Extranasal 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 types of ethmoid sinus surgery: intranasal, extranasal and transmaxillary sinus. Nasal ethmoidectomy is one of them. Treatment of diseases: chronic ethmoid sinus sinus malignant tumor Indication 1. Acute exacerbation of chronic ethmoid sinusitis, causing intra-orbital or intracranial complications, or ulceration to form a fistula. 2. Benign sinus cysts, osteoma, hemangioma and other benign lesions. 3. sinus sinus foreign body. 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. The patient is supine, and the eye is coated with antibiotic ointment to protect the cornea. After proper disinfection, a needle is sutured on the upper and lower eyelids. 2. Starting from the lower end of the eyebrow at an angle of about 0.5cm from the inner ridge, make an arc-shaped incision about 3cm long, which is deeper into the bone. 3. Use a small stripper to separate the lacrimal sac, the medial malleolus ligament and the superior oblique muscle block under the periosteum to dissipate the lacrimal sac. Pull the hook or the automatic opener, and pull the medial malleolar ligament and the eyeball together to the outside, expose the nasal bone, the maxillary frontal process, the tear bone and the sieving board. If the meshing artery is ligated, if the ligation is difficult, the bipolar coagulator can be burned. . 4. Use a small bone chisel to cut into the ethmoid sinus from behind the lacrimal sac. Use the rongeur to enlarge the surgical field, which may include part of the maxillary frontal process, the frontal part of the frontal bone and the front part of the sieving board. Most of the front screen room can be exposed. If the sieving board has been worn, the small bone can be used. Use a forceps or a spatula to enlarge the fistula and use a rongeur. 5. Use a curette or ethmoid nipper to remove the lesion from the front to the back until the ethmoid sinus is removed. During the operation, the blood is sucked up at any time by the aspirator to keep the field clear. According to the situation, the middle turbinate is determined to be resected or preserved; the middle nasal mucosa can be cut open and then turned into the sinus cavity or excised to make the operation cavity communicate with the nasal cavity. After checking for no active bleeding, residual bone fragments and foreign bodies, the sinus cavity and the nasal cavity were filled with antibiotic ointment gauze to stop bleeding, and one end of the gauze was taken out from the front nostril. If there is not much bleeding, hemostasis is more thorough, and only the gelatin sponge can be filled. 6. Separate the incision in two layers, remove the eyelid suture, and properly compress the dressing.