Abstract:ObjectiveTo explore the design principle and application of the anatomic training process through the Uninostril approach by using the fewest cadaver head specimens to complete the most surgical anatomy training, thus, it will guide more beginners to conduct efficient anatomical training.MethodsThe design principles of the process were as follows : ① the structures of previous operations were revealed without damage of the structures of subsequent operations；② the anatomic training process was finished as many clinical operations as possible by using one side of the cadaver head specimens；③ According to clinical approach commonly, the anatomic training process was designed step by step operations；④ The operation of binostril approach is not included in this procedure. Once one side is completed, the contralateral nasal cavity is not damaged. Five cases of fresh silicone resin head were used, the process was verified and completed on both sides of the head. The entire process was recorded by the system of STORZ company HD video (0°, 4 mm nasal endoscopy and HD IMAGE 1) device.ResultsAccording to the principles, an uninostril approach was designed to conduct 19 anatomic operation in sequence. It is mainly focused on lacrimal suc, sinus, pterygopalatine fossa (PPF) and infratemporal fossa (ITF). They are:① Precise dissection of unicate process; ② Dacryocystostomy; ③ Draf I and Draf II frontal sinus operation; ④ Anterior ethmoidotomy; ⑤ Posterior ethmoidotomy; ⑥ Sphenoidotomy; ⑦ Ligation of sphenopalatine artery; ⑧ Preparation of vascularized pedicled nasoseptal flap; ⑨ Fenestration of inferior nasal meatus; ⑩ Draf IIb frontal sinus operation; Preparation of free middle turbinate mucosa flap; Anterior wall resection of PPF and portion of ITF through middle meatus approach; Prelacrimal recess approach; Partial anterior wall resection of ITF through prelacrimal recess; Endoscopic modified Denker surgery; Anterior wall resection of ITF through Denker approach: Explore the lateral boundary of ITF through Denker approach; Medial wall removal of maxillary sinus; Pterygopalatine fossa surgery; subtemporal fossa surgery. This procedure can be repeated in 10 side specimens of 5 samples, and the spent time will be reduced as the increasing times of operations.ConclusionThis process can be used as a reference for endoscopic dissection of skull base, which has clear design ideas, distinct features and high repeatability. It's deserved to be promote and use.
