Nasal "H" Incision Surgery

The nasal incision of the "H" shaped incision is equivalent to the bilateral intranasal sinus surgery incision, and a transverse incision is made in the plane of the nasal foramen of the nasal root to connect the incisions on both sides. Sometimes the lesion is mainly located on one side, it can also be made into ")-(right)" or "-((left)". The operation can reach the medial side of the bilateral apex, the chiasm, the sphenoid sinus, and even the slope. The lesions in the middle of the anterior skull base and the middle part of the cranial anterior fossa were removed and repaired. Treatment of diseases: nasal septum deviation Indication Nasal "H" incision surgery is suitable for bilateral ethmoid sinus, nasal olfactory neuroblastoma, squamous cell carcinoma, chondrosarcoma involving the anterior skull base and affecting the meninges, but the brain tissue is limited or double nasal cavity, ethmoid sinus benign The lesions are extensive and involve the anterior skull base, such as osteofibrosis, ossifying fibroma. Contraindications The ethmoid sinus and nasal malignant tumors invade the anterior cranial fossa with the frontal lobe brain tissue, or the cranial anterior fossa meninges are small, but the pedicled fascia flap and the pedicled musculocutaneous flap should be repaired. - Nasal combined approach surgery; malignant tumor involving sputum content, apex and optic nerve should be performed simultaneously. Preoperative preparation 1. It is basically the same as nasal incision and extranasal ethmoid sinus surgery. 2, systemic and specialist examinations, including blood biochemistry, blood type, heart, lung, liver, kidney function, chest X-ray and paranasal sinus CT, MRI examination, if necessary, please consult the relevant departments, including neurosurgery, ophthalmology. 3, ready to take the thigh fascia to repair the meninges or sacral fascia defects in the side of the thigh skin; the use of the humerus to reconstruct the skull base defect should also be prepared to take the skin. 4. Give antibiotics 1 to 2 days before surgery and apply according to general anesthesia requirements. Surgical procedure 1. The face is disinfected with 1:1000 thiomersal and 75% ethanol; after the eye drops are applied, the upper and lower eyelids are sutured with a thin needle; the incision can be partially infiltrated with procaine or lidocaine plus adrenaline to reduce bleeding. 2, cutting From the upper edge of the bilateral iliac crest, the skin between the bridge of the nose and the medial incision is cut down the nasogastric sulcus, the subcutaneous tissue is deep, the bone surface is deep, and the lower edge of the incision is flat. Incision, straight to the bone wall. 3, separation After the periosteum is incision, a little separation is made to the sides, and the leading edge of the pear-shaped hole is exposed downward; the lacrimal sac is outwardly moved to reveal the sputum board; the separation range should not be too wide to avoid separation of the bone wall from the soft tissue. 4. Use a bone knife or a flat chisel to slant upward from the edge of the pear-shaped hole, and cut the maxillary frontal process from the inside of the lacrimal sac. Cut off the front of the cardboard and use a round chisel or a flat chisel to cut the base of the nose. The frontal and nasal bones, together with the soft tissue of the nose, are lifted forward to reveal the upper part of the nasal cavity, the ethmoid sinus and the upper part of the nasal septum. 5, resection of the lesion First cut the posterior part of the nasal septum, remove the bilateral sinus airway, medial lesion and resection of the bilateral middle turbinate, open the frontal sinus floor and the maxillary sinus upper sinus, in order to drain, prevent sinus drainage, form a mucous cyst; The sphenoid sinus was opened, and the anterior wall of the sphenoid sinus was removed with a sphenoid sinus clamp and a maxillary sinus clamp to facilitate adequate drainage 6, remove the affected skull base bone wall, remove the invasive dural vein quickly input dehydrating agent (20% mannitol 250ml), use the rongeur to remove the affected skull base bone wall, 0.2 ~ 0.3cm normal hard outside the lesion The meninges are removed from the invaded dura mater. 7, repair the dura mater and the anterior skull base bone wall When the width of the dural defect is less than 1.0cm, it can be directly sutured and closed. Otherwise, the fascia should be cut. When the free fascia is used, the outside of the fascia is placed under the dura mater, and the edge is sutured with a continuous blanket of 2.0mm or more. If the width of the bottom bone defect exceeds 1,0cm, the reconstruction of the skull base should be performed. The normal vertical plate, the vomer or the posterior part of the nasal septum can be cut. The ride is placed on the bone defect, and the fascia is placed on the nasal top to make the reconstructed skull. The bottom bone is separated from the nasal cavity, and the nasal top mucosa of the fascia covering area should be scraped off, causing the wound surface to adhere and survive the fascia; if the medial fascial defect of the iliac crest is sutured or repaired with fascia. 8, surgery cavity filling After the operation chamber is rinsed with distilled water, normal saline and antibiotic solution, it is filled with iodoform gauze. Before filling the gauze, a layer of gelatin sponge is placed on the nasal side of the skull base and the medial side of the iliac crest to reduce bleeding, tissue irritation and prevent the extraction. When the strip is pulled, the fascia or bone plate is pulled. The gauze should be sutured into one piece, the other end is taken out from the side nasal front hole, and the other side is filled with iodoform gauze. Two long iodoform yarns can also be used. The tamponade cavity is taken out from both sides of the nose hole at the two ends. When filling, the two yarns should be prevented from being twisted together to avoid difficulty in extraction. 9, nasal bone reduction A layer of gelatin sponge is also placed on the surface of the gauze, and then the nasal bones are reset, and the nose and nose bones of both sides are cut away, and the alignment is neat and the dislocation is prevented. The incision was sutured in two layers (subcutaneous tissue and skin); the suture line of the eyes was removed, the eye ointment was applied, and a partial incision and double eye bandaging were performed. complication 1. Loss of smell Because both sides of the olfactory area tissue and even the olfactory bulb olfactory nerve are removed, the patient and his family should be explained before surgery. 2, intracranial infection Including purulent meningitis and the like. 3. Graft necrosis, including implantation of bone plates and fascia. 4, cerebrospinal fluid leakage More due to poor meningeal repair or implantation of fascia necrosis.