transmaxillary ethmoidectomy

Because chronic suppurative ethmoid sinusitis is a common and frequently-occurring disease, ethmoid sinus lesions are not completely eliminated, which often becomes one of the important factors that hinder the healing of other sinus inflammation and cause repeated occurrence of nasal polyps. Therefore, ethmoid sinus opening or resection surgery has The necessity is the surgery that the otolaryngologist should master. If you take it seriously, be cautious, remember the essentials, and adapt to it, you can achieve the perfection and skill. The ethmoid sinus surgery is performed by intranasal, extranasal and transmaxillary sinus. One of them is maxillary sinus sinus resection. Treatment of diseases: chronic maxillary sinusitis and sinusitis Indication 1. Chronic suppurative sinus maxillary sinusitis or total sinusitis, relapse after repeated surgery. 2. Nasal cavity, sinus papilloma. This procedure is generally suitable for adults. Contraindications 1. Acute infection in the nasal cavity. 2. Hypertension, blood disease, cardiopulmonary dysfunction. 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 pad, head slightly reclined, upper body 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 inserted. 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. Preliminary removal of the pus and diseased tissue in the maxillary sinus, exposing 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 have small polyps pulled out, use vertebral plate rongeur and sphenoid spur rongeur or nucleus pulposus to gradually enlarge the opening, remove the sinus sinus air chamber and its diseased tissue, and use the aspirator to absorb secretions, blood at any time. And small pieces of 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 mid-segment of the maxillary sinus may be partially bitten, and sometimes the polyps and cotton pieces in the middle channel are also pulled out from the rupture. This indicates that the ethmoid sinus cavity has been The nasal cavity is connected, in order to facilitate the full drainage after surgery, the middle mucosa can be cut from the rupture to make it sag in the sinus cavity; if the mucosa is not in a piece, 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 (Figure 7), so that the middle nasal passages The ethmoid sinus cavity is connected. 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. Suture the incision. complication Hemorrhage, intraorbital hemorrhage or intracranial infection, etc., occasionally damage the orbital periosteum during surgery, resulting in damage to the optic nerve.