Endoscopic view of the removal of an obstructing Haller's cell.

Since the development of endoscopic sinus surgery techniques, pneumatization of anatomic structures of the nose and paranasal sinuses has become a topic of increasing importance to rhinologists. An anatomic anomaly in the nose or sinuses does not necessarily indicate a pathologic state, but it can predispose some patients to sinus disease by causing obstruction that can lead to inflammatory disease. (1)

One such anomaly is the Haller's cell (infraorbital cell), which can narrow the ostiomeatal complex. (2) Easily seen on coronal computed tomography (CT) of the sinuses, Haller's cells can be solitary (figure 1, A) or multiple (figure 1, B).

[FIGURE 1 OMITTED]

Surgical intervention is indicated when a Haller's cell contributes to ostiomeatal complex obstruction and inflammation of the sinuses. The cell is approached through the middle meatus by using a microdebrider to remove the uncinate process, including its inferior attachment (figure 2, A and B). The cell is visualized and carefully uncapped with a curved microdebrider blade (figure 2, C), and then its inferior and medial portions are carefully removed (figure 2, D). This procedure widens the infundibulum and the outflow tract of the maxillary sinus. The superior portion of the Haller's cell is not dissected so that the integrity of the orbital floor is not disturbed.

[FIGURE 2 OMITTED]

References

(1.) Stammberger HR. Functional Endoscopic Sinus Surgery: The Messerklinger Technique. Philadelphia: B.C. Decker; 1991.

(2.) Yanagisawa E, Citardi MJ. Endoscopic view of the infraorbital ethmoid cell (Hailer cell). Ear Nose Throat J 1996;75:406-7.

Dewey A. Christmas, MD; Joseph P. Mirante, MD; Eiji Yanagisawa, MD

From the Department of Otolaryngology, University of South Florida College of Medicine, Tampa, and the Halifax Medical Center, Daytona Beach, Fla. (Dr. Christmas and Dr. Mirante); and the Southern New England Ear, Nose, Throat, and Facial Plastic Surgery Group; the Section of Otolaryngology, Hospital of St. Raphael; and the Section of Otolaryngology, Yale University School of Medicine, New Haven, Conn. (Dr. Yanagisawa).