillary sinus ostium (schematic depiction, coronal plane).



Bulla ethmoidalis


Uncinate process

Fig. 11Left fontanelle area (yellow): anterior and posterior fontanelles (schematic depiction, sagittal plane).

Fig. 10bLeft maxillary sinus ostium (30°-endoscopic view).

Natural maxillary sinus ostium

Bulla ethmoidalis


Uncinate process

Accessory ostia

Anterior fontanellePosterior fontanelle

Inferior turbinate


1.12 Frontal Recess

The frontal recess is a three-dimensional cavity defined by the following boundaries:

O Anteriorly: uncinate process and agger nasi cell.O Posteriorly: bulla ethmoidalis and suprabullar

lamella.O Laterally: lamina papyracea.O Medially: hiatus semilunaris inferior or neck of the

middle turbinate.O Inferiorly: ethmoid infundibulum.O Superiorly: fovea ethmoidalis, supraorbital air cell,

anterior ethmoid artery and frontal ostium.

The size of the frontal recess is determined by the size of the surrounding anterior ethmoid air cells namely: bulla ethmoidalis, agger nasi cell, supra orbital air cells and frontal cells. If the bulla ethmoidalis is large anteriorly and the agger nasi is large posteriorly, the frontal recess becomes very narrow and takes on the appea rance of a fronto-nasal duct, which it is not (Figs. 12a–c).

Fig. 12aLeft frontal recess (schematic depiction, sagittal plane).

Supraorbital cell

Anterior ethmoid artery


Agger nasi

Uncinate process

Frontal recess

Suprabullar lamella

Bulla ethmoidalis

Fig. 12bNarrow left frontal recess (this is not a fronto-nasal duct) (schematic depiction, sagittal plane).


Frontal recess

Fig. 12cWide left frontal recess (schematic depiction, sagittal plane).

Agger nasiBulla ethmoidalis


Frontal recess


1.13 Supraorbital Ethmoid Air Cell

The supraorbital ethmoid air cell arises from pneu-matization of the orbital process of the frontal bone. It is located just posterior to the frontal sinus ostium. The anterior ethmoid artery [AEA] is present just posterior to the supraorbital cell and anterior to the suprabullar lamella in the fovea ethmoidalis. Pneumatization of the supraorbital air cell is subject to anatomic variation (Fig. 13).

1.14 Anterior Ethmoid Artery (AEA)

The anterior ethmoid artery is an orbital branch of the ophthalmic artery and exits the orbit through the anterior ethmoidal foramen in a medial position. From there, it passes into the orbito-cranial canal in the roof of the ethmoid, entering the lateral lamella of the cribriform plate and the olfactory fossa. Further on, the anterior ethmoid artery passes anteriorly into the ethmoidal sulcus to the cribriform plate. The vessel ultimately changes direction to run inferiorly into the cribroethmoidal canal to the nose (Figs. 14a, b).

Fig. 13Left supraorbital air cell (schematic depiction, sagittal plane).


Supraorbital air cell


Fig. 14bLeft anterior ethmoid artery (schematic depiction, coronal plane).

Crista galli

Middle turbinate

Lateral lamella

Anterior ethmoid arteryNasal septum

Olfactory fossaFovea ethmoidalis

Cribriform plate

Fig. 14aLeft anterior ethmoid artery (AEA) (schematic depiction, sagittal plane).


Agger nasi

Frontal recess

Bulla ethmoidalis

E



1.15 Frontal Sinus Ostium

Located at the bulla-uncinate angle anteriorly and superiorly, the frontal sinus opens into the frontal recess through the frontal ostium. The frontal sinus, frontal ostium and frontal recess are distinguished by their hourglass appearance (Fig. 15).

1.16 Agger Nasi Cell

Located medial to the lacrimal sac and fossa and anterior to the uncinate process, the agger nasi cell is one of the air cells of the anterior ethmoid. The antero-medial wall of the structure can be seen through the endoscope directly anterior and superior to the neck of the middle turbinate. The postero- lateral wall of the structure is hidden by the uncinate process and constitutes the anterior wall of the frontal recess. The size of the agger nasi cell contributes to the definition of the size and shape of the frontal recess (Figs. 16a, b).

Fig. 15Left frontal sinus ostium (schematic depiction, sagittal view).

Frontal sinus


Frontal recess

Fig. 16bLeft agger nasi cell (schematic depiction, axial view).

Superior turbinate

Middle turbinate

Sphenoid sinus

Posterior ethmoid

Basal lamella

Bulla ethmoidalis

Frontal recess

Uncinate process

Lacrimal sac and fossa

Agger nasi cell

Fig. 16aLeft agger nasi cell (endoscopic view).

Nasal septum

Middle meatus

Agger nasi cell

Uncinate process

Bulla ethmoidalis

Middle turbinate

Inferior turbinate


1.17 Frontal Cells

The frontal cells (Figs. 17a–d) are anterior ethmoid air cells that pneumatize the frontal recess above the agger nasi cell. They may be:

O a single small cell above the agger nasi cell,O multiple small cells above the agger nasi cell,O a single large cell above the agger nasi cell

extending to the frontal sinus,O a single small cell inside the frontal sinus.

Larger sized frontal cells may compromise the naso frontal pathway.Fig. 17a

Single small left frontal cell (schematic depiction, coronal view).

Agger nasi cell

Frontal cell

Fig. 17cSingle large left frontal cell (schematic depiction, coronal view).

Agger nasi cell

Frontal cell

Fig. 17dSingle small frontal cell inside the left frontal sinus (schematic depiction, coronal view).

Frontal cell

Fig. 17bMultiple small left frontal cells (schematic depiction, coronal view).

Frontal cell

Agger nasi cell


1.18 Middle Turbinate

Viewed from anterior, the middle turbinate is charac-terized by a conchal head, conchal neck, and conchal sinus. The conchal sinus is the cavity between the ethmoidal bulla and the middle turbinate (Fig. 18a). In a far anterior position, the structure is attached to the ethmoid crest of the maxillary bone and agger nasi cell. Far posteriorly, the structure is attached to the ethmoid crest of the perpendicular plate of the palatine bone. The middle turbinate consists of three discernible components (Fig. 18b): the first part in an anterior and medial position exhibits a sagittal plane and is attached vertically to the skull base, superiorly between the cribriform plate and the lateral lamella (Fig. 18c). Fig. 18a

Left middle turbinate (endoscopic view).

Conchal neck

Conchal sinus

Conchal head Bulla ethmoidalis

Middle turbinate

Fig. 18bLeft middle turbinate seen from its medial aspect (schematic depiction).

3rd2nd 1st

Posterior Middle Anterior

Fig. 18cFirst (anterior) part of the left middle turbinate (schematic depic tion, coronal view).

Crista galli

Olfactory fossa

Nasal septum Perpendicular plate of the ethmoid

Cribriform plate

Fovea ethmoidalisLateral lamella


Middle turbinate (1st, anterior part)


The second part is located in the middle of the struc-ture, exhibits a frontal plane, and is attached laterally to the lamina papy ra cea in an oblique fashion (Fig. 18d). This part of the middle turbinate is termed the basal lamella. The third part is located posteriorly, exhibits a horizontal plane and is attached laterally to the perpendicular plate of palatine bone. It forms the roof of the post erior part of the middle meatus (Fig. 18e).

Fig. 18eThird (posterior) part of the left middle turbinate (schematic depiction, coronal view).


Superior meatus

Superior turbinate

Middle turbinate3rd posterior part

Posterior ethmoid

Fig. 18dSecond (middle) part of the left middle turbinate (schematic depiction, axial view).

Superior turbinate

1st part of the middle turbinate

2nd part of the middle turbinate

Sphenoid sinus

Posterior ethmoid

Lamina papyracea

Bulla ethmoidalis

Uncinate process

Lacrimal sac

Agger nasi cell

Part Location Plane Attachment

First (anterior) Sagittal Skull base

Second (middle) Frontal Lamina papyracea

Third (posterior) Horizontal Perpendicular plate of the palatine bone


1.19 Basal Lamella

The basal lamella constitutes the middle portion of the middle turbinate and is an important landmark. It separates the anterior and posterior ethmoid air cells (Fig. 19a) and can be visualized by insinuating the endoscope between the middle turbinate and the ethmoidal bulla (Fig. 19b). The boundaries of the basal lamella are defined as follows (Figs. 19a–c):

O Superiorly: skull base (fovea ethmoidalis).O Laterally: lamina papyracea.O Inferiorly: the attachment of the third (posterior)

part of the middle turbinate to the basal lamella.O Medially: the attachment of the first (anterior)

part of the middle turbinate to the basal lamella.

Fig. 19bLeft basal lamella seen through the middle meatus (endoscopic view).

Skull base (Fovea ethmoidalis)

Middle turbinate

Bulla ethmoidalis

Basal lamella

Fig. 19cLateral and medial attachments of the basal lamella (schematic depiction, axial view).

Superior turbinate

Basal lamella

Sphenoid sinus

Posterior ethmoid

Lamina papyracea

Bulla ethmoidalisAnterior part of the middle turbinate

Fig. 19aSecond (middle) part of left middle turbinate (basal lamella) separates the anterior and the posterior ethmoids (schematic depiction).

Posterior ethmoid Anterior ethmoid

E

Basal lamella


Fig. 21bRoof of posterior ethmoid (schematic depiction, coronal view).

Skull base

Superior turbinate

Nasal septum

Posterior ethmoid

Fig. 20Ethmoid labyrinth (schematic depiction, coronal view).

Nasal septum (perpendicular plate of ethmoid)

Middle turbinate

Frontal bone

Ethmoid bone

Fig. 21aRoof of anterior ethmoid (schematic depiction, coronal view).

Crista galli

Olfactory fossa

Cribriform plate

Nasal septumPerpendicular plate of ethmoid

Fovea ethmoidalis

Lateral lamella

Middle turbinate

1.20 Ethmoid Labyrinth

The ethmoid labyrinth is composed of the frontal bone superiorly and ethmoid bone inferiorly, and contains the ethmoid air cells (Fig. 20).

1.21 Roof of the Ethmoids

The roof of the anterior ethmoids is composed of the frontal bone superiorly and laterally (this part is termed the fovea ethmoidalis) and the ethmoid bone inferiorly and medially (this part is termed lateral lamella of the cribriform plate). Part of the frontal bone, the fovea ethmoidalis is a thick bone (0.5 mm on average), whereas the lateral lamella is a rather thin (0.2 mm on average) part of the ethmoid bone. It should be noted that the dura of the anterior cranial fossa is relatively thin and adheres to the skull base. The roof of the anterior ethmoid has a stepladder-like appearance, whereas the roof of the posterior ethmoid is flat (Figs. 21a, b).

1.22 Lateral Lamella

The lateral lamella is thinnest at the location of the anterior ethmoid arterial passage, averaging 0.05 mm (i.e. 1/10 of the thickness of the fovea ethmoidalis), which is why this is the most common location for iatrogenic CSF leakage (Fig. 21a).

1.23 Cribriform Plate

The cribriform plate is perforated by the olfactory nerve fibers. The structure is attached to the crista galli and the perpendicular plate of the ethmoid bone medially, and to the neck of the middle turbinate and the lateral lamella laterally (Fig. 21a).


1.24 Olfactory Fossa

The olfactory fossa is located between the crista galli medially, cribriform plate inferiorly, and the later al lamella laterally. The olfactory bulb is located here. The structure may be deep or shallow, depending on the length of the lateral lamella (Figs. 24a–c), a factor which also determines the difference in level between the cribriform plate and fovea ethmoidalis (ranging from 1–16 mm) (Figs. 24d). The step ladder appearance of the anterior ethmoid roof, as defined by computed tomography, should always be born in mind during endoscopic sinus surgery, especially in contrast to the roof of the posterior ethmoid, which is flat and consists of frontal bone. Fig. 24a

Shallow olfactory fossa (1-3 mm) due to the absence of a lateral lamella.

Crista galli

Olfactory fossa

Cribriform plate

Fovea ethmoidalis


Middle turbinate

Perpendicular plate of ethmoid

Fig. 24bOlfactory fossa of average size (4-7 mm).

Crista galli

Olfactory fossa

Cribriform plate

Fovea ethmoidalis

Lateral lamella


Middle turbinate


Fig. 24cDeep olfactory fossa (8–16 mm).

Crista galli

Olfactory fossa

Fovea ethmoidalis


Lateral lamella

Middle turbinate


Cribriform plate

Cribriform plate

Fig. 24dThe roof of the ethmoid (green arrow) is usually situated at a higher level than the cribriform plate (red arrow) (ranging from 1-16 mm) (schematic depiction, coronal view).

Middle turbinate

Fovea ethmoidalis


1.25 Posterior Ethmoid Cells

The posterior ethmoid cells are larger in size and fewer in number than the anterior ethmoid cells. Posterior ethmoid cells have the following anatomical relation-ships:

O Anteriorly: the basal lamella (middle third of the middle turbinate) separates the posterior ethmoid cells from their anterior counterparts;

O Posteriorly: the anterior wall of the sphenoid sinus separates the posterior ethmoid cells from the sphenoid sinus;

O Laterally: the lamina papyracea separates the posterior ethmoid cells from the orbit;

O Medially: superior meatus and superior turbinate (Fig. 25a);

O Superiorly: the flat fovea ethmoidalis separates the posterior ethmoid cells from the anterior cranial fossa;

O Inferiorly: posterior part of the middle turbinate (Fig. 25b).

Fig. 25bLeft posterior ethmoids (schematic depiction, coronal view).

Spheno- ethmoidal recess

Superior meatus

Lamina papyracea

Posterior ethmoid

Middle turbinate 3rd (posterior) part

Skull base

Fig. 25aLeft posterior ethmoids (schematic depiction, axial view).

Sphenoid sinus

Posterior ethmoid

Basal lamella

Bulla ethmoidalis

E

E

Superior turbinate

Middle turbinate


The posterior ethmoid cells are often found to be the cause of potential complications during endoscopic sinonasal surgery (orbital, cranial and/or bleeding) resulting from the following:

O the optic nerve is too close to the posterior ethmoid air cells.

O the medial rectus muscle is closer to the poster ior ethmoid than to the anterior ethmoid, orbital fat being thinner here (Fig. 25c).

O the posterior ethmoid artery is located in the roof of the posterior ethmoid sinus just anterior to the anterior wall of the sphenoid sinus (Fig. 25d).

O the sphenoid sinus is located behind and below the posterior ethmoid air cells (Fig. 25e).

Fig. 25cLeft posterior ethmoids (schematic depiction, axial view).

Sphenoid sinus

Posterior ethmoid

Optic nerve

Medial rectus

Orbital fat

Fig. 25ePosterior ethmoid is in a higher position than the sphenoid sinus (schematic depiction, sagittal plane).

Sphenoid Posterior ethmoidAnterior ethmoid

Fig. 25dAnterior and posterior ethmoid arteries (schematic depiction, sagittal plane).

Sphenoid Posterior ethmoid Anterior ethmoid

Posterior ethmoid artery

E



1.26 Sphenoethmoidal Cell (Onodi Cell)

The Onodi cell is a lateral and superior extension of the posterior ethmoids (relative to the position of the sphenoid sinus) and arises from hyperpneumatization of the posterior ethmoid air cells. This structure is very often closely related to the optic nerve and/or internal carotid artery (Figs. 26a–d).

Fig. 26aLeft sphenoethmoidal cell (Onodi cell) (schematic depiction, axial view). Red arrow indicates lateral and posterior hyper pneumatization of the posterior ethmoids.

Sphenoid sinus

Spheno- ethmoidal cell (Onodi cell)

Posterior ethmoid

Bulla ethmoidalis

Superior turbinate

Middle turbinate

Fig. 26 cLeft sphenoethmoidal cell (Onodi cell) and optic nerve (schematic depiction, axial view).

Sphenoid sinus

Sphenoethmoidal cell (Onodi cell)

Posterior ethmoid

Optic nerve

Fig. 26dLeft sphenoethmoidal cell (Onodi cell) and optic nerve (schematic depiction, coronal view).

Right optic nerve

Left optic nerve

Spheno-ethmoidal cell

Sphenoid sinuses

Fig. 26bLeft sphenoethmoidal cell (Onodi cell) (schematic depiction, sagittal view). Red arrow indicates superior and posterior hyperpneumatization of the posterior ethmoids.

Sphenoid Posterior ethmoid

Sphenoethmoidal cell

t


1.27 Sphenopalatine Foramen

The sphenopalatine foramen is located behind the posterior end of the middle turbinate and is formed by the following structures:

The sphenopalatine foramen leads to the pterygo-palatine fossa, which forms the exit of the nasal neuro-vascular bundle (Fig. 27).

1.28 Sphenoid Sinus

Three different types of sphenoid sinus are classified on the basis of pneumatization, namely conch al, presellar, and sellar types. The spatial relationship of the struc-ture is as follows:

O Superiorly: anterior cranial fossa; O Anteriorly: spheno-ethmoid recess, superior

tur bi nate, and posterior ethmoids (Fig. 28b); O Medially: sphenoid septum or septae which may

differ in location, direction, number, thickness, and attachment to other structures;

O Inferiorly: nasopharynx; O Posteriorly: basi-sphenoid, sella, posterior cranial

fossa; O Laterally: middle cranial fossa and cavernous

sinus (Fig. 28c).

Fig. 27Right sphenopalatine foramen (schematic depiction, sagittal view).

Sphenopalatine foramen

Fig. 28cLeft sphenoid sinus (schematic depiction, coronal view).

Sphenoid septum

Nasopharynx

Anterior cranial fossa

Middle cranial fossa

Fig. 28aThe three types of the sphenoid sinus: conchal, presellar and sellar (schematic depiction, sagittal view).

Anterior cranial fossa

Posterior cranial fossa

Fig. 28bLeft sphenoid sinus anterior and inferior relationships (endo scopic view).

Naso-pharynx

Middle turbinate

Posterior ethmoid

Spheno-ethmoidal recess

Superior turbinate

Sphenoid ostium

Nasal septum

O Superiorly: sphenoid bone.O Posteriorly: sphenoid process of the palatine

bone. O Anteriorly: ethmoid process of the palatine bone. O Inferiorly: palatine bone.


1.29 Neurovascular Relationships of the Sphenoid Sinus

The sphenoid sinus is situated in close structural proximity to the following structures:

The infraoptic recess is situated between the optic nerve and the internal carotid artery. Its size and depth depend on the degree of pneumatization of the anterior clenoid process (Figs. 29a, b).

1.30 The Sphenoid Sinus Ostium

The sphenoid sinus ostium opens into the sphenoethmoidal recess. It is located just medial to the posterior end of the superior turbinate and can be identified by tracing the roof of the nasopharynx, forming the floor of the sphenoid sinus, through the choana to the anterior wall of the sphenoid. The structure is located between the nasal septum and the inferior part of the superior turbinate (Fig. 30).

Fig. 29aNeurovascular relationships of the left sphenoid sinus (schematic depiction, coronal view).

Infraoptic recess

Vidian nerve (Vidian canal)

Pharyngeal branch (Palatinovaginal canal)

Optic nerve (Optic canal)

Carotid artery (Cavernous sinus)

Maxillary nerve (Foramen rotundum)

Fig. 30Left sphenoid ostium (endoscopic view).

Sphenoid sinus

Superior turbinate

Sphenoid ostium

Nasal septum

Posterior ethmoid

Middle turbinate

Choana

Fig. 29bThe left sphenoid sinus (endoscopic view).

Infraoptic recess

Sphenoid septum

Posterior wall

Sella

Internal carotid artery

Optic nerve

O Optic nerve inside the nerve canal (6% incidence of bony dehiscence).

O Internal carotid artery inside the cavernous sinus (20% incidence of bony dehiscence).

O Maxillary nerve in the foramen rotundum.O Vidian nerve inside the pterygoid canal.


1.31 Nasopharynx

The examiner should identify the following structures in the nasopharynx:

1.32 Nasal ChoanaThe following structures demarcate the posterior nasal aperture (the nasal choana):

O Inferiorly: nasal floor.O Medially: nasal septum.O Superiorly: sphenoid sinus.O Laterally: medial pterygoid plate (Fig. 32).

Fig. 32Boundaries of the left choana (endoscopic view).

Medial pterygoid plate

Nasal floor

Sphenoid sinus

Nasal septum

Left choana

Fig. 31View of the nasopharynx through the left nasal cavity (endo scopic view).

Left Eustachian tube

Orifice of the auditory tube

Roof

Posterior wall

Left fossa of Rosenmüller

Nasal septum

E

E

Right Eustachian tube

O Ipsilateral Eustachian tube.O Ipsilateral fossa of Rosenmüller.O Roof of the nasopharynx.O Posterior wall of the nasopharynx.O Contralateral fossa of Rosenmüller.O Contralateral Eustachian tube (Fig. 31).


1.33 Anatomic Variations

The examiner must be aware that a large number of anatomic variations is encountered in this area, most commonly:

O Concha bullosa: pneumatized head of the middle turbinate (Fig. 33a).

O Interlamellar cell: pneumatized vertical lamella of the middle turbinate (Fig. 33b).

O Paradoxically bent middle turbinate: reversed C-shape of the middle turbinate (Fig. 33c).

O Medially bent uncinate process (Fig. 33d).

Fig. 33cLeft paradoxically bent middle turbinate.

Fig. 33dLeft medially bent uncinate process.

Fig. 33aLeft concha bullosa.

t

Fig. 33bLeft interlamellar air cell.

t

t

t


O Large bulla ethmoidalis (Fig. 33e)O Unpneumatized bulla ethmoidalis: the bulla

ethmoidalis is represented by a bony projection from the lamina papyracea termed torus lateralis (Fig. 33f).

O Infraorbital ethmoid cell (Haller cell): this is an ethmoid air cell positioned inferior and lateral to the ethmoid bulla and closely related to the maxillary sinus ostium and the infundibulum (Fig. 33g).

O Hypoplastic or aplastic maxillary sinus: in this variation, the maxillary sinus is smaller or non-existent, the adjacent maxillary bone is thicker, the uncinate process is hypoplastic and laterally dislocated and the ethmoid infundibulum is accordingly atelectatic (Fig. 33h).

Fig. 33eLeft large bulla ethmoidalis.

Fig. 33fLeft unpneumatized bulla ethmoidalis (torus lateralis).

t

t

Fig. 33gLeft Haller cell (schematic depiction, coronal view).

t

Haller cell

Fig. 33hRight hypoplastic maxillary sinus (schematic depiction, coronal view).

Uncinate process

Maxillary bone

t

Maxillary sinus


Fig. 34Possible orbital and intra-cranial complications of endoscopic sinonasal surgery (schematic depiction, coronal view).

cranial

Orbit

1 MESSERKLINGER, W: Endoscopy of the Nose. Urban & Schwarzenberg, 1978.

2 STAMMBERGER, H; HAWKE, M: Essentials of Functional Endoscopic Sinus Surgery. Mosby: Stamathis, G. (Publ.); Hurley, R. (Ed.), 1993

3 HOSEMANN, W G; WEBER, R K; KEERL, R E; LUND, V J: Minimally Invasive Endonasal Sinus Surgery. Thieme, 2000.

4 KENNEDy, D W; BOLGER, W B; ZINREICH, S J: Diseases of the Sinuses. Diagnosis and Management. B. C. Decker Inc., 2000.

Suggested Reading

ConclusionA detailed and thorough understanding of the anatomy of the lateral nasal wall, ostiomeatal complex and anterior skull base is mandatory for conducting safe and effective surgery. Orbital and intracranial compli-cations may result from any injury or damage inflicted on the sinonasal framework laterally and/or superiorly, a factor which should always be treated with respect during endoscopic sinus surgery (Fig. 34).


Instrument Sets for Endoscopic Diagnosis and Surgeryof the Lateral Nasal Wall,

Ostiomeatal Complex and Anterior Skull Base

as recommended by Prof. Reda KAMEL, M.D.

Telescopes, Instruments and AccessoriesCold Light Fountains and Imaging Systems

for Video Documentation


Diagnostic Endoscopy SetRecommended Set according to Prof. Reda KAMEL, M. D.

7229 BA7229 BA

723750 B

400500

203720

203730

15006 B586025203720 203730

7230 BWA 7230 BWA

456001 B

456501 B 456001 B

It is recommended to check the suitability of the product for the intended procedure prior to use.


Diagnostic Endoscopy SetRecommended Set according to Prof. Reda KAMEL, M. D.

7230 BWA 1 HOPKINS® Wide Angle Forward-Oblique Telescope 30°, enlarged view, diameter 4 mm, length 18 cm, autoclavable, fiber optic light transmission incorporated, color code: red15006 B 1 “ULTRA STOP” Antifog Solution, 25 ml, pipette bottle723750 B 1 Protection Tube, working length 19.7 cm, for use with HOPKINS® telescopes with length 18 cm 400500 1 HARTMANN Nasal Speculum, for adults, length 13 cm430300 1 LUBET-BARBON Nasal Dressing Forceps, serrated, working length 10.5 cm456001 B 1 BLAKESLEY RHINOFORCE® II Nasal Forceps, straight, size 1, with cleaning connector, working length 13 cm456501 B 1 BLAKESLEY-WILDE RHINOFORCE® II Nasal Forceps, 45° upturned, size 1, with cleaning connector, working length 13 cm203720 1 Suction Tube, cylindrical, LUER, outer diameter 2 mm, working length 9 cm203730 1 Same, outer diameter 3 mm, working length 11 cm 586025 1 v. EICKEN Antrum Cannula, LUER-Lock, long curved, outer diameter 2.5 mm, length 12.5 cm

Optional Telescope for Diagnosis in Children

7229 BA 1 HOPKINS® Forward-Oblique Telescope 30°, enlarged view, diameter 2.7 mm, length 18 cm, autoclavable, fiber optic light transmission incorporated, color code: red

723750 B 1 Protection Tube, working length 19.7 cm, for use with HOPKINS® telescopes with length 18 cm


Endoscopic Sinonasal Surgery SetRecommended Set according to Prof. Reda KAMEL, M. D.

723750 B

723770

723005 A 15006 B

7230 AA

455010 459010

651410

651410

651415449002


Endoscopic Sinonasal Surgery SetRecommended Set according to Prof. Reda KAMEL, M. D.

7230 AA 1 HOPKINS® Straight Forward Telescope 0°, enlarged view, diameter 4 mm, length 18 cm, autoclavable, fiber optic light transmission incorporated, color code: green723750 B 1 Protection Tube, working length 19.7 cm, for use with HOPKINS® telescopes with length 18 cm723770 1 STAMMBERGER Telescope Handle, flat, standard model, length 11 cm, for use with HOPKINS® straight forward telescopes 0° with diameter 4 mm and length 18 cm810506 1 Septum Needle, angular, LUER-Lock628001 1 Sickle Knife, pointed, length 19 cm474000 1 FREER Elevator, double-ended, semisharp and blunt, length 20 cm456001 B 1 BLAKESLEY RHINOFORCE® II Nasal Forceps, straight, size 1, with cleaning connector, working length 13 cm456501 B 1 BLAKESLEY-WILDE RHINOFORCE® II Nasal Forceps, 45° upturned, size 1, with cleaning connector, working length 13 cm723005 A 1 Trocar for Sinoscopy, with beak, outer diameter 5 mm, length of the cannula 8.5 cm, for use with HOPKINS® telescopes with diameter 4 mm629820 1 Probe, double-ended, maxillary sinus ostium seeker, ball-shaped ends diameter 1.2 and 2 mm, length 19 cm459010 1 STAMMBERGER RHINOFORCE® II Antrum Punch, upside backward cutting, with cleaning connector, working length 10 cm651410 1 KAMEL Punch, 30° upturned, punch head diameter 4.5 mm, circular cutting, with cleaning connector, working length 13 cm651415 1 Same, 45° upturned457712 1 KAMEL Nasal Forceps, 45° upturned, cupped jaws 20 x 4 mm, working length 11 cm455010 1 STRUYCKEN RHINOFORCE® II Nasal Cutting Forceps, with cleaning connector, working length 13 cm449002 1 HEYMANN Nasal Scissors, medium, (standard model), working length 9.5 cm203720 1 Suction Tube, cylindrical, LUER, outer diameter 2 mm, working length 9 cm203730 1 Same, outer diameter 3 mm, working length 11 cm586030 1 v. EICKEN Antrum Cannula, LUER-Lock, long curved, outer diameter 3 mm, length 12.5 cm586040 1 Same, outer diameter 4.0 mm15006 B 1 “ULTRA-STOP” Antifog Solution, 25 ml pipette bottle

629820 474000

456001 B

456501 B

456001 B

628001586030 586040

203720 203730

810506

457712


Additional Surgical Instruments and AccessoriesRecommended Set according to Prof. Reda KAMEL, M. D.

451001 B–451501 B

451001 B

451501 B

456801 B

449201

648521

456001 B 456502 B

456001 B

456502 B

449201

7230 FA/CA7230 FA

7230 CA

723750 B

723772

455500 B



7230 FA 1 HOPKINS® Forward-Oblique Telescope 45°, enlarged view, diameter 4 mm, length 18 cm, autoclavable, fiber optic light transmission incorporated, color code: black7230 CA 1 HOPKINS® Lateral Telescope 70°, enlarged view, diameter 4 mm, length 18 cm, autoclavable, fiber optic light transmission incorporated, color code: yellow723750 B 1 Protection Tube, working length 19.7 cm, for use with HOPKINS® telescopes with length 18 cm723772 1 STAMMBERGER Telescope Handle, round, standard model, length 11 cm, for use with HOPKINS® telescopes 30° – 120° with diameter 4 mm and length 18 cm451001 B 1 GRÜNWALD-HENKE RHINOFORCE® II Nasal Forceps, straight, through-cutting, tissue-sparing, BLAKESLEY shape, size 1, width 3.5 mm, with cleaning connector, working length 13 cm451501 B 1 GRÜNWALD-HENKE RHINOFORCE® II Nasal Cutting Forceps, 45° upturned, through-cutting,

tissue-sparing, BLAKESLEY shape, size 1, width 3.5 mm, with cleaning connector, working length 13 cm

455500 B 1 TAKAHASHI Nasal Forceps, straight, working length 11 cm456001 B 1 BLAKESLEY RHINOFORCE® II Nasal Forceps, straight, size 1, with cleaning connector, working length 13 cm456502 B 1 BLAKESLEY-WILDE RHINOFORCE® II Nasal Forceps, 45° upturned, size 2, with cleaning connector, working length 13 cm456801 B 1 BLAKESLEY-WILDE RHINOFORCE® II Nasal Forceps, 90° upturned, size 1, with cleaning connector, working length 13 cm457711 1 KAMEL Nasal Forceps, 45° upturned, cupped jaws 12 x 4 mm, working length 11 cm651050 1 STAMMBERGER Punch, circular cutting, for sphenoid, ethmoid and choanal atresia, diameter 4.5 mm, with cleaning connector, working length 18 cm651415 1 KAMEL Punch, 45° upturned, punch head diameter 4.5 mm, circular cutting, with cleaning connector, working length 13 cm648521 1 McKENTY Sphenoid Punch, through-cutting, reversible, size 1.6 x 2 mm, working length 17 cm449201 1 RHINOFORCE® II Nasal Scissors, straight, with cleaning connector, working length 13 cm

Set continued overleaf.

457711

651050

651415

651410


Additional Surgical Instruments and AccessoriesRecommended Set according to Prof. Reda KAMEL, M. D.Continued from page 41.

203740 479800 628701

1/1

628712

628720

634840 745900

839310 N

843219

629830



203740 1 Suction Tube, cylindrical, LUER, outer diameter 4 mm, working length 11 cm479800 1 Suction Raspatory, with stylet, length 19.5 cm628701 1 Antrum Curette, round, length 19 cm628712 1 KUHN-BOLGER Frontal Sinus Curette, 55° curved, oval, forward cutting, length 19 cm628720 1 Curette, double-ended, oval, one side short curved 45°, semisharp, diameter 2.2 mm, other side long curved 90°, sharp, diameter 2.7 mm, length 19 cm629830 1 KUHN Frontal Sinus Seeker, double-ended, No. 6, both sides curved 77°, one tip straight, other tip reverse angle, length 22 cm634840 1 BOWMAN Lachrymal Probe, length 13 cm, including: Probe, size 0000 – 000 Probe, size 00 – 0 Probe, size 1 – 2745900 1 WILDER Dilator, for salivary duct, length 11 cm839310 N 1 Suction Cannula, for nose, straight, outer diameter 3 mm, working length 10 cm26005 M 1 Unipolar High Frequency Cord, with 5 mm plug for AUTOCON® II 400 SCB system (111, 115, 122, 125), AUTOCON® II 200, AUTOCON® II 80, KARL STORZ AUTOCON® system (50, 200, 350) and Erbe type ICC, length 300 cm843219 1 Bipolar Coagulation Forceps, insulated, angular, blunt, with integrated suction channel for epistaxis, with cut-off hole, length 19 cm, for use with Bipolar High Frequency Cords 847000 or 847000 A/E/M/V847000 E 1 Bipolar High Frequency Cord, for AUTOCON® II 400 SCB systems (111, 113, 115, 122, 125), AUTOCON® II 200, AUTOCON® II 80, KARL STORZ Coagulator 26021 B/C/D, 860021 B/C/D, 27810 B/C/D, 28810 B/C/D, AUTOCON® systems (50, 200, 350), Erbe-Coagulator, T and ICC series, length 300 cm

649614 L Standard Straight Shaft Burr, stainless, length 12.5 cm, size 014, diameter 1.4 mm

649618 L Same, size 018, diameter 1.8 mm649631 L Same, size 031, diameter 3.1 mm649640 L Same, size 040, diameter 4.0 mm

649714 L Diamond Straight Shaft Burr, length 12.5 cm, size 014, diameter 1.4 mm

649718 L Same, size 018, diameter 1.8 mm649731 L Same, size 031, diameter 3.1 mm649740 L Same, size 040, diameter 4.0 mm

252572 INTRA Drill Handpiece, angled, length 18 cm, transmission 1:1 (40,000 rpm), for use with KARL STORZ high-performance EC micro motor II and burrs

280053 Universal Spray, 6x 500 ml bottles, – HAZARDOUS GOODS – UN 1950,

including: Universal Spray, 500 ml Spray Nozzle

252572


KARL STORZ CLEARVISION® II Systemfor intra-operative irrigation of the telescope lens

U N I T S I D E

P A T I E N T S I D E

Irrigation sheath

20 0142 30

One-pedal footswitch

40 3341 40

40 3341 01 KARL STORZ CLEARVISION® II Set, Lens irrigation system for telescopes, power supply: 100–240 VAC, 50–60 Hz

including: CLEARVISION® II Mains Cord One-pedal Footswitch Silicone Tubing Set

Siliconetubing set*

7230 FS

)*Optional Accessories:MTP 031229-10 Single-use tubing set. For use with KARL STORZ CLEARVISION® II. Sterile, 10 per pack

Submit your order to: mtp medical technical promotion gmbh, Take-Off GewerbePark 46, D-78579 Neuhausen ob Eck, Germany

*


KARL STORZ CLEARVISION® IIIrrigation Sheath for use with CLEARVISION® II System

Irrigation Sheath, proximally reinforced for use with Adjustable Holder 28272 RKB

Compatible HOPKINS® Telescopes

Detail Order No. Outer Diameter

Working length Order No. View Outer

DiameterWorking length

7230 AS 4.8 x 6.0 mm 14 cm 7230 AA 0° 4.0 mm 18 cm

7230 BS 4.8 x 6.0 mm 14 cm 7230 BA 30° 4.0 mm 18 cm

7230 FS 4.8 x 6.0 mm 14 cm 7230 FA 45° 4.0 mm 18 cm

7230 CS 4.8 x 6.0 mm 14 cm 7230 CA 70° 4.0 mm 18 cm

7220 AS 3.7 x 4.8 mm 10 cm 7220 AA 0° 3.0 mm 14 cm

7220 BS 3.7 x 4.8 mm 10 cm 7220 BA 30° 3.0 mm 14 cm

7220 FS 3.7 x 4.8 mm 10 cm 7220 FA 45° 3.0 mm 14 cm

7220 CS 3.7 x 4.8 mm 10 cm 7220 CA 70° 3.0 mm 14 cm

7219 AS 3.5 x 4.7 mm 14 cm 7229 AA 0° 2.7 mm 18 cm

7219 BS 3.5 x 4.7 mm 14 cm 7229 BA 30° 2.7 mm 18 cm

7219 FS 3.5 x 4.7 mm 14 cm 7229 FA 45° 2.7 mm 18 cm

7219 CS 3.5 x 4.7 mm 14 cm 7229 CA 70° 2.7 mm 18 cm

7230 AES 4,8 x 6 mm 14 cm 7230 AE 15°– 90° 4 mm 18 cm


UNIDRIVE® S III ENT SCB/UNIDRIVE® S III ECOThe multifunctional unit for ENT

UNIDRIVE® S III ENT SCB UNIDRIVE® S III ECO

Touch Screen: Straightforward function selection via touch screen

Optimized user control due to touch screen

Set values of the last session are stored

Choice of user languages

Operating elements are single and clear to read due to color display

One unit – multifunctional: – Shaver system for surgery of the paranasal sinuses and anterior skull base– INTRA Drill Handpieces (40,000 rpm and 80,000 rpm)– Sinus Shaver– Micro Saw– STAMMBERGER-SACHSE Intranasal Drill– Dermatome– High-Speed Handpieces (60,000 rpm and 100,000 rpm)

Two motor outputs: Two motor outputs for simultaneous connection of two motors: For example, a shaver and micro motor

Integrated irrigation and coolant pump:– Absolutely homogeneous, micro-processor controlled irrigation rate throughout

the entire irrigation range– Quick and easy connection of the tubing set

Easy program selection via automated motor recognition

Irrigator rod included

Continuously adjustable revolution range

Maximum number of revolutions and motor torque: Microprocessor-controlled motor rotation speed. Therefore the preselected parameters are maintained throughout the drilling procedure.

Maximum number of revolutions can be preset

SCB model with connections to the KARL STORZ Communication Bus (KARL STORZ-SCB)

l –

l l

l –

Special Features:

l –

l –

l l

l l

l –

l –

l l

l l

l –

l l

l l

l l

l –

Soft start function

Textual error messages l –

UN

IDR

IVE

® S

III

EC

O

UN

IDR

IVE

® S

III

EN

T S

CB


Motor SystemsSpecifications


Touch Screen: 6,4" / 300 cd/m2

Weight: 5.2 kg 4.7 kg

Certified to: IEC 601-1 CE acc. to MDD IEC 60601-1

Available languages: English, French, German, numerical codes Spanish, Italian, Portuguese, Greek, Turkish, Polish, Russian

System specifications

Mode Order No. rpm

Shaver mode oscillating Operation mode: in conjunction with Handpiece: Max. rev. (rpm): DrillCut-X® II Shaver Handpiece 40 7120 50 10,000*

DrillCut-X® II N Shaver Handpiece 40 7120 55 10,000*

Sinus burr mode rotating Operation mode: in conjunction with Handpiece: Max. rev. (rpm): DrillCut-X® II Shaver Handpiece 40 7120 50 12,000

DrillCut-X® II N Shaver Handpiece 40 7120 55 12,000

High-speed drilling mode counterclockwise or clockwise Operation mode: in conjunction with: Max. rev. (rpm): High-Speed Micro Motor 20 7120 33 60,000/100,000

Drilling mode counterclockwise or clockwise Operation mode: in conjunction with: Max. rev. (rpm): micro motor 20 7110 33 40,000/80,000

and connecting cable 20 7111 73

Micro saw mode in conjunction with: Max. rev. (rpm): micro motor 20 7110 33 15,000/20,000

and connecting cable 20 7111 73

Intranasal drill mode in conjunction with: Max. rev. (rpm): micro motor 20 7110 33 60,000 and connecting cable 20 7111 73

Dermatome mode in conjunction with: Max. rev. (rpm): micro motor 20 7110 33 8,000 and connecting cable 20 7111 73

Power supply: 100 – 240 VAC, 50/60 Hz

Dimensions: 300 x 165 x 265 mm (w x h x d)

Two outputs for parallel connection of two motors

Integrated irrigation pump: Flow: adjustable in 9 steps

* Approx. 4,000 rpm is recommended as this is the most efficient suction/performance ratio.

[ ]

[ ]

[ ]

[ ]


Motor SystemsSpecial features of high-performance EC micro motor IIand of the high-speed micro motor

l Self-cooling, brushless high-performance EC micro motor

l Smallest possible dimensionsl Autoclavablel Reprocessable in a cleaning machinel Detachable connecting cable

## INTRA coupling for a wide variety of applications

## Maximum torque 4 Ncm## Number of revolutions continuously adjustable up to 40.000 rpm

## Provided a suitable handle is used, the number of revolutions is continuously adjustable up to 80,000 rpm

20 7110 33

20 7110 33 High-Performance EC Micro Motor II, for use with UNIDRIVE® II/UNIDRIVE® ENT/OMFS/NEURO/ECO and Connecting Cable 20 7110 73, or for use with UNI-DRIVE® S III ENT/ECO/NEURO and Connecting Cable 20 7111 73

Special features of high-performance EC micro motor II:

l Brushless high-speed micro motorl Smallest possible dimensionsl Autoclavablel Reprocessable in a cleaning machinel Maximum torque 6 Ncm

## Maximum torque 6 Ncm## Number of revolutions continuously adjustable up to 60.000 rpm

## Provided a suitable handle is used, the number of revolutions is continuously adjustable up to 100,000 rpm

Special Features of the high-speed micro motor:

20 7120 33

20 7120 33 High-Speed Micro-Motor, max. speed 60,000 rpm, including connecting cable, for use with UNIDRIVE® S III ENT/NEURO

20 7111 73 Connecting Cable, to connect High-Performance EC Micro Motor 20 7110 33 to UNIDRIVE® S III ENT/ECO/NEURO


UNIDRIVE® S III ENT SCB UNIDRIVE® S III ECORecommended System Configuration

* mtp medical technical promotion gmbh, Take-Off GewerbePark 46, D-78579 Neuhausen ob Eck, Germany

40 7016 20-1 40 7014 20

40 7016 01-1 UNIDRIVE® S III ENT SCB, motor control unit with color display, touch screen, two motor outputs, integrated irrigation pump and SCB module, power supply 100 – 240 VAC, 50/60 Hz

including: Mains Cord Irrigator Rod Two-Pedal Footswitch, two-stage, with proportional function Silicone Tubing Set, for irrigation, sterilizable Clip Set, for use with silicone tubing set SCB Connecting Cable, length 100 cm Single Use Tubing Set*, sterile, package of 3


Specifications:

Touch Screen

Flow

Power supply

UNIDRIVE® S III ENT SCB: 6,4"/300 cd/m2

9 steps

100-240 VAC, 50/60 Hz

Dimensions w x h x d

Weight

Certified to

300 x 165 x 265 mm

5.2 kg

EC 601-1, CE acc. to MDD

40 7014 01 UNIDRIVE® S III ECO, motor control unit with two motor outputs and integrated irrigation pump, power supply 100 – 240 VAC, 50/60 Hz

including: Mains Cord Two-Pedal Footswitch, two-stage, with proportional function Silicone Tubing Set, for irrigation, sterilizable Clip Set, for use with silicone tubing set


DrillCut-X® II N Shaver Handpiece, optional adaptability to Shaver Tracker, for use with UNIDRIVE® S III ECO/ENT/NEURO

40 7120 55

20 7116 40

Silicone Tubing Set

U N I T S I D E

P A T I E N T S I D E

Shaver Blade

41305 DN

Shaver Blade, curved

41201 KN

41302 KN

Sinus Burr

Two-Pedal Footswitch

20 0166 30

DrillCut-X® II Shaver Handpiece, for use with UNIDRIVE® S III ECO/ENT/NEURO

40 7120 50

252660 – 252692

High-Speed Handpiece

High-Speed Micro-Motor

20 7120 33

660000

Intranasal Drill

High-Performance EC Micro Motor II

20 7110 3320 7111 73

252575 – 252590

INTRA Drill Handpiece

UNIDRIVE® S III ENT SCB UNIDRIVE® S III ECOSystem Components


* mtp medical technical promotion gmbh, Take-Off GewerbePark 46, D-78579 Neuhausen ob Eck, Germany

Optional Accessoriesfor UNIDRIVE® S III ENT SCB and UNIDRIVE® S III ECO

031131-10* Tubing Set, for irrigation, for single use, sterile, package of 10

280053 C Spray Nozzle, for the reprocessing of INTRA burr handpieces, for use with Universal Spray 280053 B

280053 Universal Spray, 6x 500 ml bottles – HAZARDOUS GOODS – UN 1950 including: Spray Nozzle


Max. 10,000 rpm for shaver blades, max. 12,000 rpm for sinus shaver

Straight suction channel

Integrated irrigation channel

Powerful motor, also suitable for harder materials

Absolutely silent running, no vibration

Completely immersible and machine-washable

LOCK allows fixation of shaver blades and sinus shavers

Extremely lightweight design

Optional, ergonomic handle, detachable

Can be adapted to navigation tracker

l

Special Features:

l l

l

l

l

l

–

l

l

l

l

l

l

l

l

l

l

l

l

Dri

llCut

-X®

II

4071

2050

Dri

llCut

-X®

II N

40

7120

55

DrillCut-X® Shaver HandpiecesSpecial Features

40 7120 50 DrillCut-X® II Shaver Handpiece, for use with UNIDRIVE® S III ECO/ENT/NEURO/OMFS

40 7120 50

40 7120 55 DrillCut-X® II N Shaver Handpiece, optional adaptability to Shaver Tracker 40 8001 22, for use with UNIDRIVE® S III ECO/ENT/NEURO/OMFS

40 7120 55


DrillCut-X® II Shaver Handpiece

Special Features:l Powerful motorl Absolutely silent runningl Enhanced ergonomicsl Lightweight designl Oscillation mode for shaver blades,

max. 10,000 rpml Rotation mode for sinus shavers,

max. 12,000 rpml Straight suction channel and

integrated irrigation

40 7120 50 DrillCut-X® II Shaver Handpiece, for use with UNIDRIVE® S III ECO/ENT/NEURO/OMFS

40 7120 50

l The versatile DrillCut-X® II Shaver Handpiece can be adapted to individual needs of the user

l Easy hygienic processing, suitable for use in washer and autoclavable at 134 °C

l Quick coupling mechanism facilitates more rapid exchange of work inserts

l Proven DrillCut-X® blade portfolios can be used

40 7120 90

40 7120 90 Handle, adjustable, for use with DrillCut-X® II 40 7120 50 and DrillCut-X® II N 40 7120 55

41250 RA

41250 RA Cleaning Adaptor, LUER-Lock, for cleaning DrillCut-X® shaver handpieces

Optional Accessory:


DrillCut-X® II Shaver N Handpiece

Special Features:l Powerful motorl Absolutely silent runningl Enhanced ergonomicsl Lightweight designl Oscillation mode for shaver blades,

max. 10,000 rpml Rotation mode for sinus shavers,

max. 12,000 rpml Straight suction channel and integrated irrigationl The versatile DrillCut®-X II Shaver N Shaver

Handpiece can be adapted to the individual needs of the user

40 7120 55

40 7120 55 DrillCut-X® II N Shaver Handpiece, optional adaptability to Shaver Tracker 40 8001 22, for use with UNIDRIVE® S III ECO/ENT/NEURO/OMFS

l Easy hygienic processing, suitable for use in washer and autoclavable at 134 °C

l Quick coupling mechanism facilitates more rapid exchange of working inserts

l Proven DrillCut-X® blade portfolios can be usedl Optional adaptability to Shaver Tracker

40 8001 22l Allows shaver navigation when used with

NPU 40 8000 01

40 7120 90


41250 RA

41250 RA Cleaning Adaptor, LUER-Lock, for cleaning DrillCut-X® shaver handpieces

Optional Accessory:


Handle for DrillCut-X® II Shaver Handpiecefor use with DrillCut-X® II 40 7120 50 and DrillCut-X® II N 40 7120 55

Special Features:## Ergonomic design## Ultralight construction## Easy handle control allows individual adjustment

40 7120 90

## The adjustable handle can be mounted to DrillCut®-X II or -X II N Shaver Handpiece

## Easy fixation via rotary lock## Sterilizable



Shaver Blades, straightfor Nasal Sinuses and Skull Base Surgery

For use with DrillCut-X® II and DrillCut-X® II N

41201 GN

serrated cutting edge, diameter 4 mm, color code: blue-red

concave cutting edge, oblique cutting window, diameter 4 mm, color code: blue-black

straight cutting edge, diameter 4 mm, color code: blue-blue



Shaver Blade length 12 cmDetail 40 7120 50 DrillCut-X® II Handpiece

40 7120 55 DrillCut-X® II N Handpiece

41201 KN

41201 KK

41201 GN

41201 LN

41201 SN

41201 KSA

double serrated cutting edge, diameter 3 mm, color code: blue-yellow

41201 LSA


concave cutting edge, oval cutting window, diameter 4 mm, color code: blue-green


41201 KKSB

Shaver Blades, straight, sterilizable

for use with

41201 KKSA

41200 RA Cleaning Adaptor, LUER-Lock, for cleaning the inner and outer blades of reusable Shaver Blades 412xx

Optional Accessory:


Shaver Blades, curvedfor Nasal Sinuses and Skull Base Surgery


41204 KKB

curved 35°, cutting edge serrated backwards, diameter 4 mm, color code: blue-red

curved 40°, cutting edge serrated backwards, double serrated, diameter 4 mm, color code: blue-yellow

41202 KN

curved 40°, cutting edge serrated forwards, double serrated, diameter 4 mm, color code: blue-yellow

41204 KKF

41204 KKB


41204 KKFA

41204 KKBA




Shaver Blades, curved 35°/40°, sterilizable

for use with


Optional Accessory:




41203 KKF

curved 65°, cutting edge serrated forwards, diameter 4 mm, color code: blue-red


41203 KNF


41203 KKF

41203 KNB


curved 65°, concave cutting edge, oval cutting window, forward opening, diameter 4 mm, color code: blue-green

curved 65°, concave cutting edge, oval cutting window, backward opening, diameter 4 mm, color code: blue-green

41203 KKB

41203 KKFA

41203 KKBA

41203 GNF

41203 GNB





Shaver Blades, curved 65°, sterilizable

for use with


Optional Accessory:


Shaver Blades, straightfor Nasal Sinuses and Skull Base Surgery

41301 KK



straight cutting edge, diameter 4 mm, color code: blue-blue





concave cutting edge, oval cutting window, diameter 4 mm, color code: blue-green

41301 KN

41301 KK

41301 GN

41301 LN

41301 SN

41301 KSA

41301 KKSA

41301 LSA

Shaver Blade length 12 cm

Detail 40 7120 50 DrillCut-X® II Handpiece40 7120 55 DrillCut-X® II N Handpiece


41301 KKSB

for use with

Shaver Blades, straight, for single use , sterile, package of 5





41302 KN

for use withShaver Blade length 12 cmDetail 40 7120 50 DrillCut-X® II Handpiece







Shaver Blades, curved 35°/40°, for single use , sterile, package of 5

41302 KN

41304 KKF

41304 KKB

41304 KKFA

41304 KKBA



41303 KKB


Shaver Blades, curved 65°, for single use , sterile, package of 5

41303 KNF

41303 KKF

41303 KNB

41303 KKB

41303 KKFA

41303 KKBA

41303 GNF

41303 GNB

curved 65°, cutting edge serrated forwards, diameter 4 mm, color code: blue-red




curved 65°, cutting edge concave forwards, oval cutting window, diameter 4 mm, color code: blue-green

curved 65°, cutting edge concave backwards, oval cutting window, diameter 4 mm, color code: blue-green



Shaver Blade length 12 cmDetail

for use with

40 7120 50 DrillCut-X® II Handpiece40 7120 55 DrillCut-X® II N Handpiece


Sinus Burrs, curvedfor Nasal Sinuses and Skull Base Surgery


41305 RN

Sinus Burrs, curved 70°/55°/40°/15°, for single use , sterile, package of 5

41303 WN

41303 DT

41304 W

41305 RN

41305 DN

41305 D

Sinus Burr length 12 cmDetail 40 7120 50 DrillCut-X® II Handpiece


for use with

curved 55°, cylindric, drill diameter 3.6 mm, shaft diameter 4 mm, color code: red-blue

curved 15°, bud drill, drill diameter 4 mm, shaft diameter 4 mm, color code: red-black

curved 15°, diamond head, drill diameter 3 mm, shaft diameter 4 mm, color code: red-yellow

curved 70°, diamond head, drill diameter 3.6 mm, shaft diameter 4 mm, color code: red-yellow

curved 40°, cylindric, drill diameter 3 mm, shaft diameter 4 mm, color code: red-blue


41305 DW



Accessories for Shaver

39550 A Wire Tray, provides safe storage of accessories for KARL STORZ paranasal sinus shaver systems during cleaning and sterilization

for storage of: – Up to 7 shaver attachments

– Connecting cable

39550 A

Please note: The instruments displayed are not included in the sterilizing and storage tray.


INTRA Drill Handpiecefor Surgery in Ethmoid and Skull Base Area

252571


252574 Same, Transmission 1:2 (80.000 rpm)

Special Features:## Tool-free closing and opening of the drill## Right/left rotation## Max. rotating speed up to 40,000 rpm / 80,000 U/min

## Detachable irrigation channels

## Lightweight construction## Operates with little vibrations## Low maintenance## Reprocessable in a cleaning machine## Safe grip

252574

252591

SizeDetail Dia. mm Standard Diamond Diamond

coarse

014 1.4

018 1.8

023 2.3

027 2.7

031 3.1

035 3.5

040 4

045 4.5

050 5

060 6

649614

649618

649623

649627

649631

649635

649640

649645

649650

649660

649714 –

–649718

649723

649727

649731

649735

649740

649745

649750

649760

649723 G

649727 G

649731 G

649735 G

649740 G

649745 G

649750 G

649760 G

070 7 649670 649770 649770 G

649700 Diamond Straight Shaft Burr, stainless, size 014 – 070, length 9.5 cm, set of 11

649700 G Rapid Diamond Straight Shaft Burr, stainless, with coarse diamond coating for precise drilling and abrasion without hand pressure and generating minimal heat, size 023 – 070, length 9.5 cm, set of 9, color code: gold

280033 Rack, for 36 straight shaft burrs with a length of 9.5 cm, foldable, sterilizable, size 22 x 14 x 2 cm

9.5 cm

649600 – 649770 G

649600 Standard Straight Shaft Burr, stainless, size 014 – 070, length 9.5 cm, set of 11

252591 INTRA Drill Handpiece, straight, length 13 cm, transmission 1:1 (40,000 rpm), for use with KARL STORZ high-performance EC micro motor II and burrs


INTRA Drill Handpiecefor Surgery in Ethmoid and Skull Base Area

Special Features:## Tool-free closing and opening of the drill## Right/left rotation## Max. rotating speed up to 40,000 rpm / 80,000 U/min

## Detachable irrigation channels

## Lightweight construction## Operates with little vibrations## Low maintenance## Reprocessable in a cleaning machine## Safe grip

252572

252575

252575 Same, transmission 1:2 (80,000 rpm)


649700 GL Rapid Diamond Straight Shaft Burr, stainless, with coarse diamond coating for precise drilling and abrasion without hand pressure and generating minimal heat, sizes 023 – 070, length 12.5 cm, set of 9, color code: gold

649700 L Diamond Straight Shaft Burr, stainless, size 014 – 070, length 12.5 cm, set of 11


649600 L Standard Straight Shaft Burr, stainless, size 014 – 070, length 12.5 cm, set of 11

12.5 cm

649600 L – 649770 GL

SizeDetail Dia. mm

Standard Diamond Diamond coarse

014 1.4

018 1.8

023 2.3

027 2.7

031 3.1

035 3.5

040 4

045 4.5

050 5

060 6

649614 L

649618 L

649623 L

649627 L

649631 L

649635 L

649640 L

649645 L

649650 L

649660 L

649714 L –

–649718 L

649723 L

649727 L

649731 L

649735 L

649740 L

649745 L

649750 L

649760 L

649723 GL

649727 GL

649731 GL

649735 GL

649740 GL

649745 GL

649750 GL

649760 GL

070 7 649670 L 649770 L 649770 GL

sterilizable sterilizable sterilizable

252592 INTRA Drill Handpiece, straight, length 17 cm, transmission 1:1 (40,000 rpm), for use with KARL STORZ high-performance EC micro motor II and burrs252592


Accessories for Burrs

Please note: The burrs displayed are not included in the racks.



280043 Rack, flat model, to hold 21 straight shaft burrs with a length of 7 cm (6 pcs) and 9.5 cm (15 pcs), folding model, sterilizable, size 17.5 x 11.5 x 1.2 cm

280033 280034

280043

n


Accessories for Burrs

39552 B

39552 A Wire Tray, provides safe storage of accessories for KARL STORZ drilling/grinding systems during cleaning and sterilization, includes tray for small parts, for use with Rack 280030, rack not included

for storage of: – Up to 6 drill handpieces

– Connecting cable – EC micro motor – Small parts

39552 B Wire Tray, provides safe storage of accessories for KARL STORZ drilling/grinding systems during cleaning and sterilization, includes tray for small parts, for use with Rack 280030, rack included

for storage of: – Up to 6 drill handpieces

– Connecting cable – EC micro motor – Up to 36 drill bits and burrs – Small parts

Tray for small parts included

Please note: The instruments displayed are not included in the sterilizing and storage tray.


UNIDRIVE® S III ENT SCBHigh-Speed Handpieces, angled, 100,000 rpm

For use with High-Speed Drills, shaft diameter 3.17 mm and with High-Speed Micro Motor 20 7120 33 100,000 rpm

diameter 7.5 mm

252681 High-Speed Handpiece, medium, angled, 100,000 rpm, for use with High-Speed Micro-Motor 20 7120 33

252682 High-Speed Handpiece, long, angled, 100,000 rpm, for use with High-Speed Micro-Motor 20 7120 33

252681

252682

53 mm

93 mm

7.5 mm

7.5 mm

20 7120 33


UNIDRIVE® S III ENT SCBHigh-Speed Handpieces, angled, 60,000 rpm

252661 High-Speed Handpiece, short, angled, 60,000 rpm, for use with High-Speed Micro-Motor 20 7120 33

252662 High-Speed Handpiece, medium, angled, 60,000 rpm, for use with High-Speed Micro-Motor 20 7120 33

For use with High-Speed Drills, shaft diameter 2.35 mm and with High-Speed Micro Motor 20 7120 33

252661

252662

51 mm

71 mm

252663 High-Speed Handpiece, long, angled, 60,000 rpm, for use with High-Speed Micro-Motor 20 7120 33

252663

91 mm

60,000 rpm

diameter 5.5 mm

5.5 mm

5.5 mm

5.5 mm

20 7120 33


UNIDRIVE® S III ENT SCBHigh-Speed Handpieces, straight, 60,000 rpm

252691 High-Speed Handpiece, short, straight, 60,000 rpm, for use with High-Speed Micro-Motor 20 7120 33

252692 High-Speed Handpiece, medium, straight, 60,000 rpm, for use with High-Speed Micro-Motor 20 7120 33

For use with High-Speed Drills, shaft diameter 2.35 mm and with High-Speed Micro Motor 20 7120 33

252691

252692

51 mm

71 mm

60,000 rpm

diameter 5.5 mm

5.5 mm

5.5 mm

20 7120 33


UNIDRIVE® S III ENT SCBHigh-Speed Handpieces, malleable, slim, angled, 60,000 rpm

252671 High-Speed Handpiece, extra long, malleable, slim, angled, 60,000 rpm, for use with High-Speed Micro-Motor 20 7120 33

252672 High-Speed Handpiece, super long, malleable, slim, angled, 60,000 rpm, for use with High-Speed Micro-Motor 20 7120 33

For use with High-Speed Drills, shaft diameter 1 mm and with High-Speed Micro Motor 20 7120 33

252672

128 mm

252671

108 mm

60,000 rpm

diameter 4.7 mm

malleable

The handpieces have malleable shafts that can be bent up to 20° according to user requirements.

4.7 mm

4.7 mm

20 7120 33


UNIDRIVE® S III ENT SCBHigh-Speed Standard Burrs, High-Speed Diamond Burrs

For use with High-Speed Handpieces, 100,000 rpm

252681 252682

High-Speed Standard Burrs, 100,000 rpm, for single use , sterile, package of 5

Diameter in mm

1

medium long

350110 M –

2 350120 M 350120 L

3 350130 M 350130 L

4 350140 M 350140 L

5 350150 M 350150 L

6 350160 M 350160 L

7 350170 M 350170 L

High-Speed Diamond Burrs, 100,000 rpm, for single use , sterile, package of 5

Diameter in mm

1

medium long

350210 M –

2 350220 M 350220 L

3 350230 M 350230 L

4 350240 M 350240 L

5 350250 M 350250 L

6 350260 M 350260 L

7 350270 M 350270 L

100,000 rpm

diameter 7.5 mm


UNIDRIVE® S III ENT SCBHigh-Speed Diamond Burrs, High-Speed Acorn,High-Speed Barrel Burrs, High-Speed Neuro Fluted Burrs


252681 252682

High-Speed Coarse Diamond Burrs, 100,000 rpm, for single use , sterile, package of 5

Diameter in mm

3

medium long

350330 M 350330 L

4 350340 M 350340 L

5 350350 M 350350 L

6 350360 M 350360 L

7 350370 M 350370 L

High-Speed Acorn, 100,000 rpm, for single use , sterile, package of 5

Diameter in mm

7.5

medium

350675 M

9 350690 M

High-Speed Barrel Burrs, 100,000 rpm, for single use , sterile, package of 5

Diameter in mm

6

medium

350960 M

9.1 350991 M

High-Speed Neuro Fluted Burrs, 100,000 rpm, for single use , sterile, package of 5

Diameter in mm

1,8

medium

350718 M

3 350730 M

long

350718 L

350730 L

100,000 rpm

diameter 7.5 mm


UNIDRIVE® S III ENT SCBHigh-Speed Standard Burrs, High-Speed Diamond Burrs


252661 252662

252691 252692

252663

High-Speed Standard Burrs, 60,000 rpm, for single use , sterile, package of 5

Diameter in mm

1

short medium

330110 S 330110 M

2 330120 S 330120 M

3 330130 S 330130 M

4 330140 S 330140 M

5 330150 S 330150 M

6 330160 S 330160 M

7 330170 S 330170 M


Diameter in mm

0.6

short medium

330206 S –

1 330210 S 330210 M

1.5 330215 S –

2 330220 S 330220 M

3 330230 S 330230 M

4 330240 S 330240 M

5 330250 S 330250 M

long

–

330120 L

330130 L

330140 L

330150 L

330160 L

330170 L

long

–

–

–

330220 L

330230 L

330240 L

330250 L

6 330260 S 330260 M 330260 L

7 330270 S 330270 M 330270 L

60,000 rpm

diameter 5.5 mm


UNIDRIVE® S III ENT SCBHigh-Speed Diamond Burrs, High-Speed Cylinder Burrs,LINDEMANN High-Speed Fluted Burrs



Diameter in mm

3

short medium

330330 S 330330 M

4 330340 S 330340 M

5 330350 S 330350 M

6 330360 S 330360 M

7 330370 S 330370 M

long

330330 L

330340 L

330350 L

330360 L

330370 L

High-Speed Cylinder Burrs, 60,000 rpm, for single use , sterile, package of 5

Diameter in mm

4

short

330440 S

6 330460 S

LINDEMANN High-Speed Fluted Burrs, 60,000 rpm, for single use , sterile, package of 5

Size in mm (diameter x length)

Diameter 2.1/11

short

330511 S

Diameter 2.3/26 330526 S

252661 252662

252691 252692

252663

60,000 rpm

diameter 5.5 mm


UNIDRIVE® S III ENT SCBHigh-Speed Diamond Burrs


252671 252672


Diameter in mm

2

extra long

320220 EL

super long

320220 SL

3 320230 EL 320230 SL

4 320240 EL 320240 SL


Diameter in mm

2

extra long

320320 EL

super long

320320 SL

3 320330 EL 320330 SL

4 320340 EL 320340 SL

60,000 rpm

diameter 4.7 mm


Innovative Design## Dashboard: Complete overview with intuitive menu guidance

## Live menu: User-friendly and customizable## Intelligent icons: Graphic representation changes when settings of connected devices or the entire system are adjusted

## Automatic light source control## Side-by-side view: Parallel display of standard image and the Visualization mode

## Multiple source control: IMAGE1 S allows the simultaneous display, processing and documentation of image information from two connected image sources, e.g., for hybrid operations

Dashboard Live menu

Side-by-side view: Parallel display of standard image and Visualization mode

Intelligent icons

Economical and future-proof## Modular concept for flexible, rigid and 3D endoscopy as well as new technologies

## Forward and backward compatibility with video endoscopes and FULL HD camera heads

## Sustainable investment## Compatible with all light sources

IMAGE1 S Camera System n


Brillant Imaging## Clear and razor-sharp endoscopic images in FULL HD

## Natural color rendition

## Reflection is minimized## Multiple IMAGE1 S technologies for homogeneous illumination, contrast enhancement and color shifting

FULL HD image CHROMA

FULL HD image SPECTRA A *

FULL HD image

FULL HD image CLARA

SPECTRA B **

* SPECTRA A : Not for sale in the U.S.** SPECTRA B : Not for sale in the U.S.



TC 200EN* IMAGE1 S CONNECT, connect module, for use with up to 3 link modules, resolution 1920 x 1080 pixels, with integrated KARL STORZ-SCB and digital Image Processing Module, power supply 100 – 120 VAC/200 – 240 VAC, 50/60 Hz

including: Mains Cord, length 300 cm DVI-D Connecting Cable, length 300 cm SCB Connecting Cable, length 100 cm USB Flash Drive, 32 GB, USB silicone keyboard, with touchpad, US

* Available in the following languages: DE, ES, FR, IT, PT, RU

Specifications:

HD video outputs

Format signal outputs

LINK video inputs

USB interface SCB interface

- 2x DVI-D - 1x 3G-SDI

1920 x 1080p, 50/60 Hz

3x

4x USB, (2x front, 2x rear) 2x 6-pin mini-DIN

100 – 120 VAC/200 – 240 VAC

50/60 Hz

I, CF-Defib

305 x 54 x 320 mm

2.1 kg

Power supply

Power frequency

Protection class


Weight

TC 300 IMAGE1 S H3-LINK, link module, for use with IMAGE1 FULL HD three-chip camera heads, power supply 100 – 120 VAC/200 – 240 VAC, 50/60 Hz, for use with IMAGE1 S CONNECT TC 200ENincluding:Mains Cord, length 300 cm

Link Cable, length 20 cm

For use with IMAGE1 S IMAGE1 S CONNECT Module TC 200EN


TC 300 (H3-Link)

TH 100, TH 101, TH 102, TH 103, TH 104, TH 106 (fully compatible with IMAGE1 S) 22 2200 55-3, 22 2200 56-3, 22 2200 53-3, 22 2200 60-3, 22 2200 61-3, 22 2200 54-3, 22 2200 85-3 (compatible without IMAGE1 S technologies CLARA, CHROMA, SPECTRA*)

1x

100 – 120 VAC/200 – 240 VAC

50/60 Hz

I, CF-Defib

305 x 54 x 320 mm

1.86 kg

Camera System

Supported camera heads/video endoscopes

LINK video outputs

Power supply

Power frequency

Protection class


Weight

Specifications:

TC 200EN

TC 300

* SPECTRA A : Not for sale in the U.S.** SPECTRA B : Not for sale in the U.S.


For use with IMAGE1 S Camera System IMAGE1 S CONNECT Module TC 200EN, IMAGE1 S H3-LINK Module TC 300 and with all IMAGE 1 HUB™ HD Camera Control Units

TH 100 IMAGE1 S H3-Z Three-Chip FULL HD Camera Head, 50/60 Hz, IMAGE1 S compatible, progressive scan, soakable, gas- and plasma-sterilizable, with integrated Parfocal Zoom Lens, focal length f = 15 – 31 mm (2x), 2 freely programmable camera head buttons, for use with IMAGE1 S and IMAGE 1 HUB™ HD/HD

IMAGE1 FULL HD Camera Heads

Product no.

Image sensor


Weight

Optical interface

Min. sensitivity

Grip mechanism

Cable

Cable length

IMAGE1 S H3-Z

TH 100

3x 1/3" CCD chip

39 x 49 x 114 mm

270 g

integrated Parfocal Zoom Lens, f = 15 – 31 mm (2x)

F 1.4/1.17 Lux

standard eyepiece adaptor

non-detachable

300 cm

Specifications:

TH 104

TH 104 IMAGE1 S H3-ZA Three-Chip FULL HD Camera Head, 50/60 Hz, IMAGE1 S compatible, autoclavable, progressive scan, soakable, gas- and plasma-sterilizable, with integrated Parfocal Zoom Lens, focal length f = 15 – 31 mm (2x), 2 freely programmable camera head buttons, for use with IMAGE1 S and IMAGE 1 HUB™ HD/HD

IMAGE1 FULL HD Camera Heads

Product no.

Image sensor


Weight

Optical interface

Min. sensitivity

Grip mechanism

Cable

Cable length

IMAGE1 S H3-ZA

TH 104

3x 1/3" CCD chip

39 x 49 x 100 mm

299 g

integrated Parfocal Zoom Lens, f = 15 – 31 mm (2x)

F 1.4/1.17 Lux

standard eyepiece adaptor

non-detachable

300 cm

Specifications:

IMAGE1 S Camera Heads n

TH 100


9826 NB

9826 NB 26" FULL HD Monitor, wall-mounted with VESA 100 adaption, color systems PAL/NTSC, max. screen resolution 1920 x 1080, image fomat 16:9, power supply 100 – 240 VAC, 50/60 Hzincluding:External 24 VDC Power SupplyMains Cord

9619 NB

9619 NB 19" HD Monitor, color systems PAL/NTSC, max. screen resolution 1280 x 1024, image format 4:3, power supply 100 – 240 VAC, 50/60 Hz, wall-mounted with VESA 100 adaption,including:

External 24 VDC Power SupplyMains Cord

Monitors


Monitors

Optional accessories:9826 SF Pedestal, for monitor 9826 NB9626 SF Pedestal, for monitor 9619 NB

26"

9826 NB

l

–

l

l

l

l

l

–

l

–

l

l

l

l

l

l

19"

9619 NB

l

–

–

l

l

l

l

l

l

l

–

l

l

l

l

l

KARL STORZ HD and FULL HD Monitors

Wall-mounted with VESA 100 adaption

Inputs:

DVI-D

Fibre Optic

3G-SDI

RGBS (VGA)

S-Video

Composite/FBAS

Outputs:

DVI-D

S-Video

Composite/FBAS

RGBS (VGA)

3G-SDI

Signal Format Display:

4:3

5:4

16:9

Picture-in-Picture

PAL/NTSC compatible

19"

optional

9619 NB

200 cd/m2 (typ)

178° vertical

0.29 mm

5 ms

700:1

100 mm VESA

7.6 kg

28 W

0 – 40°C

-20 – 60°C

max. 85%

469.5 x 416 x 75.5 mm

100 – 240 VAC

EN 60601-1, protection class IPX0

Specifications:

KARL STORZ HD and FULL HD Monitors

Desktop with pedestal

Product no.

Brightness

Max. viewing angle

Pixel distance

Reaction time

Contrast ratio

Mount

Weight

Rated power

Operating conditions

Storage

Rel. humidity


Power supply

Certified to

26"

optional

9826 NB

500 cd/m2 (typ)

178° vertical

0.3 mm

8 ms

1400:1

100 mm VESA

7.7 kg

72 W

5 – 35°C

-20 – 60°C

max. 85%

643 x 396 x 87 mm

100 – 240 VAC

EN 60601-1, UL 60601-1, MDD93/42/EEC, protection class IPX2


20 134001 Cold Light Fountain XENON NOVA® 300, power supply: 100–125 VCA/220–240 VAC, 50/60 Hz

including: Mains Cord20 1330 28 XENON Spare Lamp, only,

300 watt, 15 volt

Cold Light Fountain XENON NOVA® 300

Cold Light Fountain XENON 300 SCB

20 133101-1 Cold Light Fountain XENON 300 SCB

with built-in antifog air-pump, and integrated KARL STORZ Communication Bus System SCB power supply: 100 –125 VAC/220 –240 VAC, 50/60 Hz

including: Mains Cord SCB Connecting Cable, length 100 cm20133027 Spare Lamp Module XENON

with heat sink, 300 watt, 15 volt20133028 XENON Spare Lamp, only,

300 watt, 15 volt

Fiber Optic Light Cable

495 NA Fiber Optic Light Cable, with straight connector, diameter 3.5 mm, length 230 cm


Data Management and DocumentationKARL STORZ AIDA® – Exceptional documentation

The name AIDA stands for the comprehensive implementation of all documentation requirements arising in surgical procedures: A tailored solution that flexibly adapts to the needs of every specialty and thereby allows for the greatest degree of customization.

This customization is achieved in accordance with existing clinical standards to guarantee a reliable and safe solution. Proven functionalities merge with the latest trends and developments in medicine to create a fully new documentation experience – AIDA.

AIDA seamlessly integrates into existing infrastructures and exchanges data with other systems using common standard interfaces.

WD 200-XX* AIDA Documentation System, for recording still images and videos, dual channel up to FULL HD, 2D/3D, power supply 100-240 VAC, 50/60 Hz

including: USB Silicone Keyboard, with touchpad ACC Connecting Cable DVI Connecting Cable, length 200 cm HDMI-DVI Cable, length 200 cm Mains Cord, length 300 cm

WD 250-XX* AIDA Documentation System, for recording still images and videos, dual channel up to FULL HD, 2D/3D, including SMARTSCREEN® (touch screen), power supply 100-240 VAC, 50/60 Hz

including: USB Silicone Keyboard, with touchpad ACC Connecting Cable DVI Connecting Cable, length 200 cm HDMI-DVI Cable, length 200 cm Mains Cord, length 300 cm

*XX Please indicate the relevant country code (DE, EN, ES, FR, IT, PT, RU) when placing your order.


Workflow-oriented use

Patient

Entering patient data has never been this easy. AIDA seamlessly integrates into the existing infrastructure such as HIS and PACS. Data can be entered manually or via a DICOM worklist. ll important patient information is just a click away.

Checklist

Central administration and documentation of time-out. The checklist simplifies the documentation of all critical steps in accordance with clinical standards. All checklists can be adapted to individual needs for sustainably increasing patient safety.

Record

High-quality documentation, with still images and videos being recorded in FULL HD and 3D. The Dual Capture function allows for the parallel (synchronous or independent) recording of two sources. All recorded media can be marked for further processing with just one click.

Edit

With the Edit module, simple adjustments to recorded still images and videos can be very rapidly completed. Recordings can be quickly optimized and then directly placed in the report. In addition, freeze frames can be cut out of videos and edited and saved. Existing markings from the Record module can be used for quick selection.

Complete

Completing a procedure has never been easier. AIDA offers a large selection of storage locations. The data exported to each storage location can be defined. The Intelligent Export Manager (IEM) then carries out the export in the background. To prevent data loss, the system keeps the data until they have been successfully exported.

Reference

All important patient information is always available and easy to access. Completed procedures including all information, still images, videos, and the checklist report can be easily retrieved from the Reference module.


UG 540 Monitor Swifel Arm, height and side adjustable, can be turned to the left or the right side, swivel range 180°, overhang 780 mm, overhang from centre 1170 mm, load capacity max. 15 kg, with monitor fixation VESA 5/100, for usage with equipment carts UG xxx

UG 540

Equipment Cart

UG 220

UG 220 Equipment Cart wide, high, rides on 4 antistatic dual wheels equipped with locking brakes 3 shelves, mains switch on top cover, central beam with integrated electrical subdistributors with 12 sockets, holder for power supplies, potential earth connectors and cable winding on the outside,

Dimensions: Equipment cart: 830 x 1474 x 730 mm (w x h x d), shelf: 630 x 510 mm (w x d), caster diameter: 150 mm

inluding: Base module equipment cart, wide Cover equipment, equipment cart wide Beam package equipment, equipment cart high 3x Shelf, wide Drawer unit with lock, wide 2x Equipment rail, long Camera holder


Recommended Accessories for Equipment Cart

UG 310 Isolation Transformer, 200 V – 240 V; 2000 VA with 3 special mains socket, expulsion fuses, 3 grounding plugs, dimensions: 330 x 90 x 495 mm (w x h x d), for usage with equipment carts UG xxx

UG 310

UG 410 Earth Leakage Monitor, 200 V – 240 V, for mounting at equipment cart, control panel dimensions: 44 x 80 x 29 mm (w x h x d), for usage with isolation transformer UG 310

UG 410

UG 510 Monitor Holding Arm, height adjustable, inclinable, mountable on left or right, turning radius approx. 320°, overhang 530 mm, load capacity max. 15 kg, monitor fixation VESA 75/100, for usage with equipment carts UG xxx

UG 510

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