nasal microsurgery

Microscopy is used in nasal surgery since the 1960s. In 1978, Belal introduced the application of microscopy in the diagnosis and operation of nasal diseases in more detail, and emphasized that the microscope should be used for nasal surgery; the system report was not seen until 1981 in China. The best treatment time: general surgery is recommended to be treated after the initial diagnosis of the disease, special surgery should be prescribed. Treatment of diseases: paranasal sinusitis and sinusitis Indication 1, chronic suppurative sinus maxillary sinusitis or total sinusitis, after repeated surgery still relapse. 2, nasal cavity, sinus papilloma. This procedure is generally suitable for adults. Contraindications Patients with poor cardiac function compensation, high blood pressure, bleeding disorders, and recent upper respiratory tract infections should be suspended. Preoperative preparation Appropriate application of antibiotics 3 to 7 days before surgery to reduce sinus infection, reduce bleeding during surgery, clear field, and facilitate surgical operation. Intravenous infusion can be used for severe sinus infections. Take a sinus piece to understand the sinus condition. Surgical procedure 1, supine position, shoulder pads, the head is slightly reclined, the upper body is raised about 10 °. 2. Anesthesia and initial steps were performed according to conventional maxillary sinus radical surgery, but with the following differences. (1) The incision is slightly longer so as to be placed in the automatic hook (modified by the mastoid opener, and the upper side of the hook is changed to a curved metal sheet of 4 cm in length and 2 cm in width. (2) The bone of the anterior wall of the maxillary sinus was not chiseled, but the bone piece was removed by hand-cranked drill with a special circular drill with a diameter of 1.2 cm to prepare for re-insertion before the end of the operation. (3) After the anterior wall bone piece is removed, the opening is enlarged inward and upward by the mastoid rongeur to facilitate the exposure of the surgical field under the microscope. 3. After the opening is completed, the maxillary sinus automatic hook is placed. In order to increase the opening force, after the automatic hook is placed, the nascent nose device can be inserted between the two leaves to help open the surgical field to full exposure. 4. The pus and lesions in the maxillary sinus are initially removed to expose the natural opening of the maxillary sinus. 5. Under the microscope, after further cleaning the lesions in the maxillary sinus, use the long-neck sinus occlusion forceps to enlarge the natural sinus of the maxillary sinus and bite the mucosa and bone wall backwards and upwards into the ethmoid sinus. Liquid out or a small polyp is pulled out, gradually expand the opening with a laminar rongeur and sphenoid spur or a nucleus pliers, remove the sinus sinus and its diseased tissue, and use the aspirator to absorb secretions at any time. Blood and small polyps to keep the surgical field clear. Generally, the bone wall of the sieve room and its small and medium polyps are thin and brittle. Under the microscope, the bite forceps gently pushes the force under the guidance of the air chamber, while attracting and biting, avoid using the forceps to blindly penetrate and forcefully bite. Until the sieve room and polyp tissue were all removed, the hard and smooth sinus surrounding the bone wall was seen. The anterior anterior ethmoid sinus is poorly exposed due to the microscopic angle. It can make the patient's head tilt later. If it is still not exposed, it can be replaced with an intranasal approach. 6. During the ethmoid sinus resection, the mucosa corresponding to the middle nasal passage in the middle part of the maxillary sinus may be partially bitten, and sometimes the polyps and cotton in the middle will be pulled out from the rupture. In order to facilitate the full drainage after surgery, the middle mucosa can be cut from the rupture mouth and turned over to the sinus cavity; if the mucosa is not formed, the residual mucosa can be bitten or excised so as not to affect the sinus drainage. 7. Adjust the focal length of the microscope, transfer the microscope head to the nasal cavity, expose the nasal cavity with a long leaf sneeze or nasal automatic opener, and remove the residual polyps in the nose with a polyp forceps or ethmoid sinus open clamp to make the middle nasal sinus and ethmoid sinus cavity The same. If there is a residual anterior sieving room, it can also be removed with a sinus sinus open clamp. For example, the middle turbinate changes, the olfactory fissure is narrow, and the middle turbinate can be partially removed. After examination of no obvious bleeding or residual polyps and pathological tissue, the intranasal and maxillary sinus cavity was filled with a gelatin sponge soaked with lincomycin and dexamethasone solution (each with saline to 10 ml), and the original was removed. The round bone piece covers the anterior wall of the maxillary sinus. 8. Stitch the incision. complication May cause wound infection and swelling of the cheeks.