maxillary sinus puncture

Maxillary sinus puncture is a commonly used diagnosis and treatment in outpatient clinics. According to the nature of pus, the nature of diagnosis and estimation of lesions can be determined. Most patients can achieve the purpose of cure. Treatment of diseases: maxillary sinusitis Indication Maxillary sinus puncture is suitable for: 1. Suspected to have lesions in the maxillary sinus, to clarify the findings of X-ray films, can be used for experimental puncture. 2. Acute or subacute maxillary sinusitis, help the pus absorption can repeatedly puncture and wash the maxillary sinus. 3. Chronic maxillary sinusitis can be repeatedly puncture and inject antibiotics into the maxillary sinus. 4. Clinically suspected maxillary sinus puncture and lipiodol angiography in the presence of benign or malignant masses in the maxillary sinus. 5. Patients with clinical diagnosis of maxillary sinus malignant tumors can be treated with maxillary sinus puncture or endoscopic biopsy or irrigating fluid for tumor cell examination. Contraindications In children under 1.3 years of age, the maxillary sinus is too small to develop and the puncture is dangerous. 2. Individual adult patients have small maxillary sinus cavities and thick bone walls, which are not suitable for maxillary sinus puncture. Surgical procedure 1. The patient's head is kept in the middle position. The surgeon uses a dilating nose to spread the nose and place the puncture needle at the front end of the inferior turbinate 1.0~1.5cm. The lower nasal turbinate is attached to the lower turbinate, and the back of the nasolacrimal duct is opened. The thinnest, which is good for puncture. The needle is oriented outward and points upwards in the same direction of the lateral direction. At this time, take out the dilating mirror, fix the head with one hand, fix the puncture needle with one thumb and finger, and pin the needle against the big fish. Gently push the needle or spin it to pierce the bone wall. After entering the sinus cavity, there is a cavity feeling. . If the puncture site is too far forward or backward, the bone wall is thick and hard, and it is necessary to enter the sinus cavity with vigorous force. 2. After the puncture needle enters the sinus cavity, the needle core is withdrawn, and the 20 ml syringe with the rubber tube is sucked into the sterile saline solution and connected to the puncture needle. First pump back, if there is air and pus, it is confirmed that the needle is in the maxillary sinus cavity. At this time, the patient's hands are bent on the plate, the head is tilted forward, and the saline is slowly injected, that is, there is pus from the middle nasal sinus maxillary sinus. The natural opening is discharged, and until it is washed, 40,000 U of gentamicin can be injected, the needle core is inserted, the puncture needle is pulled out, and the ephedrine cotton sheet is applied to the lower nasal passage. complication 1. Air sputum due to rupture of vascular injury in the sinus, the negative effect of venous intravascular negative pressure, after blowing into the sinus after flushing, the air enters the damaged vein in the sinus, through the pterygoid plexus, face total Venous, internal jugular vein, superior vena cava, right atrium, right ventricle, pulmonary artery, pulmonary vein, left atrium, left ventricle and coronary artery. More than 1 to 2 minutes after puncture, the patient developed dizziness, convulsions, and convulsions. If a small amount of air enters the blood, it can be dissolved and absorbed without serious harm. If a large amount of air enters the blood, it is difficult to take emergency measures. Therefore, try not to blow when puncture and flushing to prevent the occurrence of air locks. 2. Intraorbital or pterygopalatine infection, excessive force through the maxillary sinus apex or posterior wall during puncture, when the patient injects the flushing liquid, if the patient has pain in the sac or the back of the eye, stop flushing and give enough A broad spectrum of antibiotics. 3. Facial emphysema or swelling of the face If the puncture needle penetrates into the soft tissue outside the sinus, facial swelling and subcutaneous emphysema may occur during rinsing. The rinsing should be stopped and antibiotics should be given.