Endoscopic Nasal Surgery

Endoscopic surgery is performed by using hopkins endoscope with high resolution and changeable angle of view to perform sinus surgery, so that the nasal cavity, sinus, and especially the deep surgery can be performed under direct vision. It also facilitates the cleansing and drainage of the sinus in some depressions and lesions in the fissure. Under direct vision, the surgical tissue has less damage, less bleeding, clear intraoperative vision, can avoid some complications, and become a supplement to routine nasal and sinus surgery. Treatment of diseases: sinus mucosa cysts and sinusitis Indication 1. The frontal sinus larger cyst, invading the ethmoid sinus and the nasal cavity can be seen in the nasal cavity or the middle turbinate presents a smooth bulging. 2. Sphenoid sinus lesions include sphenoid sinus cyst, sphenoid sinus mycosis or sphenoid sinus occupying lesions. 3. ethmoid sinus inflammation, nasal sinus sinus polyps, recurrence after repeated surgery. 4. Screen foreign bodies in the sphenoid sinus. 5. Maxillary sinus biopsy of maxillary sinus lesions, or chronic recurrent maxillary sinusitis is not treated conservatively. 6. Nasal itching, snoring, and clear water sputum can be performed by nasal endoscopic sinus surgery. Preoperative preparation 1. For patients with chronic sinusitis, sinus X-ray or sinus ct examination should be performed to understand the location and extent of the lesion. 2. Those who need general anesthesia, do preoperative examination of general anesthesia, such as electrocardiogram, chest, liver and kidney function and hematuria. 3. Trim the nose hair and add 1% ephedrine solution to the nose. Surgical procedure (a) frontal sinus surgery 1. Intranasal drainage of ethmoid sinus cysts, mostly used for the anterior sac cyst has been extended to the middle nasal passage caused by the middle nasal bulge or the middle turbinate and the middle nasal passages all bulged. (1) Intranasal anesthesia with 1% dicaine plus 1 adrenaline cotton for nasal turbinate, middle nasal passage and nasal mucosa, and basic anesthesia if necessary. (2) Insert the 0° or 30° endoscope into the anterior part of the nasal turbinate and the middle nasal passage, see the bulging part, and puncture the puncture needle from the bulging point first, such as pumping out the cystic fluid or pus cyst fluid, which means this is The lower wall of the cyst. (3) Pull out the puncture needle, there may be a sac fluid, so that the suction tube is aspirated as much as possible, the bottom wall of the cyst is opened from the puncture site, and the sinus rongeur is enlarged as much as possible to expand until it is no longer locked. Then, the endoscope is inserted into the cavity, and the capsule wall is peeled off as much as possible by the septal stripper. However, if there is a bone defect in the posterior sinus wall, care should be taken to prevent the dura mater from rupturing and causing cerebrospinal fluid leakage. (4) The iodoform gauze can be loosely packed at the drainage opening, or a plastic tube can be expanded, and the iodoform gauze is filled in the nasal cavity. 2. In case of frontal sinus disease, in order to understand the nature of the lesion, local 1% procaine plus a small amount of 1 adrenaline infiltration anesthesia, after the puncture of the frontal sinus of the upper corner of the eyelid, the endoscopic observation, And can take the biopsy of the sinus. After the examination, the catheter needle was pulled out, a needle was sutured at the puncture and pressurized and wrapped for about 24 hours. (B) intranasal sphenoid sinus exploration surgery for sphenoid sinus cyst, sphenoid sinus disease, chronic sphenoid sinus and sphenoid sinus space occupying lesions. 1. The nasal cavity is treated with topical anesthesia, deep into the nasal cavity and near the posterior nostril, supplemented with basic anesthesia. 2. Use the endoscope to insert the nasal cavity directly to the posterior nostril, and the oblique upward direction is equivalent to the natural opening of the sphenoid sinus at the posterior end of the upper turbinate. 3. If the natural opening is not easy to find or has been locked, it can be removed 1~1.5cm above the posterior nostril, above the posterior margin of the middle septum, the mucosa is removed, the anterior wall of the sphenoid sinus is opened, and the anterior wall of the sphenoid sinus is opened as far as possible. If it is a cyst, the wall of the capsule can be peeled off; if it is a fungus, the bacteria will be sucked up, and the sinus cavity will be washed regularly with the fungal drug; if there is a new living space in the sphenoid sinus, it can be used for biopsy. 4. Place a gelatin sponge on the edge of the sinus drainage port and fill the nasal cavity with iodoform gauze. (C) endoscopic intranasal ethmoid sinus surgery nasal endoscopic sinus surgery for chronic ethmoid sinusitis, middle turbinate hypertrophy polymorphism, poor drainage of the middle nasal passage by drug treatment failed to improve. In addition, the recurrence of the nasal top polyps after multiple operations, the primary sinus cyst, papilloma, chronic ethmoid sinusitis affect the sphenoid sinus, frontal sinus and maxillary sinus ventilation. 1. Apply nasal anesthesia to the nasal cavity and add basic anesthesia if necessary. 2. The semi-recumbent position and the head cannot be reclined. 3. Remove the nasal top polyps. The polyps in the middle nasal passage or the olfactory sulcus were all removed under a 0° or 30° endoscope to completely expose the middle nasal passages. 4. Bite the sieving and enter the anterior ethmoid sinus. At this time, the ethmoid sinus can be clearly seen under the endoscope, and the interval is opened, gradually expanding outward, downward and backward. And after biting off the sinus sinus small room and clear the lesions in the cavity, directly to the anterior wall of the sphenoid sinus. Subsequently, the sinus sinus forceps can be used under the inverted endoscope to bite the anterior group sinus air chamber forward and upward. Then use a curette to scrape the interval between the surgery and the residual mucosa. Surgery can also enter the sieve room from the middle nasal passage, and gradually remove the ethmoid sinus from front to back. The middle turbinate is obvious, and it can be partially removed to improve the ventilating drainage of the middle nasal passage. 5. For those with chronic frontal sinusitis, after the ethmoid sinus is removed, the front end of the middle nasal passage is cleaned up to the opening of the nasal frontal tube, and the nasal frontal tube is enlarged. 6. For patients with chronic sphenoid sinusitis, open the sphenoid sinus under endoscopic direct vision, clean the sinus lesions, and improve ventilation drainage. (four) maxillary sinus surgery 1. Middle nasal sinus surgery Chronic maxillary sinusitis after the conservative treatment of drugs is not significant, can be used for middle nasal incision. Insert the 0° or 30° endoscope into the middle nasal passage to find the natural opening of the maxillary sinus, so that the opening expands forward with the cutting punch of the inverted opening, and opens the outer side wall of the middle nasal passage into the maxillary sinus to improve the maxillary sinus. Ventilation drainage. 2. Double approach method Maxillary sinus biopsy is performed by the cusp and the lower nasal passage for maxillary sinus biopsy. (1) Firstly, topical anesthesia is applied from the lower nasal passage. The maxillary sinus catheter needle is inserted into the maxillary sinus from the lower nasal passage, the tube is withdrawn, and the endoscope is inserted into the site of the lesion in the sinus. (2) Local anesthesia was performed under the mucosa at the cusp, and the mucosa was cut. A small hole was drilled in the anterior wall of the maxillary sinus with a drill. The biopsy forceps were inserted from the small hole, and the pathological tissue was taken under the endoscope. an examination. (3) After the end of the operation, the cleft lip is incision 1~2 stitches; after the intranasal catheter needle is withdrawn, the gelatin sponge is used to fill the lower nasal passage to prevent bleeding. If there is more bleeding, the nasal cavity can be blocked with iodoform gauze. 3. For patients with chronic suppurative maxillary sinusitis, the nasal sinus can be puncture through the lower nasal passage to observe the sinus cavity and flush the sinus cavity to inject drugs for therapeutic purposes.