Endoscopic surgery on the maxillary sinus

Endoscopic surgery in the nasal cavity

To eliminate the inflammation in the nasal cavity and paranasal sinuses is pharmacological therapy, lavage and surgical procedures. All of these methods aims to eliminate swelling of the mucous membranes and improvement of the outflow of secretions. In our article we will talk about current surgical method of treating sinusitis — functional endoscopic sinus surgery.

Methods of treatment of sinusitis

Intranasal medications, is represented by sprays, drops, inhalations, anti-inflammatory, vasoconstrictor or anti-bacterial effect. They facilitate nasal breathing, prevent growth of pathogens on the surface of the mucous membranes and reduce inflammation. Drugs with astringent envelop the nasal cavity and prevent it from drying. Washing saline is a good way to clean out the sinuses of the accumulated mucus. However, this method is applicable for adults and children older than 5 years (the younger the child, the greater the risk of otitis).

The hardest for washing the place can be called maxillary sinus. Due to the anatomical location, the usual manipulations do not affect accumulated in the maxillary division mucus. In-patient and outpatient treatment are used three ways:

  • displacement (popular name «cuckoo»);
  • the use of sinus catheter;
  • puncture of the sinuses (in medical language – puncture).

In most cases, combination drug therapy with one or more ways of cleansing the sinuses of mucus is enough to significantly alleviate the patient’s condition and subsequent full recovery. However, the hope of many patients to «maybe it will sort itself out» often leads to the fact that normal inflammation that with adequate action and timely medical care would have passed for a week into a more serious condition, causing lesions and other organs.

Most often at risk are the ears (otitis media), mouth (dental disease), lungs (pneumonia, bronchitis), and even the brain (meningitis, encephalitis). Loss sinusitis from acute stage may go into a chronic form, the person providing constant headaches, recurrent nasal congestion, snoring and other unpleasant phenomena.

In situations where conservative methods of treatment are powerless, doctors have resorted to surgery. One of the common methods of the last century, has been used successfully to this day, an open operation is used to visually examine the sinuses and capital to clear them from pus and mucus. But the complexity of the process and the need for General anaesthesia has resulted in an increasing number of surgical interventions in the nasal cavity is carried out internally. Such manipulations are called functional endoscopic sinus surgery in the nasal cavity. For the first time this method was tested in 50-ies of the last century, and since 60-70-ies, has been used successfully in otolaryngology around the world.

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Advantages of endoscopy

In States with a high level of medicine endoscopic practice is considered a «gold standard» in the treatment of chronic forms of inflammation of the sinuses and conditions, is resistant to conservative therapy. One of the obvious advantages of such manipulation, especially in comparison with the traditional approach, absence of visible postoperative defects, since the sections of tissue are required.

Another advantage is the possibility of a detailed diagnosis. Endoscope introduced into the nasal cavity, is a light guide device which can be used not only to examine the affected sinus, but also to assess the extent of inflammation, to understand the anatomical features, and identify «surprises». And most importantly – to find and neutralize the source of the disease, thereby speeding up recovery time, reducing the risk of trauma and possible complications. After this intervention the scar is formed, pain on the stage of rehabilitation is less pronounced, although for a few days may persist swelling of mucosal and soft tissues.

Paranasal sinuses include subtle channels of bone that are covered with mucosal tissue. For any inflammation, be it allergic or viral rhinitis, these tissues swell and block the passage. Endoscopic surgery on the maxillary sinus (see the video in the gallery) is designed to expansion of the bone canal. Another advantage of such interventions is that even if the patient then faces with lesions of the nasal cavity, the lumen of the sinuses did not block that gives an advantage in the treatment of subsequent acute conditions. Besides the main task to increase the bone canal using the endoscopic technique can eliminate a variety of unwanted tissue in the nasal cavity: cysts, polyps, growths.

As the surgical field during such operations is close enough to vital organs, safety and accuracy of manipulations, parameters of paramount importance. In this regard, the endoscopic technique is constantly being improved and studied.

One of the key updates in recent years is the use of control visualization: a computer program that retrieves data from a CT scan, a special way of processing incoming information and reconstructs a three-dimensional image of the nasal cavity of the patient.

This layout displays the whole structure of the sinuses and the adjacent soft tissues, besides through this program you can easily track each surgical tool and calculate the next action. This technique with engaging visual control is often used in complex cases: in case of lesion of the paranasal sinuses, the ineffectiveness of conventional operations, unconventional structure of the nasal cavity of the patient.

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Preoperative preparation

The first and one of the most important step before surgery remains a diagnosis to determine the cause of the disease, especially the disease, the condition of the air passages and to plan therapy. For this purpose data of x-ray, CT scan, analysis of smell, Cytology and rhinomanometry, revealing the thickened wall of the mucous membranes, cysts, polyps, localization of the blockage of the nasal openings and other elements of the disease. Accurate knowledge allows to determine the tactics of treatment in General and strategy of surgical intervention in particular.

Endoscopic manipulation

Earlier in the surgical practice of ENT doctors, it was believed that a complete cure of severe and chronic forms of sinusitis require major elimination of mucous membranes of the sinuses, a modern method FAHP (functional endoscopic surgery of the sinuses) refutes this opinion. Technical basis and updated tools used in endoscopic operations, provide gentle treatment interventions with preservation of mucosal tissues. This improves the outflow of the purulent mass and mucus, restoring the air passages and shell get the possibility of regeneration and self — «correction.»

Cleaning sinus surgery performed under local anesthesia, which reduces the time of manipulation and accelerates rehabilitation of the patient. First, in the nasal cavity entered the endoscope, equipped with microminiature. It allows surgeons to visually assess the amount of work the structural features of the sinuses and to find a primary lesion of the disease. Then, after the endoscope in the affected area are special microinstruments are used to provide high precision with each movement the doctor. Eventually the affected tissue is removed without any harm to healthy cells, has a beneficial effect on postoperative recovery.

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This method is minimally traumatic for mucous membranes and as most interventions are carried out through nasal cavities and leaves no external defects in the form of scars or scars. After endoscopic manipulation may be a small swelling, soft tissue swelling and minor discomfort.

Foreign body in the nose

Along with pathogens, inflammation of the maxillary sinuses can cause the ingress of a foreign body in the nasal cavity. If you have small children this is due to the accidental inhalation of small items or food particles and handwritten inserting the elements of the toys in the nostrils, in the conscious adult is most likely caused be dental procedures. Another way of getting foreign particles into the sinus an open wound. A symptom of foreign elements in the nasal passages can serve as an abundant discharge of mucus from one nostril. But there are cases when first caught in the nasal cavity of the subject does not cause discomfort, but over time, necessarily provoke inflammation.

With the development of minimally invasive methods and surgery to remove a foreign body from the maxillary sinus was carried out using an endoscope, which allows to gently eliminate trapped object without harm to healthy tissues. In some cases, extraction of the particles is carried out through access under the upper lip. The hole size does not exceed 4 mm, which ensures the safety of anastomosis of the maxillary sinus.

Unfortunately, endoscopic equipment is quite expensive, so such operations are not in all medical institutions, moreover, for a flawless intervention necessary knowledge and practical experience of the surgeon.