Sphenoid surgery

The disease of the sphenoid sinus is not uncommon. Inflammation of the sphenoid sinus often coincides with inflammation of the posterior ethmoid sinus. Sphenoid sinus cyst and sphenoid sinus fungal disease have also been found. Early sphenoid sinus disease has no characteristic clinical manifestations. Due to advances in radiodiagnostics, especially after the application of ct and mr in clinical practice, the discovery of sphenoid sinus disease has also increased. The treatment of sphenoid sinus disease is mainly based on surgical treatment. The purpose is to eradicate the lesion and open the sinus cavity to achieve ventilatory drainage. Treatment of diseases: sphenoid sin Indication 1. The sphenoid sinus inflammation has been treated for a long time and cannot be improved. 2. Sphenoid sinus cyst. 3. Unexplained sphenoid sinus space-occupying lesions. 4. Sphenoid sinus mycosis. Preoperative preparation 1. Trim the nose hair and nasal astringent to improve the ventilating drainage of the nasal cavity and sinus. 2. Preoperative routine x-ray examination, ct examination to understand the extent of the lesion and its relationship with the surrounding tissue. Surgical procedure There are three routes of surgery: 1 extranasal route, 2 intranasal route, 3 through the upper lip and lower nasal septum. (a) extranasal route 1. The incision from the brow tip down 0.5 cm from the medial side of the medial condyle down to 1 cm below the medial malleolus for all the mouth, incision of the skin, subcutaneous tissue and periosteum. 2. Exfoliate the skeletal cardboard and tear bone under the periosteal peel. 3. Cut into the ethmoid sinus from the back of the lacrimal sac. In order to enlarge the surgical field, the nasal process of the frontal sinus and frontal bone of the maxilla can be bitten. Or open by the cardboard on the inner side wall into the ethmoid sinus. All the sinus air chambers are opened from front to back. If the anterior or posterior ethmoid artery is to be ligated or electrocauterized. 4. The sinus sinus can also be removed after the maxillary sinus is scraped, reaching the anterior wall 5. The natural opening of the sphenoid sinus can be found at the sac of the butterfly screen at the top of the upper turbinate. 6. The natural opening of the sphenoid sinus is extended downward and inward, and the anterior wall of the sphenoid sinus is enlarged by the proximal septum. If the natural opening is closed, the mucosa can be peeled off about 1 to 1.5 cm from the upper edge of the posterior nostril, the anterior wall of the sphenoid sinus is opened, and the open sinus cavity is enlarged downward and near the midline. 7. Clean the diseased tissue in the sinus, but the normal mucosa should be preserved. 8. The sphenoid sinus is built with a gelatin sponge. The iodoform gauze in the ethmoid sinus is taken out from the nasal cavity. For example, in the maxillary sinus, the iodoform sinus can also be filled from the nasal cavity. 9. Suture the nasal incision and compress the dressing. (two) intranasal route 1. After sphenoid sinus puncture and nasal mucosal surface anesthesia, the long pyeuroscope is placed between the nasal septum and the middle turbinate. The middle turbinate was pushed outward, and the anterior wall of the sphenoid sinus was slowly pushed into the sinus cavity with a puncture needle, and the sinus cavity was washed with physiological saline, and the antibiotic solution was injected into the sinus (Fig. 1). This method is suitable for inflammation of the sphenoid sinus. 2. Expose the anterior wall of the sphenoid sinus with the above method. After finding the natural opening, use the sphenoid spur rongeur to bite the anterior sinus wall inward and downward from the natural opening and enlarge the surgical field (Fig. 2). 3. If polyps or granulation tissue should be removed in the sinus, the swollen hypertrophic mucosa should be preserved. If there is a caseous necrotic tissue, thoroughly clean it, then rinse the sinus cavity with saline. If there is bleeding, plug it with gelatin sponge and fill in the iodoform gauze. 4. Intranasal sphenoid sinus surgery can also be performed after the anterior wall of the sphenoid sinus is fully exposed on the basis of the scraping technique. If the operation is performed under nasal endoscopy, it is more intuitive, and the field is clear and the tissue damage is less. 5. If there is not much bleeding after surgery, you can use gelatin sponge to fill the edge of the sphenoid sinus window and fill the nose with iodoform gauze. If there is more bleeding, the iodoform gauze is filled from the sinus cavity to the nasal cavity. (C) through the upper lip nasal septum (1) Make a mouth at the labial groove of the upper lip and cross the lip to the bilateral canine. (2) The mucosa is cut open, peeled off to the plow hole, and the mucosa of the pear-shaped hole is cut to sufficiently expose the pear-shaped hole and the nasal floor. (3) Peeling under the mucosa on both sides of the nasal septum and excising the septal cartilage. At the same time, the condyles of the vomer are removed with a rongeur or osteotome. (4) The anterior wall of the sphenoid sinus can be exposed by inserting a large two-leaf spreader between the bilateral septal mucosa membranes. (5) Open the anterior wall of the sphenoid sinus with an osteotome or electric drill and fully expose the sphenoid sinus cavity, remove the sphenoid sinus spacing, make the surgical field wide, and see the posterior superior wall of the sphenoid sinus as the anterior inferior wall of the pituitary fossa. Sometimes it can be seen that the tumor has penetrated the bone wall and protruded into the sphenoid sinus cavity.