Surgery for sinusitis the sinuses: surgical treatment
How do surgery for sinusitis?
The catarrhal form of inflammation of the maxillary sinus amenable to therapy with decongestants, antiseptic, antihistamines in combination with natural and physical factors. The lack of positive dynamics or chronic pathology requires drastic measures – surgical treatment of sinusitis.
Modern medicine offers several variations of the solution. Which one will be best for a specific clinical case, identifies the doctor, analyzing the risks and benefits of techniques.
The etiology of sinusitis
The maxillary cavity located in the upper jaw, the parameters dominates the cells of the ethmoid, frontal and sphenoid paranasal cavities. The integrity of the sinus violate the viruses and bacteria that penetrate through the pin hole.
The revitalization of the pathogenic microflora inhibits the production of the mucociliary apparatus, sinuses cease to be cleansed in a natural way, the mucosa becomes inflamed and swells. In the projection of the upper respiratory tract of accumulated mucus, which creates favorable conditions for the growth and propagation of pathogenic agents. So developing sinusitis.
The disease starts with nasal congestion, production of thick aconselho secret with impurities of purulent exudate. The patient experiences intense headaches, discomfort spread to the whole of the front of the head, reduced sense of smell, acute reaction to light, deteriorating overall health.
For reference! The growth of the maxillary sinus occurs by 4 years of life, they further increase in volume is proportional to the formation of the facial skeleton.
In the absence of medical care, there is a risk of complications that dangerous pneumonia, frequent bronchitis, sepsis, and meningitis.
Surgical treatment of sinusitis
When conservative therapy does not bring the desired effect, the audiologist provides endoscopic manipulation.
There are a number of indications that determine the need for removal of the sinusitis:
- recurrent purulent process;
- the failure of etiotropic therapy;
- intracranial complications;
- the closed form of the maxillary sinus;
- the spread of the infection beyond the pneumatic cavities;
- hypertrophy of soft tissues;
- fungal infection;
- localization of tumors: cysts, polyps, adenoids.
The possibility of invasive therapy determines the General physiological state. History of the patient must be no pathology of the cardiovascular and endocrine systems, infectious and General inflammation.
Surgery for sinusitis the sinuses are aimed at restoring aeration of the nasal cavities, natural breathing, excision of the obstructive tissue, the prevention of complications. To do this, the doctor removes the inflamed areas of the epithelium or mucous abnormal growths, cuts off part of the bone.
In medical practice there are three ways of surgery – puncture, endoscopy and traditional method.
Puncture of the maxillary sinus
Minimally invasive therapy is prescribed for forced drainage of the nose, sampling of biological material for research. Remove sinusitis in a hospital or on an outpatient basis in several stages:
- Anesthesia. To reduce the sensitivity of nerve receptors of the patient undergoes thermal pain (treated with antiseptic the outer surface of the nose or injected into the nasal cavity with a cotton turundy impregnated «Lidocaine», «Novocaine») or infiltration (injection). In pediatric patients prefer General anesthesia.
- Puncture of the bone septum. In the projection of the middle or inferior nasal meatus, where the bone thickness is minimal, needle Kulikovskii doctor pierces the wall of the sinus 1-1. 5 cm With the syringe to evacuate the pathological contents, washed the cavity with sterile saline solution. The liquefied fluid flows into the tray, placed under the chin of the patient.
- Recovery. The therapeutic effect occurs instantly. Upon completion of the procedure in the nasal holes, leave the catheter for a few days for daily irrigation of the nose. To prevent the negative effects of antibiotics penicillin the course of 7-10 days (the»flemoksin soljutab», «Augmentin», «Ospamox»).
Fact! In violation of the integrity of the bone, the patient is not experiencing pain, however, there are unpleasant sensations, accompanied by the crunch.
The restriction on the procedure leaves a patient’s predisposition to hypertension, diabetes mellitus, congenital anomalies of nasal cavity, early age.
Identical name maxillaria antrostomy refers to the most functional method of Rhino-sinus surgery. Less traumatic technique combined with minimum risk of side effects and the active rehabilitation period, does not require special training.
Numb the area, through a small puncture near the gums of the upper teeth or nasal cavity in maxillary sinus endoscopic device is introduced to control the operation, and a surgical instrument. Using the installer clean the nasal cavity from irritants, pulmonary tissue formations, which cover an outlet for the outflow of mucus.
Nuance! To remove the blocking items to choose to use laser or savernow system.
Depending on the complexity of the procedure’s duration varies from 20 to 40 minutes. After 2-3 hours after surgery the patient allowed to go home, followed by a visit to the surgeon every 5-6 days until there is a need for removal of blood clots and dried mucus.
For the relief of inflammation, regeneration of the epithelium and formation of local immunity, the doctor will prescribe corticosteroids course to 6 months.
Traditional surgical intervention (operation Caldwell-Luc)
The radical method is effective in chronic sinusitis or the infection spread on the facial bone structure, the brain membrane. The procedure requires the surgeon’s skills with complex endoscopic devices in municipal hospitals financed by the health system.
For reference! 6 hours before invasive activities limit the consumption of food.
How do surgery for sinusitis? The sequence of actions is represented by the following algorithm:
- Initially open the passage to the pneumatic cavity through an incision above the upper lip or the skin on the cheek, followed by dissection of soft tissues to bone structure. Using a drill in the sinus wall make a hole for the introduction into the cavity of the surgical tool.
- The next phase – the rehabilitation of the nose. Revision nasal pockets relieves sinuses from pathological sputum, exudate, issecheny tumors and obstructive tissues. Then through the middle nasal meatus establish drainage.
- Completes the operation by plugging the nose with cotton harness excretion in the nasal passages. On the wound surface from the gums sutured. After 24 hours the tampon is removed, rinsed nasal cavity. To restore nasal breathing, eliminate hyperemia of soft tissues a short course 3-5 days appoint vasoconstrictive drugs («Nazivin», «Expra», «ksimelin», «Otrivin»,».», «Snoop»).
As additional preventive measures carried out by local pharmacotherapy antihistamine, decongestant and antibacterial drugs prescribed irrigation of the sinuses with saline or Sodium Chloride.
Complications after surgical treatment of sinusitis occur very rarely. The likelihood of side effects determines the operative technique, competence of the specialist training and rehabilitation period.
The list of possible negative consequences of the operation:
- nasal bleeding, provoked by the violation of the integrity of the blood vessels;
- an air embolism. Characterized by filling with air the surrounding tissue and voids. Threat to the health of the patient is localization of pus in the healthy projections. To prevent diseases in the recovery period spend antibacterial therapy;
- puncture of the cheek wall of the orbit, which is associated with the anatomical features of pneumatic bones of the skull. Complications do not affect the health of the patient, because bacteriostatic drugs prevent the spread of infection;
- hematoma in facial bones. This condition is preceded by damage to the posterior wall of the sinus, the bone structure of the pterygoid-palatal recess;
- temporary reduction of visual acuity, sense of smell;
- anaphylactic shock antiseptic used. The development of non-standard reaction indicates that before the operation was not carried out individual test tolerance analgesic.
Fear and strong emotions provoke collaptoid reactions: loss of consciousness, drop in blood pressure, change in color of skin.
Patients should be prepared for the fact that after completion of the procedure, occasional nasal congestion, due to damage to soft and bone tissue with a medical instrument.
Surgical treatment of sinusitis – a necessary measure, in which the risk of pathological complications outweighs the potential discomfort during invasive therapy. The operation experienced a qualified professional reduces the likelihood of negative consequences.
The patient will require strict adherence to medical recommendations, hospital visits to full recovery.