transnasal ethmoidectomy

The ethmoid sinus lesions often involve the maxillary sinus, orbital sinus, frontal sinus. Different approaches should be used according to different conditions; if the maxillary sinus is involved, the sinus sinus can be taken after maxillary sinus resection. If the eyelid or frontal sinus is involved, the nasal sinus should be performed. Surgery, this operation is easy to observe the extent of the lesion, and the sinus sinus and its adjacent lesions can be completely removed. Treatment of diseases: rhinitis atrophic rhinitis Indication 1. Chronic ethmoid sinusitis has no improvement in symptoms after drug treatment, or multiple polyps in the middle nasal passage, middle turbinate hypertrophy or polypoid changes. 2. Chronic ethmoid sinusitis with frontal sinusitis, sphenoid sinusitis, should be performed intranasal ethmoid sinus surgery, and then further treatment of frontal sinus and sphenoid sinus inflammation. Contraindications 1. Acute infection in the nasal cavity. 2. Hypertension, blood disease, cardiopulmonary dysfunction. Preoperative preparation Bacterial culture and drug sensitivity tests of nasal secretions began several days before surgery. Anaerobic bacteria are often necessary in the pathogenic bacteria of sinusitis, so it is necessary to cultivate anaerobic bacteria. If it is positive, it should be taken 200 mg of metronidazole twice a day before surgery. Surgical procedure (1) Facial disinfection: face disinfection is performed with 75% alcohol, and red mercury can be disinfected in the nostrils. Thiomersal can damage the mucosa and should not be used. Do not cover the patient's eyes when laying the surgical towel so that the patient's vision and extraocular muscles can be checked at any time during the operation. (2) Incision: If there is no polyp in the middle nasal passage, a longitudinal incision in front of the middle nasal passage corresponding to the leading edge of the middle turbinate may be used, or a semilunar incision may be made in the anterior lower edge of the middle nasal passage. If there is polyp in the middle nasal passage or polyposis in the middle turbinate, it should be cut between the inner side of the middle turbinate and the polyps. The laser knife can be used to avoid bleeding, and the operation is guided by a 0-degree speculum. (3) Separating the middle nasal mucosa with a nasal septum stripper, revealing the nebula, gently pressing with a stripper or opening the sieve with a straight forceps. For those with thick bone walls, they can be cut open. In order to fully expand the approach, the middle turbinate can be pushed to the nasal septum. The size of the sieving can be used as a reference for preoperative imaging. (4) Cleaning the sinus apex of the middle group sieve room is pale yellow under the endoscope. Care should be taken when handling this, usually with a 30 or 70 degree mirror with a curette, without a polyp forceps. (5) Before the cleaning, the sieve room and the sifting room: use a 70-degree mirror with a large opening polyp forceps, clean the front sieve room and the upper sifting room, reach the frontal sinus floor, and reach the paper template, and the middle sieve area. The paper samples are continuous, leading to the maxillary frontal process. Sometimes the anterior ethmoid artery that runs along the base of the skull should be seen, so be careful not to cause damage. When cleaning the pre-screening room, be careful not to damage the lacrimal sac and the nasolacrimal duct. (6) After the cleaning, the sieve room: use 4mm 0 degree wide-angle lens with large open straight pliers, use the open straight pliers when entering the last set of sieve room, remove all the rear set sieve room, reach the top of the sieve, and reach the paper board After reaching the anterior wall of the sphenoid sinus, the inner to the middle turbinate makes the entire ethmoid sinus a cavity. (7) Open and explore the frontal sinus: Use a 70-degree mirror with a curette or aspirator to explore the frontal sinus and find the frontal sinus opening and then expand it along the sinus ostium with a curette. There is a bone bulge between the frontal crypt and the top of the anterior group, which is an important sign. The front is the frontal sinus floor and the frontal sinus opening, and the posterior part is the apex, which is the anterior skull base. It cannot be operated after this bone bulge. The range of the frontal sinus opening should not be less than 0.5 cm in order to adequately drain and prevent postoperative sinus occlusion. Unless the sinus has polyps or new organisms, the mucosa in the frontal sinus is generally not treated. (8) Open and explore the maxillary sinus: Under the guidance of 70 or 90 degrees, use the reverse rongeur to enlarge the maxillary sinus opening about 1.0cm, and observe the sinus with different angles of endoscope. If polyps or cysts are found, Should be removed; if there is still mucosal hypertrophy, do not have to deal with; if there are more purulent secretions in the sinus, you can make holes in the lower nasal passages, so that the sinus has two openings in order to promote ventilating drainage. This method is also called the combined pore making method. (9) Open and explore the sphenoid sinus and clean the posterior sieving room. If the sphenoid sinus opening position is low, use a curette to expand along the circumference; if the position is high, use the sharp ethmoid sinus clamp to open the anterior wall of the sphenoid sinus. Use a probe to determine its position, and then use a rongeur to enlarge it. The distance from the anterior wall of the sphenoid sinus to the anterior nares is 7.5-7.8 cm, and rarely less than 7.2 cm can be used as a reference for finding the anterior sinus wall. According to Xu Geng's observation of 100 adult skulls, about 20% of those with a butterfly screening room can't be mistaken for sphenoid sinus to avoid complications. Preoperative sinus coronal CT scan can be used as a reference in surgery. If there is a suspected point during surgery, it can be observed with a 0 degree lens or a speculum for general observation. complication Nasal pain.