nasal endoscopy

The endoscope is a rigid endoscope with a well-lit cold light source. Through mirror magnification, the anatomy can be clearly observed from the front to the back. The nasal surgery changes from blind empirical operation to protection of normal structural and physiological functions. Surgery. At present, the endoscopes commonly used in clinical practice are 0°, 30° and 70°, the diameter is 4.0mm, and the length of the lens is 180mm. This endoscope has a large field of view and good brightness. Children can use a 2.7mm diameter endoscope. At the same time, there should be a cold light source and a light source wire. In order to do some simple operations, the following instruments should also be prepared for 0° and 45° ethmoid sinus clamps, straight suction tubes, curved suction tubes, maxillary sinus sinus needles, maxillary sinus biopsy forceps, and sphenoid spur rongeurs. If there is a video recording system, it is helpful for operation, teaching and data storage. The nose hair should be cut before the inspection. Basic Information Specialist Category: Otolaryngology Examination Category: Endoscope Applicable gender: whether men and women apply fasting: not fasting Tips: nose hair should be cut before inspection. Normal value The normal nasal mucosa is reddish and the surface is smooth, moist and shiny. There is no congestion, edema, no dryness, ulceration, no bleeding, vasodilation and new organisms in the nasal cavity and nasopharyngeal mucosa; no purulent secretions. The normal maxillary sinus mucosa is thin and transparent, and the yellow bone wall under the mucosa can be seen. The small blood vessels are clearly visible, and the natural opening can be seen above the inner side wall, and sometimes the secondary mouth can be seen. There is a depression in the back of the natural mouth, which is slightly blue, and is a thin wall between the maxillary sinus and the posterior ethmoid sinus. Clinical significance Indication 1. Indications for nasal endoscopy (1) Find the site of nosebleeds and stop bleeding under endoscopic direct vision. (2) Find the source of purulent secretions. (3) Early nasal and nasopharyngeal tumor localization and biopsy under direct vision. (4) The location of the cranial fluid rhinorrhea. 2. Indications for maxillary sinus endoscopy (1) X-ray or CT imaging examination suggests that the maxillary sinus is blurred or suspected of occupying lesions; (2) foreign body of the maxillary sinus; (3) odontogenic maxillary sinusitis; (4) fracture of the maxillary sinus wall or bursting of the fundus; (5) The cause of pain in the cheeks or swelling of the cheeks is unknown; (6) There are still symptoms after maxillary sinus surgery. Inspection result analysis 1. The mucous membrane is bright red when there is acute inflammation, and there is sticky secretion. 2. The mucous membrane is dark red in chronic inflammation, and the front end of the inferior turbinate is sometimes mulberry-like, and the secretion is mucopurulent. 3. The mucosa of allergic rhinitis is pale edema or lavender, and the secretions are dilute. 4. Atrophic rhinitis mucosa is atrophied, dry, loses normal luster, covered with purulent sputum, the lower turbinate shrinks, and the middle turbinate occasionally has hypertrophy or polypoid changes. 5. The middle nasal passages are caused by sinus lesions in the anterior group of purulent secretions, and the purulent discharge in the olfactory sulcus is caused by the sinus lesions in the posterior group. High results may be diseases: nasal cancer, nasal tumor, nasal anterior skull tumor, pediatric allergic rhinitis, chronic ethmoid sinusitis, paranasal sinusitis, septal hematoma, suppurative sinusitis, congenital posterior atresia, acute rhinitis matter 1. Front nose examination: The examiner holds the nose on the left, pinches the joint of the front nose with the thumb and forefinger, one handle is placed on the palm of the hand, and the other three fingers are held on the other handle, and the front nose of the two leaves is closed. The mirror extends into the nasal vestibule parallel to the bottom of the nose and opens gently. The nose should not be too deep to avoid pain or damage to the nasal septum mucosa. 2. Do not completely close the double leaves when removing the nose to avoid pain caused by clamping the nose hair. 3. Check should pay attention to: mucous membrane color, swelling, hypertrophy, atrophy, surface moist, dry; total nasal passage widening, stenosis; nasal secretions location, color, nature, quantity; nasal septum deviation, sputum, distance There are no new creatures. 4. For suspected sinusitis and no secretions in the nasal passages, it can be used as a body drainage to help check, that is, first use 1% ephedrine saline droplets to place in the middle nasal passage and the olfactory groove to contract the nasal mucosa. Make the sinus patency, then place the head and body in a certain position, and check again after about 10~15 minutes. If you suspect that the maxillary sinus is empyema, take the side of the lower head and the healthy side down. If you see the pus in the middle nasal passage, you can confirm it. Before the examination, the sinus vertebral head was raised later, and the posterior ethmoid sinus was slightly tilted forward. The frontal sinus was taken to take the sitting position. 5. Strictly control contraindications. Inspection process (1) The patient takes a sitting position or a reclining position, the head is biased toward the examiner, the conventional nasal face is disinfected, and a sterile towel is placed. (2) 1% dicaine ephedrine cotton tablets for nasal mucosal surface anesthesia and contraction of mucosal blood vessels. (3) Apply a 0° endoscope to the nose or (and) the lower nasal passage, and observe the front of the inferior turbinate, the middle and back of the inferior turbinate, the nasal septum and the lower nasal passage from the front to the back. Apply a 30° endoscope from the nose to the posterior nostril, and gently rotate the lens with the posterior margin of the nasal septum to observe the nasopharyngeal wall and eustachian tube opening, pay attention to the eustachian tube round pillow and pharyngeal recess. The endoscope gently exits, the upper surface of the turbinate is supported, observe the middle turbinate and the middle nasal passage, pay attention to the uncinate process, the sieving and the sieve funnel; continue to enter the mirror along the lower edge of the middle turbinate, and face the mirror at the rear end of the middle turbinate External rotation 30 ° -45 °, observe the butterfly sieve crypt and sphenoid sinus opening. Apply a 70° endoscope from the nose to the posterior nostril, observe the top of the nasopharynx, and then withdraw the endoscope. The following turbinate surface is supported. From the lower edge of the middle turbinate, the posterior end of the middle turbinate is found, and the mirror is turned outward. Looking for the maxillary sinus opening in the back of the nasal passage; if the middle turbinate is well contracted and has a gap with the nasal septum, a 70° endoscope is used to enter the mirror between the middle turbinate and the nasal septum, and the upper turbinate and the upper nasal passage can be observed. A few people can also See the top turbinate and the top nasal passage. Nasal endoscopy should pay attention to the nasal cavity and nasopharyngeal mucosa with or without congestion, edema, dryness, ulcers, hemorrhage, vasodilation and new organisms; pay attention to the origin, size and extent of new organisms and the source of purulent secretions; Suspected new organisms should be taken for biopsy, and sinus purulent secretions can be aspirated for bacteriological examination. Not suitable for the crowd Generally there are no people who are not suitable. Adverse reactions and risks Generally no adverse reactions.