maxillary sinus endoscopic surgery

Treatment of diseases: maxillary sinusitis Indication Maxillary sinus endoscopic surgery is applicable to: 1. Chronic recurrent maxillary sinusitis is cured for a long time. 2. Fungal maxillary sinusitis. 3. Maxillary sinus cyst. 4. Maxillary sinus polyps. 5. Foreign body of the maxillary sinus. Preoperative preparation 1. Identify diagnostic and surgical indications and eliminate contraindications. 2. Read the film carefully to determine the surgical plan. 3. Conventional preoperative examination (blood routine, platelet, liver and kidney function, coagulation function, electrocardiogram and chest radiograph). 4. Pre-operative signature. 5. Use antibiotics 1 to 3 days before surgery. 6. Cut nose hair 1d before surgery. 7. Intramuscular hemostatic drugs 30 min before surgery. 8. General anesthesia according to general anesthesia routine. Surgical procedure 1. Remove the uncinate process and see the ethmoid sinus surgery. 2. Find the natural opening of the maxillary sinus and enlarge it. The positioning of the maxillary sinus is very important, and sometimes it is difficult to see the sinus directly under the endoscope. 1 The maxillary sinus opening is between the sputum and the uncinate process. After the uncinate process is removed, the curved cap or the curved applicator head can be carefully explored along the inferior turbinate under the endoscope, if there is a purulent discharge, Or small bubbles appear, usually indicating the position of the natural opening of the maxillary sinus. 2 The natural mouth of the sinus mouth may be covered by nearby polyps, granulation or sticky secretions, and the sinus ostium can be seen after cleaning. The reasons for the natural opening of the maxillary sinus are not easy to identify as follows: A. The lesion mucosa covers or closes the natural opening of the maxillary sinus; B. The uncinate residue covers the maxillary sinus opening downward; C. The maxillary sinus naturally opens the scar. Thorough removal of the uncinate tail bone is the key to finding and expanding the natural mouth of the maxillary sinus. 3 If the natural opening of the maxillary sinus is difficult to identify, a 5mm maxillary sinus cannula needle can be inserted into the maxillary sinus through the cannula, inserted into the endoscope, and the natural opening can be explored through the middle nasal passage under bright vision, which is beneficial to reduce eyelid complications. After inserting the curved aspirator head or probe into the maxillary sinus, the inner wall and the membrane of the maxillary sinus can be bitten forward and backward by scissors and anti-biting forceps, respectively, and then the lower wall of the natural mouth is bitten. Expanding the natural mouth of the maxillary sinus to 1.5cm × 1.5cm, maintaining the upper wall mucosa of the natural mouth is an important measure to prevent postoperative stenosis of the natural mouth. If you see the upper sinus sinus, you should connect the secondary port to the natural opening. Do not ring the maxillary sinus opening to avoid ring narrowing after surgery. When expanding the maxillary sinus opening forward, be careful not to damage the nasolacrimal duct. The bone wall of the nasolacrimal duct is hard and easy to identify. 3. Clear the lesions in the maxillary sinus. Under the 30° or 70° endoscopic observation, the enlarged maxillary sinus natural opening absorbs purulent or sticky secretions, and the mucosal lesions are not heavy, and the mucosa should be retained. The sinusoidal anhydride casein and fungal mass should be completely removed, otherwise there will still be pus after surgery. The cyst should be removed completely to prevent recurrence. The mucous membrane with severe polypoid changes can be removed by the aspirator. The part that cannot be absorbed indicates that the edema is not obvious and can be retained. For pedicled polyps, use a curette. In benign tumor resection, if the tumor invades the maxillary sinus, use a curette to scrape the sinus mucosa. If necessary, the maxillary sinus cannula needle can be inserted into the maxillary sinus through the cusp of the cannula, inserted into the endoscope or surgical instruments, and the maxillary sinus lesions can be cleaned through the combination of the canine fossa and the middle nasal passage.