endonasal ethmoidectomy

The ethmoid bones are composed of multiple small air chambers with large variation and are located in the center of each sinus. They are separated from the orbital and anterior cranial fossa by a thin bone plate, which is close to each other. It is small in size and deep in position, so the sieve is applied. Sinus surgery, if not anatomical, blind and rude, there are considerable difficulties and dangers; on the other hand, because chronic suppurative ethmoid sinusitis is a common, frequently-occurring disease, ethmoid sinus lesions are not completely removed, often become a hindrance Other sinus inflammation is one of the important factors for the cure of nasal polyps. Therefore, it is necessary for ethmoid sinus opening or resection. It is an operation that otolaryngologists should master. If you take it seriously, be careful, remember If you live in the essentials and adapt to it, you will be able to achieve the perfection and skill. There are three ways of ethmoid sinus surgery: intranasal, extranasal and transmaxillary sinus; one of them is intranasal ethmoidectomy. Treatment of diseases: chronic ethmoid sinusitis and sinusitis Indication 1. Chronic ethmoid sinusitis or chronic total sinusitis, poor drainage of the middle and nasal passages, treated by non-surgical treatment, symptoms are not lost, long-term unhealed. 2. Multiple nasal polyps, multiple recurrences after surgical removal. 3. Benign tumors such as cysts or papilloma that originate in the ethmoid sinus. 4. Used to open surgical procedures for frontal sinus, sphenoid sinus and pituitary surgery. 5. It is used as a treatment for improving the visual acuity of patients with posterior optic neuritis of unknown cause. Preoperative preparation 1. Detailed medical history, especially the previous surgical situation, and sinus x-ray or ct examination to understand the development of ethmoid sinus and the extent of the disease, for reference during surgery, to reduce blindness. 2. Trim the nose hair. 3. Do a skin allergy test for local anesthetics. Surgical procedure 1. Sitting position or semi-recumbent position, the head should not be over-rear, the scope of surgery is limited to the bilateral intraocular iliac crest line, the internal iliac vertical line, and the middle turbinate attachment. 2. If there is a nasal polyp, firstly follow the routine of nasal polyps, and roughly remove it. Use a cotton pad or gauze dipped in topical adrenaline to stop bleeding, and the middle turbinate can be reduced, and the middle nasal passage is fully exposed. 3. Bite the wall of the sinus with a straight ethmoid sinus clamp, ie enter the anterior ethmoid sinus. Therefore, the bone wall is thin and it is relatively easy to enter. Generally, after opening the sieve room, there will be a spill of purulent secretions, or a beaded small polyp will be pulled out, and an open ethmoid sinus small room can be seen in the deep, and the gap is gradually enlarged toward the outside, the lower and the rear, and the sieve is removed after the bite. Sinus small room and clear the lesions in the cavity until the anterior wall of the sphenoid sinus (the pliers extend into the depth of 7.5 ~ 8cm); change the sinus sinus occipital forceps, the front anterior, upper and outer sides continue to bite the anterior ethmoid sinus Small rooms. After the ethmoid sinus resection is basically completed, the residual mucosa and bone space in the surgical cavity are scraped off with different curving curettes to make the cavity wide, smooth and flat. You can also use the curette from the nose and the nose, the blade is pressed outwards, and the bone wall is pressed into the sieve room. The ethmoid sinus is gradually scraped from the front to the back, and the residual tissue and bone pieces are repaired together with the biting forceps. If the middle turbinate polyps become obvious and affect the exposure of the sputum area, the front end of the middle turbinate can be properly removed to facilitate the operation. If the surgery is completed thoroughly and adequately hemostasis, a tip-shaped, posterior, posterior, posterior, posterior, posterior, posterior, posterior, posterior, posterior, posterior, posterior, posterior, posterior, posterior, posterior, posterior, posterior, posterior, posterior, posterior, posterior, stenotic 4. For patients with chronic frontal sinusitis, poor frontal sinus drainage, and frequent forehead pain, after the ethmoid sinus resection, in order to improve the frontal sinus drainage, the curb can be used to advance the lower frontal tube along the nose. Squeeze it up, or use the frontal sinus to stick to the front wall. 5. If combined with chronic sphenoid sinusitis, if necessary, the sphenoid sinus occlusion can be used to enlarge the sphenoid sinus opening for drainage; if there is lesion tissue in the sphenoid sinus, it will be removed. 6. The operative cavity is blocked with chlortetracycline ointment gauze or iodoform gauze to prevent postoperative bleeding; but the resection is more thorough, intraoperative bleeding is not much, and the operation cavity is smooth at the end of the operation, no active bleeding It can also be blocked without clogging, or only filled with gelatin sponge. Generally, bleeding does not occur, and the patient feels much more comfortable after surgery.