Philosophy The "grasp and tear" surgical techniques used in the past to resect the anterior and medial wall of the ethmoid bulla are often responsible for the inadvertent stripping of intact mucosa from the lamina papyracea. The resulting exposed bone often forms granulation tissue and adhesions, which complicates the healing process. Scarring in the middle meatus and anterior ethmoid cavity contributes to surgical failure.

The MicroFrance MicroBite™ Through-Cutting Sinus Forceps have been designed to precisely resect the anterior and medial wall of the ethmoid bulla without damage to delicate mucosa overlaying the lamina papyracea. These forceps are sized appropriately for pediatric or adult sinus surgery, and their precise cutting action allows for sharp resection of mucosa without stripping mucosa.

Surgical Technique After opening the anterior wall of the ethmoid bulla with a curette, the anterior wall of the bulla is precisely dissected from its lateral attachment near the lamina papyracea using several fine cutting motions of the 450 and 900 MicroBite Forceps (MCEN74 and MCEN 75, respectively). As the dissection extends superiorly and  posteriorly, the 00 MicroBite Forceps (MCEN 73) provide better access to the attached regions (Figure 1).		Figure 1
The first inferior cut is made along the inferior edge of the bullae. The inferior cuts extend to the posterior attachment of the bulla, at the basal lamella. The 450 forceps are used to connect the incision into the ostium posteriorly. Once all attachments are sharply transected, the medial wall of the ethmoid bulla can be removed without traumatizing the mucosa along the lamina papyracea (Figure 2).		Figure 2

The same technique can be used in adolescent and adult patients. These instruments are designed to sharply transect and not strip mucosa from its underlying bone. 

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Nota Bene: The technique description herein and the use of instructions for the related procedures are made available by Medtronic Xomed, Inc. to the healthcare professional to illustrate the author's suggested treatment for the uncomplicated procedure. In the final analysis, the preferred treatment is that which, in the healthcare professional's judgment, addresses the needs of the individual patient.