Surgery for snoring

In addition to the snoring of most snoring patients, there are also different degrees of hernia, the so-called obstructive sleep apnea syndrome, a series of hypoxic symptoms, easy to be complicated by secondary hypertension and arrhythmia, potentially lethal The possibility is very harmful to health. The pathogenesis of snoring is mainly pharyngeal obstruction. The so-called pharyngeal obstruction refers to the narrow left and right diameter of the pharyngeal isthmus caused by physiological abnormalities of the oropharynx. The anteroposterior diameter of the pharyngeal sail gap is shortened or the tongue root hypertrophy is raised to make the upper and lower diameter of Physiological abnormalities refer to normal tissue structures and dysfunction, such as long soft palate, excessive uvula sag, wide posterior pharyngeal column, submucosal fat deposition in the pharyngeal wall, soft palate relaxation, and pharyngeal lymphatic hypertrophy. Sickness surgery is a treatment for snoring, that is, surgery and tonsillectomy. Treatment of diseases: obstructive sleep apnea syndrome Indication 1. The loudness of the snoring is greater than 60db, which hinders the sleep of the same room. 2. During the sleep period, each time the sputum lasts for more than 10s, the sleep is at least 10 times per hour. 3. In addition to the snoring sound, the morning starts to swell, and it is easy to snoring during the day. The instrumental examination confirmed the presence of sleep suffocation and hypoxemia. 4. Family members reflect typical symptoms, and the examination is indeed a narrow pharyngeal cavity. Contraindications 1, patients with bleeding tendency should first treat coagulation function, and then surgery. 2, allergic to local anesthetics, or anti-anaesthetic should pay attention. Preoperative preparation Although tonsill surgery is simple, it should not be carried out rashly. The following checks should be done before surgery: 1. A detailed history of the disease, with or without bleeding, infectious diseases, rheumatism and nephritis, and physical examination. 2. Blood routine tests and clotting time should be checked. For patients with a history of rheumatism, check for anti-"o", erythrocyte sedimentation rate, mucin, etc. Patients with a history of nephritis should check their urine routine to choose surgery during a stable period. 3. Care should be taken to clean the mouth before surgery, and rinse with 1:5000 nitrofurazone solution or saline. 4. Patients with tonsils due to lesions, such as rheumatism, nephritis, etc., use antibiotics before surgery to prevent postoperative lesions, generally preoperative injection of penicillin 3d. 5. Take phenobarbital 0.1g 2 hours before surgery, subcutaneous injection of atropine 0.5mg half an hour before surgery to reduce the excessive secretion of oral secretions during surgery. Children's dosage should be reduced according to age. 6. Carry out missions before surgery to reduce unnecessary concerns of patients and make the operation go smoothly. Surgical procedure In order to reduce complications such as postoperative drinking water reflux, the steps of the velopharyngeal angioplasty are as follows: 1. The incision is cut along the outer side of the lingual arch, starting from the lower pole of the tonsil to the root of the uvula, and then turning to the pharyngeal arch to the underside, removing the mucosa and submucosal tissue within the incision. The length of each crotch is different, and the height of the soft palate is cut to avoid the incomplete pharyngeal stagnation. 2. Removal of tonsils is usually performed according to the tonsillectomy procedure. Whenever the lower part of the tonsil is separated, the patient complains of pain, and at the same time, there is bleeding under the tonsil socket, which affects the visual field of operation. Here, the use of segmental peeling, hemostasis and two injections of anesthetic method can be painless and clear in the whole process of the room surgery, and the patient can cooperate with good purposes. When the upper part of one side of the tonsil is peeled off, the hemostatic ball is filled into the upper part of the socket to stop bleeding, and the isotonic blood stops. Take the tonsil grasping forceps and clamp the peeled tonsil, gently pull forward and downward, second time. A local anesthetic is injected between the lower half of the tonsil and the tonsil socket, and the tonsils are completely removed by conventional methods. Open the tongue and bow to see if the longitudinal side of the tonsil vein is exposed in the upper part of the tonsil socket. If necessary, it should be ligated in the upper part to reduce the possibility of primary bleeding. 3. Cut open the pharyngeal arch pharyngeal disease. The upper part of the pharyngeal arch is usually in the middle of the uvula or at the proximal end of the pharyngeal arch. It is wedge-cut open at the inner edge of the pharyngeal arch adjacent to the uvula, suitable for thinning and shearing. The pharyngeal arch was swallowed and turned up and outward. The 2-0 gut was used to suture the corresponding soft palate and the tonsil fossa. The trimmed mucosa range was mainly tension-free. 4. The uvula of the uvula is removed from the apex of the uvula, and is supported by the pair of uvula. The muscle bundles on both sides are 6 mm wide and 3 mm thick. , , , , , , , , , , , , , , , vel vel vel vel vel vel vel vel vel vel vel vel vel vel vel vel vel vel vel vel vel vel vel vel vel vel vel vel vel vel vel vel vel vel vel vel vel vel vel vel vel vel It does not affect the treatment effect. The uvula should be strictly stopped to stop bleeding, and the posterior margin mucosa should be slightly longer to be closely attached to the mucosa of the anterior margin to prevent the formation of hematoma. The gut should not be too thick, and the knot should be shortened as much as possible to avoid complaint of foreign body sensation after surgery. 5. Check the wound to see how wide the pharyngeal cavity is, whether there is bleeding, whether the soft palate can be close to the posterior pharyngeal wall when the sound is pronounced. If the posterior pharyngeal wall still sees thicker longitudinal cord-like tissue, a semi-circular additional incision can be made on the outside of the posterior pharyngeal wall to remove the mucosa, and the medial arc-shaped margin is pulled outward to suture the lateral mucosa of the margin. The ropes are raised. After the gut absorption, the pharyngeal cavity is often enlarged after discharge. The surgical design of the uvula and bilateral posterior pharyngeal column resection is suitable for patients with wide left and right pharyngeal and pharyngeal sails, and atrophy of the tonsils. It is only a soft palate and a long uvula, which is characterized by small surgical trauma. After the reaction is light. If the cause of pediatric hysteria is hyperplasia or tonsil hypertrophy, the preferred treatment of agave and tonsillectomy should be performed. The hypertrophy and tonsil must be removed at the same time, and the single tonsectomy or proliferative scraping alone can be effective. Very little. complication 1. Incision infection: timely use of effective antibiotics, a small amount of hormones and hemostatic drugs, intravenous medication for 7 days, to prevent wound infection. 2. Obese patients with postoperative edema of the zygomatic arch and the fall of the tongue can cause paralysis of the patient's respiratory obstruction: postoperative patients take the lateral position and intravenous infusion of dexamethasone 10 mg once a day to reduce the occurrence of this complication Probability, such as the patient's pharyngeal cavity is too narrow, intraoperative preventable tracheotomy.