Posterior nostril atresia surgery

Surgical removal of the atresia interval, there are four ways of transnasal, transurethral, transnasal septum, and maxillary sinus, depending on the age of the child, the degree of symptoms, the nature and thickness of the interval, and the general condition. Open surgery for nostril atresia. Treatment of diseases: congenital posterior nostril atresia Indication Posterior nostril atresia. Contraindications 1, with systemic diseases, can not tolerate surgery. 2, local infection, not suitable for surgery. Preoperative preparation For safety, it is advisable to do a tracheotomy first. Surgical procedure Surgical removal of the atresia interval, there are four ways of transnasal, transurethral, transnasal septum, and maxillary sinus, depending on the age of the child, the degree of symptoms, the nature and thickness of the interval, and the general condition. For safety, it is advisable to do a tracheotomy first. 1. Nasal approach: Applicable to the nasal cavity is wide enough to see the interlocking interval, the membranous interval or the thin interosseous space is relatively thin, the newborn or the child is poorly in general condition and urgently need to recover the recurrent nasal breath. (1) Anesthesia: General anesthesia for children and topical surface anesthesia for adults. (2) Incision: The left nasal cavity is made into a "["-shaped incision, and the right nasal cavity is made into a "]" incision to separate the mucosa and expose the bone surface. (3) Resection interval The bone partition is removed by an osteotome, a curette or an electric drill bit, and the posterior (pharyngeal side) mucosa of the bone partition is retained to cover the lateral bone wound. During the operation, the posterior end of the nasal septum should be removed so that the pores on both sides can pass through. The pore size is such that it can pass the index finger. Then put a correspondingly sized rubber tube or plastic tube, or press the balloon to fix it. The indwelling time depends on the nature of the interval. The membranous interval is two weeks, and the bone interval is 4 to 6 weeks. In order to prevent further stenosis, expansion can be performed regularly within one year. Such surgery is more convenient if performed under a fiberoptic nasal endoscope. The newborn can be scraped off the nose with a small mastoid curette, and the bone partition can be removed by a rotary scraping method at the bone septum to a sufficient size. The posterior mucosa still needs to be preserved. A cross-shaped incision is feasible, and the nasopharyngeal retrograde is pulled with a rubber tube. Out to fix the mucosal flap on the bone surface. Nasal approach is used, and during surgery, care should be taken to avoid injury to the arteries, skull base and cervical vertebrae. 2. The sputum approach: The advantage is that the surgical field is well exposed, the lesion can be directly seen, the interval can be completely removed, and the mucosa can be fully covered by the wound, which is suitable for those with thicker interval. (1) Position and anesthesia: the child is supine, the head is extended backwards, and 0.1% adrenaline cotton is inserted into the anterior wall of the deep atrial septum, and a small amount of 1% procaine containing epinephrine is injected at the junction of the hard and soft palate. To reduce intraoperative bleeding, through tracheotomy for general anesthesia. (2) Incision: Owens hard semi-circular incision is made, the mucosa is cut, and the ends of the incision are posterior to the maxillary trochanter. The periosteal flap was separated to the edge of the hard palate. (3) After the trailing edge of the hard palate is exposed, a thick thread is passed through the free periosteal flap for traction backwards. (4) Removal of the interlocking interval: the nasal mucosa of the back of the hard palate (nose bottom) is separated, and the bone wall of the posterior border of the affected side of the tibia is removed with a rongeur, and the sphenoid body of the septum can be found, and the mucosa of the septum is separated. Excision of the bone septum, and then remove the part of the pear bone by the method of removing the submucosal submucosal resection under the posterior margin of the pear bone, so that the posterior nostril is enlarged as much as possible to ensure smoothness. The mucosa can be used to cover the bone surface before and after the bone septum and the nasal septum. (5) suture incision: the periosteal flap of the hard ankle incision is turned back to the position, and the suture is tightly sutured with a thin thread. If the hand is close to the soft palate, if it is torn, it should be tightly and properly sutured to avoid postoperative perforation. Finally, the rubber tube or plastic tube was placed through the anterior nares, and the nasal mucosa after the dressing was fixed. After 4 weeks, the rubber tube was taken out and scheduled for regular follow-up. If there is adhesion after the posterior nostril, it should be treated in time and expanded if necessary. 3. Transnasal septal approach This method is only suitable for the treatment of adult nostril atresia. Unilateral, bilateral, membranous, and bony, all can be used. (1) position and anesthesia: the same submucosal resection of the submucosal resection. (2) Incision: Use a killan incision, or a slight incision to make an incision. (3) Peeling of the periosteum: The range should be expanded as much as possible, especially in the range of upward and downward peeling, which may include bilateral nasal mucosa to enlarge the field of vision backward. (4) Incision of the septal cartilage, peeling off the contralateral nasal mucosa, the scope should be expanded as much as possible. When peeling to the rear, the nasal septal cartilage and the vertical plate of the ethmoid can be removed, and the bone is removed by the osteotome until the anterior wall of the sphenoid sinus can be seen. Finally, a rubber tube or a plastic tube is inserted through the anterior nares to prevent adhesion of the posterior nostrils. Regular expansion after surgery if necessary. 4. Transmaxillary sinus approach: This method is only suitable for unilateral posterior nostril atresia in adults. It is performed by de Lima surgery. After the maxillary sinus is opened, the sinus sinus is reached and the posterior nostril area is reached. complication Postoperative infection.