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Foreman rotunda. Okay. And this area here is your brain. Okay. What else can we see here? We can see this area which is highlighted in green. This area is known as the oh, you just slipped my head. It will come back to me. You'll come back to me later. Sorry, dad's the word infratemporal Phosa that you're right. So that, that that area is the infratemporal fossa. Okay. So this is an extra view, extra cut of the sinuses. Um I can also demonstrate to you that there is this structure here. This structure lies interior of your um maxillary sinus and it's connected to the eye. So this is actually lacrimal sect that is bounded around a bone. As you can see over here, it's bounded around the bone. This patient also, as you can see the septal cartilage here is slightly deviated, followed by the bony cartilage. They run straight along this in this patient. Okay, right enough about maxillary sinus, let's move on to our frontal sinus. So our frontal sinus is contained above the eye at your frontal bones. Yeah. It's shaped like a funnel and it is known as a projection from the Ethmoid air cells migrating forward. So you can see that it shapes like a funnel like this with its base right at the bottom and it drains into your middle meatus. The posterior wall over here is said to be thinner than the interior wall. And that makes sense because you kind of one the front bed of your head to be stronger if if not, you'll get injury straight into your frontal lobe. Okay. What else can we see here? The narrowest portion of the uh funnel over here is also known as the peak of the frontal sinus. So just just remember that uh I will be talking to you about it, more air cells later and just remember that structure uh and we'll revisit it later on. Okay. The frontal sinus is the last sinus to numa ties it is an upward growth as I mentioned earlier from the ethmoid sinus. And it's innovated by the super orbiter and super Tropea enough, which is the first division of your trigem. Okay. The next sinus is the sphenoid sinus. The sphenoid sinus has a lot of anatomy. And the interesting thing about this sphenoid sinus is it does not arise and biologically similar to the other sinuses. It is separate. So what's the implication of that? And firstly, it grows from here and then it migrates forward to join the other parts of your sinuses. So what is the implication there is basically varying degree of new matiz ation. As you can see in this actual view of the sinuses. This patient has a predominant left sphenoid sinus and they're very tiny, right sphenoid sinus because there is basically different degree of new matiz ation. What are the important structures to be aware of the back wall of your sphenoid sinus? Here is your clavus and below that is where your adenoid sets in this extra view. My colleague in the future will also focus on this area is also known as the mastoid process and the ear, which we will not cover today. This structure here is your uh spinal cord and is going sorry, it's going to be your midbrain and it's going to go down into your spinal cord. I want to bring your attention to the eyes and the globe. So your optic nerve is going to run just like this and it's going to go up and above the sphenoid sinus like this. And from your textbook, you will all come together above where the optic is um is which we'll talk about in a short while later. Okay. So the a sphenoid sinus is supplied by the sphenopalatine artery. And the sensation is by the 1st and 2nd division of the trigeminal enough, the drainage of the scenic sinus is different from the other sinuses. It drains into this fino ethmoidal recess and the best place to look for it is on the actual cut and you can see and I can demonstrate it on, on here for you. You can see that over there. That's the drainage pathway of the right sphenoid sinus into the spine, know it'll, it'll recess and that's the drainage pathway on the left side. Okay. It is um it is medial to the middle, terminate and sometimes just below the superior turbine. It which I could not demonstrate on this view, right. So you can see that the top portion of your skin oy is the skull base and there is a depression that runs just behind. And this depression is also known as the cenotaph sica. And that's where your Petri tree sinus. I'm sorry, your pituitary gland sit. So as e ent surgeons or sometimes neurosurgeons, what we can do is actually access it through the nose and straight into the Petritsch event, also known as the trans uh finial approach or endoscopic approach to the Patriots. I plan uh this uh Corona view show you other important structures as mentioned previously. So which is drawing in blue. So this is the okay optic nerve that runs superior and lateral to your sphenoid sinus. Over here, we need to be very weary that this is your internal carotid artery that runs on the electoral wall of your screen night sinus, electoral posterior wall of your screen night sinus. And it also houses, we talked about the video in canal earlier and the forearm and wrote tandem which I showed you from the back wall of your maxillary sinus, okay economic sinus. So the ethmoid sinus, as we talked about earlier, it has multiple combs. It comes together multiple cells that comes together. It sits in the ethmoid bone and it sits between both the eyes. The boundary of it is the middle terminate as I will draw here, you are bound by the middle turbinates. It immediately laterally is bounded by the eye and this bone here we call it lemina Propecia to in Latin amina is bone preparation. A is paper. So this this bone is actually really thin and it's called paper thin bone. Sometimes when you see surgery, if we press against the eye, you can see this bone moving as well. These air cells or these eat more little honeycomb. Air cells are divided from each other by very thin septation of bones. Okay. As we mentioned before, the ethmoid sinus has multiple small honeycomb appearance. So what happens then is this kind of air cells can grow very differently, it can grow into different places and hence is given an eponymous name to each or is given name to each of itself. So we'll go through each cells individually, right? So the first one we talk about is an air cell that goes above the orbit. So it's called the supra orbital air cells. Where do you look for them? You look for them on an X uh sorry on uh corona view. And the first thing you look for is this area. This area is also known as the candidates nipple where the interior it more artery comes out and supplies the nasal cavity. So the anterior is my artery is a branch of your internal carotid artery. So it comes from the brain through the eye and out into the nasal cavity. If the more an cells grow above this blood vessel, we call it the supra orbital air cell. Okay. The next one is the uh ethmoid. Uh so that grows backwards into the sphenoid. It is also known as this fino ethmoidal air cells. It grows superior early. And the important clinical implication of this is it can change the anatomy that is important inside the screen security. So let's let us just revisit the anatomy. So over here, our draw in purple. This is the right fit, annoyed sinus. This is the left three noid sinus and actually in green, this is your spino ethmoidal as well. So in yellow, I'm going to draw other important structures. This is the optic nerve on the left hand side, sorry, the right hand side. And this is the optic nerve on the left hand side of the patient. So essentially, if you do not recognize this, you can get north during surgery just to reiterate this. About here is where the internal character artery runs on both sides. And this is if you ever had the opportunity to scope a patient or see a patient in the ent clinic. This is where we call the coin A that opens the nasal cavity into the nasal pharynx. Okay. The next interesting cell is the ethmoid sell that grows below the orbit or below the eye. As you all know, it's going to be called the infra orbital air cells. So what's the important bit about this infraorbital and sell? So you can see in this uh CT scan, this patient has multiple infraorbital air cells and also an infraorbital air cells on the opposite side, what it changes, it changes several things. One you can see that the infra orbital canal changes its location. Other than that this kind of cell can also impede the drainage from the maxillary sinus just there. So these are important as cells to be aware during your report of uh investigation of the patient's sinuses. Mhm frontal sinus. This is where it becomes very interesting. So the it might sinus has several names to it. So the first sl or the most interior Ethmoid air cells is called the aga knees. I so name it A N okay. So that's the first most interior sl of the Ethmoid. The second sl that goes behind this is called the bulla. It models which sits here. So this is called the bulla ethamide Alice. Now, what the frontal sinus, an atomic classification tells us is when you have a wrestles that grows from the Ethmoid into the frontal sinus. And there are several classification to it. So firstly, if your air cell sits just above the agoneaze I but behind and below this beak. Yeah. Sorry. Let me use a different color. I need a smaller hand, don't I? So if it sits below and behind this beak, then this cell is called the supra Eggo cell because it's sitting above the Eggo knees. I this is the Ebola. So if you have a cell that sits above the bulla but not going into the frontal sinus just behind that. So this is called this supra bulla cell. Simple, very easy. The next one is a cell that sits above the agonies. I but it goes all the way into in front of sinus. This will be called the supra Eggo frontal cell. And last but not least is the cell that goes above the Ebola and into the frontal sinus. And it's called a supra bulla, frontal sell, why is this important? This will impede the drainage pathway of the, of the frontal sinus which we will talk a bit more when we talk about CT sinus in relation to surgery, Karen. Okay. Inquest. You just repeat them one more time because this one is really confusing, I think especially for multi trainees. Sure, I will just find another picture of uh okay. There we go. Right. I would just repeat myself. So you can see I'll try not to sign myself out from this. The front most it might itself is known as the IGA knees. I so okay. The second which sits just behind it, it's called the bulla or the bulla. It models this area up here, the narrow bit of the frontal sinus. This is what we call the beak. Yeah. The narrowest bit where the frontal sinus drain into the uh middle mediators. Now, if the cell sits above the organiser but do not project into the frontal sinus, we call it a supra Eggo cell. Yeah, super, I'm being above egg a cell. If the cell sits above the buller but not into the front of sinus, then it's called this supra bulla cell. Okay. Unfortunately, the human it might sinus do not behave the same. So all of us are slightly different. Sometimes this cell can decide to grow into the frontal sinus just like this. And if it projects from above the agonies er and going into the frontal sinus, then we call this this supra Eggo frontal cell. And if it goes behind and above the bulla like this and this will be called this supra bulla frontal sell. Yeah. The clinical implication of this is it changes the drainage pathway or the pathway of how mucus dropped from the swan. So sinus into the nose and we'll cover that in greater detail where we talk about city interpretation in relation to surgery itself. Okay. I hope that that kind of clears the mind of frontal sinuses, very complicated, but it's something that we can talk about, we're almost towards the end. Now. Um Other bits of the ethmoid sinus, the ethmoid sinus right at the roof of the ethmoid sinus. It's called the fovea. It model s and it's also known as the cribriform plate where your olfactory nerve and the olfactory fibers forms and comes down into your nose. So it's the fitness portion of your skull base that is related in your nose. So this is very, very important when it comes to the, the cribriform plate or the skull base. Unfortunately, as we talked about earlier, the air cells within our ethmoid sinuses developed very differently from individual to individual. So clinically, this skull base here does vary from individual to the individuals and we'll talk about that in the next series of uh interpretation. I think that's about all I can tell you from an estimate point of view. Have anyone has any questions? Let me just stop my screen share. I can go back to messages over there. We go. Important provost. Perfect. Thank you for answering that. Yes, important Provence. Uh uh huh So, so Darren, that was really, really, really you have, you have really put in a lot of hard work in that. I was really excellent. I must say that I have learned this especially frontal self. They're really, really difficult. So you have made it really, really easy for me as well. So really, really thank you for doing such a hard work and putting it all together. It's not an easy topic but you have made it very easy. Uh, I'm sure that it would have, uh, it has helped junior trainees as well. Yeah, it was really helpful. It's, it's nice that you actually drew through the anatomy and demonstrated it as well. So I was actually also, um, thinking that all of us probably should do the same thing, you know, draw lines, point, uh point to the structures. It's really important. It was very easy to follow Darren why he was explaining. I think if we just say, you know, like just point a finger and it just probably not, not very good. So I think we as all me and Laura and all of those who are presenting, we should probably um tell them, I mean, speak to them as well and tell them how to how Darren presented and uh do the same thing. If Darren, she's guys cosmic, no questions. It is a difficult topic for you to be honest. I mean, ct scan for junior training is always a difficult, yeah, they'll probably be happy just to no someone applicant details guys. If there are no more questions. Um at the end of this teaching session, you should all get a feedback form um sent over to your email address is um or in the message um chat section just now, I'd really appreciate it. Um If you could fill in that feedback form and once you submit it, you should all have the certificates automatically generated into your um emails as well. Love it. Reggae. What else would you like us to talk about it? Can you hear me? Yes. Yes, you can. I thought that you're going to take us to the surgical approaches and, and uh how to identify it, an endoscopy. And that's uh but because you said we speak about the surgical approach, but if it's only radiology, okay, we'll leave that for uh for EMT course. Yes. So, um we have separated this to uh CT with focus on anatomy and CT with focus to surgery. So um if you stay tuned to the next part of it, it will be a slightly different lecture where we talk about important key bits as ent surgeons, what we look for in the CT sinuses. Um Unfortunately, this is a radiology teaching series rather than a key teaching series. Um We will not be presenting any form of uh endoscopic visualization of things, but uh I'll go, I'll go and see if I can find pictures. Uh but we will definitely talk about about it in, in the next one. Yeah. So groggy. All right, are registrar is one of our young dynamic registrars at Peterborough. Uh Definitely we can always go through the anatomy endoscopically. All right. No worries. This was a very lovely presentation. It helped me a lot. I learned a lot from you and of course, uh, if we have a record of that, it would be fantastic. So I use it, uh.