Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4458_Библиотеки_им_академика_М_И_Перельмана

above the buccogingival sulcus, running from the canine ridge to the maxillary buttress paral­lel to the dental line [9] (Fig.35.2a). After dis­section down to the bone, the periosteal elevator is used to expose the anterior maxillary wall superiorly up to, but not including, the infraor­bital foramen [10] (Fig.35.2b). To reduce the chances of damaging the anterior superior alve­olar nerve when performing the canine fossa punch, an osteotome or 4mm trocar should be used at the point where the mid-pupillary line intersects with a horizonal line from the oor of the nasal vestibule [11, 12] (Fig. 35.2c). Once through the anterior wall, the antrostomy is enlarged with a 3mm Kerrison Rongeur, com­pleting the anterior antrostomy [9] (Fig.35.2d). At the end of the case, the incision is closed in layers, avoiding gaps to prevent stulation [9]. Depending on the requirement, the maxillary sinus may or may not be packed with either a dissolvable pack or ribbon gauze instilled with bismuth iodoform parafn paste. On waking, the patient is nursed at 30° and ice packs may be applied to the face to reduce facial swelling and pain.