Endoscopic management of nasal orbital abscess drainage

Intraorbital abscess is a serious complication of sinusitis, which poses a risk of permanent vision loss, and in serious cases is life-threatening. The clinical manifestations of intraorbital abscess are obvious swelling of the eyelids, prominent eyeballs, conjunctival edema, paralysis of the eyelids, double vision, loss of vision or loss. In the past, the external incision drainage was used for the intrasacral abscess. With the development of endoscopic techniques, endoscopic drainage through the nasal abscess has shown good prospects. Advantages of endoscopic abscess drainage in the orbit: 1. Simultaneous treatment of sinusitis and intrasacral abscess, no damage to unrelated structures. 2. No facial scars. 3. The operation is safe, the effect is good, and the complications are few. Treatment of diseases: sinusitis Indication Endoscopic treatment of nasal abscess drainage is suitable for nasal abscess. Once diagnosed, surgical decompression should be performed in time. Preoperative preparation 1. Detailed nasal examination, pay attention to the presence or absence of pus in the middle nasal passage, with or without mucosal swelling and polyps. 2. Detailed eye examination, observation and recording of eye movement, eyeball protrusion, visual acuity and so on. 3. CT scan of the sinus and eyelids to understand the size and location of the abscess. Surgical procedure Endoscopic nasal septoplasty, ethmoid sinus surgery, middle nasal maxillary sinus surgery, frontal sinus and sphenoid sinus surgery were performed as appropriate according to the patient's specific conditions. After ethmoid sinus resection, the paper template is fully exposed, and the paper template may be partially damaged due to inflammation. The blunt stripper is used to separate the paper plate from the periosteum, and the paper plate is partially or completely removed. When the pus is discharged, the submucosal abscess can be diagnosed, and the periosteum is not necessary to be cut. In the site of the abscess, the thickened, white-protrusive periosteum is cut from the front to the back, and the intra-abdominal abscess is drained toward the nasal cavity (due to inflammation, the surface of the periosteum may have granulation tissue, or partial damage). If necessary, gently press the eyeball to induce pus drainage. The abscess cavity was observed with a 70° endoscope. It is not necessary to place a drainage strip under the premise of ensuring adequate drainage. The operating cavity can be filled with an expansion sponge.