Nasopharyngeal biopsy

Nasopharyngeal biopsy is a commonly used method for confirming nasopharyngeal lesions, especially nasopharyngeal malignancies. Because China is one of the high incidence areas of nasopharyngeal carcinoma, it is necessary to be familiar with the anatomy of the nasopharynx and nasopharyngoscopy. Master the method of nasopharyngeal biopsy. There are two methods currently used for oral nasopharyngeal biopsy and transnasal nasopharyngeal biopsy. Basic Information Specialist classification: otolaryngology examination classification: pathological examination Applicable gender: whether men and women apply fasting: not fasting Tips: Before the biopsy, the nasopharynx can be washed with warm saline. Normal value The biopsy results of the nasopharynx were normal, and no nasopharyngeal lesions or malignant tumors of the nasopharynx were found. Clinical significance Abnormal results: In addition to misdiagnosis of fibroangioma, the nasopharyngeal biopsy can cause severe hemorrhage. After surgery, there are only a few micro-bleeds that disappear quickly. A small amount of bleeding, 1% ephedrine solution in the nasal cavity, will gradually stop, no need to deal with other. Individual bleeding is more, should stop bleeding properly, close observation, bleeding continues, if necessary, can also use the posterior nostril yarn for nasopharynx occlusion. When the nasopharyngeal biopsy is negative, it is considered clinically necessary to perform another biopsy, or even multiple biopsies. People who need to be examined: Clinically diagnosed nasopharyngeal lesions, especially those suspected of nasopharyngeal carcinoma, should be biopsied. Precautions Inappropriate people: For nasopharynx fibrous aneurysm and skull base tumor, it is generally not suitable for biopsy to avoid serious complications. In addition, melanoma is easy to diagnose because of clinical diagnosis, and biopsy is easy to spread, so no biopsy is performed. Pre-inspection contraindications: Explain to the patient the purpose of spraying the anesthetic liquid and the temporary nature of the pharyngeal discomfort after spraying, so that the patient can relieve the concern and actively cooperate. Requirements for examination: 1. Nasopharyngeal biopsy through oral route, because under the nasopharyngoscopy, it is easier to see the bite, the positive rate of biopsy is also higher, the operation is also called simple, so it is often in clinical work. The preferred method. However, when the mouth is difficult and cannot be operated according to the oral method, the nasal biopsy can be used. This method can not be used to visually identify the specific lesions unless it is directly applied to the nasopharyngeal mirror. Mucosa, and patients accept this method is also more concerned than oral methods, therefore, it is not currently used as a routine examination method. In this case, it is best to use a biopsy under nasal endoscopy. 2. Regardless of the oral or nasal cavity method, the tissue is clamped and violently pulled, so as not to tear the mucosa, damage the deep tissue, and even cause bleeding. 3. In the case of a small number of superficial mucosal tumors, due to the deep submucosal tissue lesions, general biopsy, often difficult to get a positive result, you can try to cut the mucosa, the forceps stretched deep into the mucosa bite. 4. For patients who have undergone radiotherapy, the nasopharynx is full of necrotic tissue or dryness. Before the biopsy, the nasopharynx can be used to wash the nasopharynx, or the nasopharyngeal forceps can be used to remove the above substances before biopsy. Inspection process Anesthesia: Anesthesia was performed with a 1% tetracaine mucosal surface spray. Spray on the posterior wall of the pharynx and soft palate, then spray the nozzle upwards, spray the posterior oropharynx to the nasopharynx, and biopsy is feasible after 10 minutes. Surgical methods: 1. Oral route for nasopharyngeal biopsy. The assistant or the patient's own tongue depressor presses the tongue down. The operator holds the indirect nasopharyngoscope on the left and the nasopharyngeal biopsy force in the right hand. After clarifying the lesion, the tissue is bitten at this point. If the nasopharyngeal cavity is small and the exposure is poor, the soft palate can be pulled open with a soft sputum hook, or the catheter can be pulled into the pharynx from the nasal cavity, and the two ends of the catheter are pulled out from the front nostril and the mouth respectively, and the knot is tightened instead of the soft shackle. To widen the nasopharyngeal cavity and facilitate exposure. 2. Nasopharyngeal biopsy through the nasal route in addition to the pharyngeal spray to make the nasopharyngeal cavity surface, the nasal cavity also needs to be surface anesthesia, and then the nasopharyngeal biopsy forceps or nasal biopsy forceps directly from the front side of the affected side to the nasopharynx Align the direction of the tumor and take a biopsy. The application of direct nasopharyngoscopy is also through the nasal passage to reach the nasopharyngeal cavity. In case of turbinate hypertrophy or septum deviation obstructing the biopsy forceps or the lens tube, the nose and mucosa may be converged with 1% ephedrine solution as appropriate. Not suitable for the crowd There are no special taboos. Adverse reactions and risks No related complications and hazards have been found.