Pediatric sphenoidotomy.

The posterior ethmoid air cells and the sphenoid sinuses have a complex anatomy that is surrounded by vital structures. To more easily protect these structures, three approaches are presented that make pediatric sphenoidotomy a safer procedure. The approaches include measuring the distance from the anterior nasal spine to the anterior and surgical posterior faces of the sphenoid sinus intraoperatively and comparing these to the patient's height and age, the use of the "ridge" to ensure a safe entry into the sphenoid, and, in patients where isolated sphenoid disease is present, the use of a powered instrument to enlarge the sphenoid ostium. The availability of measurements relating the height of the patient to the location of the sphenoid sinus, the use of the "ridge," and the use of powered instrumentation, should help the surgeon enter the sphenoid with greater confidence and achieve a more effective result.