Endoscopic surgery for maxillary. Don't worry. How endoscopic nose surgery is performed and what are its benefits

The video shows a radical operation of the right maxillary sinus. Such operations were often performed in the past, because there was no endoscopy. This patient developed purulent meningitis against the background of purulent sinusitis. The cause of meningitis is rhinogenic, i.e. purulent sinusitis. According to the standards and tactics of treatment, the focus of infection (i.e., the maxillary sinus) from which the infection entered the brain must first be sanitized. It is impossible to cure meningitis or other purulent diseases without sanitizing the focus of infection. In this situation, the issue was not decided about cosmetics, but about the patient's life, because she was taken to the infectious diseases ward, already unconscious and transferred to the intensive care unit. X-ray of the sinuses showed total darkening of the maxillary sinus (pus and possibly a foreign body).
The wound heals after such an operation rather quickly 5-7 days. The hole in the bone (the anterior wall of the maxillary sinus) is preserved, but the patient is not worried.
a matoma in the projection of the maxillary sinus after surgery will last 7-10 days. Outwardly, no traces of the operation will remain.
Currently, we almost always perform a micronectomy (access to the sinus through a puncture, 5mm). The time of such operations is 5-15 minutes. They are performed under local anesthesia and do not require hospitalization. I posted several such operations on my website http://lunev-lor.ru/endoskopicheskie-...
We also often perform endoscopic operations on the maxillary sinus through the nasal cavity using the expansion of the natural anastomosis.
Unfortunately, radical operations on the maxillary sinus are often and still performed without vital indications.
The patient who underwent this operation is doing well. She recovered and was discharged from the hospital 14 days later. In this case, her life depended on the time of the operation (the faster the better).

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There are various types of sinus surgery:

classic Caldwell-Luke operation (performed through an incision under the upper lip);
endoscopic sinusitis (performed by endonasal access, without incisions);
minor surgical manipulations (puncture of the maxillary sinus and its alternative - balloon sinusoplasty using the YAMIK sinus catheter).

Indications

Factors and diseases that are direct indications for surgery:

lack of effect from conservative methods of treating chronic sinusitis;
maxillary sinus cysts (formations in the form of bubbles filled with fluid);
the presence of polyps inside the sinus;
the presence of neoplasms (if a malignant tumor is suspected, a biopsy is performed);
foreign bodies of the maxillary sinus, which are a complication of dental interventions (fragments of tooth roots, particles of dental implants, particles of filling material);
the presence of blood clots and granulations in the cavity;
damage to the walls of the maxillary sinus.

The most common reason why an operation on the maxillary sinuses is prescribed is sinusitis - inflammation of the mucous membrane of the maxillary sinus, as a result of which there is an accumulation of purulent exudate and the formation of hyperplastic changes in the mucous membrane.

The main symptoms

nasal congestion;
mucopurulent discharge;
increased body temperature;
symptoms of general intoxication of the body (weakness, drowsiness, malaise, headache);
pain in the projection of the maxillary sinuses.

Preoperative preparation

Preparation for surgery on the maxillary sinuses includes a number of instrumental and laboratory studies. Before surgery, you will need:

computed tomography or x-ray of the paranasal sinuses;
rhinoscopy;
complete blood count (including leukocyte count and platelet count);
study of the hemostatic function of blood - coagulogram;
general urine analysis;
analysis for the presence of HIV, syphilis, markers of viral hepatitis;
determination of blood group and Rh factor.

If an operation is planned under general anesthesia, it is additionally necessary to make an electrocardiogram and consult with an anesthesiologist. It is very important to strictly follow the instructions given by this doctor, since their violation entails serious consequences.

Contraindications to sinusitis:

the presence of serious somatic pathology;
blood clotting disorders (hemorrhagic diathesis, hemoblastosis);
acute infectious diseases;
exacerbation of chronic diseases;
acute sinusitis (relative contraindication).

How is the operation going

Small operations: puncture and its alternative - balloon sinusoplasty

The simplest surgical intervention in the maxillary sinus is a puncture (puncture), which is performed through the wall of the nasal passage for diagnostic or therapeutic purposes.
Balloon sinusoplasty using a YAMIK catheter is a more progressive method for restoring drainage of the maxillary sinus. The essence of this method lies in the atraumatic expansion of the anastomoses by introducing and inflating a flexible catheter. Further, a vacuum is created in the sinus cavity, this makes it possible to effectively remove the accumulated purulent exudate. The next step after cleansing is the introduction of a solution of drugs into the sinus cavity. This manipulation is carried out under the video control of endoscopic equipment, but it can be performed without it, which makes it accessible to most patients. The indisputable advantages of this method are:

painlessness;
no bleeding;
maintaining the integrity of anatomical structures;
minimal risk of complications;
no need for hospital stay.

Endoscopic sinusitis

This surgical intervention is performed with an endonasal approach, without violating the integrity of the maxillary sinus wall. Modern endoscopic technology allows highly efficient performance of rhinosurgical procedures. Thanks to the use of long-focus microscopes and high-quality fiber-optic technology, high-quality visualization of the surgical field is achieved, which minimizes the risk of injury to healthy tissues.

The procedure for cleansing the sinuses is carried out using modern rhinosurgical equipment: a coagulator (performing the function of cauterizing tissues and blood vessels), a shaver (a tissue grinder with the function of instantaneous suction), forceps and other surgical instruments. This is followed by washing with antiseptic solutions with the addition of broad-spectrum antibacterial drugs, proteolytic enzymes and corticosteroid hormones (in case of severe edema).

Classic surgical method

The classic Caldwell-Luke operation is performed by intraoral access. General anesthesia is most commonly used with this method.

Main steps:

Formation of access to the maxillary paranasal sinus by excision of soft tissues.
Sanitation of the pathological focus (removal of polyps, granulations, sequesters, foreign bodies).
Sampling of material for histological examination.
Formation of a full-fledged communication between the maxillary sinus and the lower nasal passage.
Installation of a drainage catheter for irrigation of the cavity with medicinal solutions.

Complications of radical sinusitis:

the possibility of developing intense bleeding;
damage to the trigeminal nerve;
fistula formation;
severe swelling of the nasal mucosa;
loss of sensitivity of the dentition and cheekbones from the side of the surgical intervention;
decreased sense of smell;
sensations of heaviness and soreness in the maxillary sinuses.

With minimally invasive interventions (endoscopic sinusitis, puncture and balloon sinusoplasty, complications are rare.

Postoperative period

There are a number of measures to reduce the risk of recurrence of the disease and the occurrence of various complications:

irrigation (irrigation) of the nasal cavity with water-salt solutions;
desensitizing therapy (taking antihistamines);
topical application of topical corticosteroids;
antibiotic therapy;
taking drugs that strengthen the walls of blood vessels.

Typically, the postoperative rehabilitation period lasts about one month. At this time it is undesirable

the use of hot, cold, spicy foods;
perform hard physical work (especially related to weight lifting);
visiting baths and saunas, swimming in the pool.

You should also avoid hypothermia and contact with patients with acute respiratory viral infections. A good end of the rehabilitation period will be a sanatorium treatment at a seaside resort or a visit to a salt cave. During the year after the operation, you should be observed by an otolaryngologist.

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When an operation is needed to treat sinusitis

Not all patients with sinus inflammation with sinusitis require surgery. This is necessary only in cases where drug therapy does not help enough or the process has developed far and it is impossible to wait any longer. Basically, the indications for surgery are as follows.

Surgical treatment of sinusitis may be required if a healthcare professional has noticed a large amount of pus accumulated in the sinus cavity. It may be necessary to artificially remove harmful content in cases where the excretory ducts are completely blocked. For purulent inflammation, it is not uncommon for a harmful substance to accumulate in a confined space. Gradually, it will exert a pressing effect on the walls of the bone cavity, this leads to intense headaches. As a result, due to sinusitis, the general well-being is seriously deteriorating, and in the absence of treatment, the volume of purulent contents increases. Often this ends in a breakthrough into structures in the neighborhood and pus spills over the palate, eye sockets, jaws or meninges.
Chronic sinusitis, for which a long course and very frequent exacerbations are considered characteristic.
The sinus cavity itself is closed, it is equipped with a small excretory section, so any inflammation cannot be ignored, since it can become an impetus for the manifestation of a chronic form. Chronic sinusitis is a common source of problems for the ENT organs. With constant inflammation of the mucous membrane of the sinuses, even flowing sluggishly, a variety of additional tissue formations can appear, such as: adhesions, polyps, cystic cavities. They aggravate the course of the disease, since they gradually grow to such an extent that they significantly complicate the removal of unnecessary substances from the sinuses. In this case, surgical treatment of sinusitis will be, perhaps, the only possible way out.
Congenital and newly formed anomalies in the sinus cavity. Congenital problems are understood as the abnormal structure of the bone septa, the presence of cysts and tumors, ridges and protrusions of the bone substance. All of them are a serious obstacle to the outflow from the sinuses, which complicates ventilation. Removing problem areas with sinusitis helps to restore the normal operation of the canals. All that is listed in the previous paragraph can be called acquired formations; foreign bodies should be added to this list. For example, in the case of children, these can be peas and beads, parts from the designer, which the child sticks into his nose and cannot then pull out. During inhalation, they are also pulled into the sinus cavity. Also, it is not uncommon for options when, during the treatment of teeth in the upper jaw, the sinuses turned out to be clogged due to fragments of a tooth or pieces of fillings that had flown off and remained in the problem area. Any foreign body trapped in the sinus automatically becomes the cause of inflammation.

Examination of the patient and preparation for the operation

Endoscopic surgery for sinusitis, like any other intervention, is not prescribed by health workers without good reason. Before doing an operation for sinusitis, it is necessary to perform some examinations at least according to the minimum list. They are especially important if the operation to remove sinusitis is supposed to be open.

The procedures are as follows.

X-ray of the paranasal sinuses. If the process goes into a chronic stage, it is difficult to call this type of examination informative. It can be characterized as a variant of the preliminary determination of the patient's condition in order to choose a method for treating sinusitis. It is also used as an express method for acute purulent disease.
For such an operation, computed tomography can be used. This method is more informative and helps to more accurately describe the picture of the disease. It is possible to obtain layer-by-layer images of the problematic sinus. After using computer graphics, the specialist receives information about the smallest nuances of the site, the presence of foreign bodies, changes in the mucous membrane.
Routine clinical analyzes are also performed. These are urine and blood tests, bacteriological cultures from the sinuses.

For the surgical treatment of sinusitis, conditions must be met.

The patient should not have any diseases like pyelonephritis, tonsillitis before surgery, there should not be exacerbated diseases of a chronic nature. Contraindications to surgery are bronchial asthma, diabetes mellitus during periods of exacerbation.
Women on the day the manipulation is performed should not menstruate.
During pregnancy, routine intervention should not be performed. If absolutely necessary, it can be transferred to the third trimester.

All of these points are not taken into account in the acute course of purulent processes. In such a situation, a puncture of the maxillary sinus is still performed or a puncture is performed.

Types of operations for sinusitis

Many patients who have been diagnosed with sinusitis are interested in how the operation is done. You can familiarize yourself with the basic methods of their implementation.

Punctures and punctures

This option can be safely attributed to the category of manipulations, it is easy to perform and low trauma. Punctures are more often performed if acute sinusitis with a large accumulation of pus is noted. The intervention helps to free the sinus cavity from pus, which is then additionally treated with antiseptic substances.

The advantage of manipulation is that when it is performed, it is easy to take the separated substance for bacteriological research. Thus, the pathogen is determined, and then how sensitive it is to the action of antibiotics. This is necessary for the appointment of postoperative treatment.

Before performing surgical procedures, the nasal cavity is cleaned. Cleansing is followed by thorough rinsing using antiseptic solutions. Cleaning the maxillary sinuses before the operation is carried out to remove pus, mucus, and other contaminants. A vasoconstrictor is dripped into the nose to minimize the risk of bleeding.
Local anesthesia is performed. The puncture is carried out with a special instrument - a thick needle. It passes easily into the thin bone plate that borders the nasal wall. A syringe or aspirators are used to remove pus. The process is complemented by treatment with antiseptics.

How is Luke-Caldwell's operation done for sinusitis?

This type of surgical intervention has been known for over a hundred years and has been used very successfully. Thanks to the open access, surgeons have enough space to perform all the necessary manipulations at the highest level. During the operation, all unnecessary formations are removed.

Preparation for the operation is carried out in the same way as in the previous version. Both local anesthesia and general anesthesia are used. The essence of the intervention is to penetrate the cavity of the sinuses. For access, select the maxillary fossa or a point located on the upper jaw. The mucous membrane is removed until the bone is exposed, then, with the help of special instruments, it is penetrated into the sinus.

The sinus cavity is cleaned, unnecessary tissue is removed. Washes with antibiotic substances are performed. Sometimes a natural hole, even after a complete cleaning, cannot cope with its direct responsibility. Then the specialist can decide on the additional formation of the canal on the inner wall of the sinus artificially. The channel will be led out into the nasal cavity. They can also try to forcibly restore the possibility of the passage of the natural anastomosis. At the end of the work, the entrance is closed with a tissue flap.

Performing intranasal antrostomy

The purpose of this operation is similar to the previous ones - to perform high-quality cleaning. Then the cleaned cavity is sanitized. The only difference is choosing a different access point. In the case of intranasal antrostomy, access is performed through the side wall inside the nose.

How are endoscopic maxillary sinus surgeries performed?

Endoscopic interventions are state-of-the-art and have countless benefits.

Their implementation helps to preserve the anatomy and physiological characteristics of the sinuses. Endoscopic interventions are minimally invasive and bloodless. If necessary, you can repeat this kind of procedure several times afterwards.

The methods have some disadvantages as well. Their cost turns out to be quite high due to the prices of modern optical systems that are used in the process. In addition, specially trained professionals are in huge shortage.

Postoperative period

The rehabilitation phase is extremely important for the patient's complete recovery. Good postoperative care is as important as the operation itself. Any manipulation at this stage must be fully coordinated with the attending physician. You can not self-medicate and take any drugs bypassing the treating specialist.

After the operation, the patient should regularly visit the doctor and try to independently monitor the condition of his own nasal cavities. You should ensure the most careful attitude to your own health. Activities to be organized after surgery.

Regular use of medications is anti-inflammatory drugs and antibiotics, nasal drops. An important procedure for postoperative recovery is sinus flushing with prepared saline solutions and antiseptic drugs.
To monitor the condition, it is necessary to regularly visit the ENT doctor.
Apparatus physiotherapy methods are useful. It can be ultrasound and laser, magnetotherapy and so on.
The patient should be more careful about his own health. Hypothermia and colds should not be allowed - this can provoke a new round of the disease. Long and frequent walks in the fresh air are useful for recovery.
During the recovery period, it means giving up alcohol and tobacco.
Shown spa treatment and vitamin therapy.

In the future, inflammatory processes can be easily avoided by regularly applying caring procedures. Compliance with the doctor's recommendations will help prevent complications of the condition after surgery for a patient with sinusitis.

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When an operation is needed for sinusitis

As already mentioned, not every patient with inflammation in the maxillary sinuses needs surgical treatment. Let's list the main indications for surgical interventions.

Accumulation of pus in the sinus cavity. In this case, most often artificial removal of pus is necessary in the case of complete closure of the sinus - that is, blockage of the sinus duct into the nasal cavity. Pus, accumulating in a closed bone cavity, presses on its walls and leads to unbearable headaches. With a further increase in the volume of pus, its breakthrough under pressure into neighboring structures is possible: the upper jaw, palate, eye socket, meninges.
The presence of chronic sinusitis with frequent exacerbations and prolonged course. To begin with, it is important to understand that a closed sinus cavity with a tiny excretory duct is very predisposing to the development of chronic inflammation. Therefore, chronic sinusitis is a fairly common pathology of the ENT organs. In the course of constant sluggish inflammation in the sinus mucosa, various abnormal "plus-tissues" are formed - polyps, adhesions, cystic cavities. These formations, in turn, contribute to the further development and course of chronic inflammation, often additionally blocking the exit from the sinus. It turns out to be such a vicious vicious circle.
The presence of abnormal formations in the sinus cavity - both congenital and acquired. Congenital formations include pathological bony sinus septa, various tumors and cysts, bony protrusions and ridges that prevent adequate ventilation and outflow from the sinus. The acquired structures include the structures listed in the previous paragraph, as well as various foreign bodies. Such a foreign inclusion in the maxillary sinus becomes the smallest toys or their parts, thrust by the child deep into the nose and, when inhaling, drawn into the sinus cavity. Fortunately, these are extremely rare cases. Most often, you can see fragments of dental filling material, bone fragments of teeth or dental devices that have fallen into the sinus cavity during the treatment of molars of the upper jaw. These foreign bodies cause chronic sinus inflammation.

Preoperative preparation and examination

Of course, any surgical intervention is not done just like that. The patient should undergo a minimum list of examinations, especially if an open operation is expected.

X-ray of the paranasal sinuses. It is a simple, quick and cheap examination. Unfortunately, its informational content in a chronic process is not too high. Rarely, an x-ray shows changes in the mucous membrane, does not always see abnormal "plus-tissue". X-ray is rather a preliminary diagnostic method or an express method in the case of, for example, acute purulent sinusitis.
Computed tomography of the sinuses is a more modern and informative method. With the help of CT, the doctor receives layer-by-layer thinnest slices-pictures of the sinus of interest. Having restored the picture with the help of computer graphics, one can see the smallest nuances of the cavity - altered mucosa, polyps and other formations, foreign bodies. It is also important that with the help of CT it is possible to see the relationships of structures within the cavity. Therefore, it is computed tomography, and not X-ray or clinical examination, that is the gold standard for preoperative examination before elective surgery.
General clinical tests of blood, urine, bacteriological culture from the nasal cavity and sinus are very important before planned surgery.

Prerequisites for elective surgery:

The patient must be relatively healthy before performing the surgical procedure. Any acute (angina, pyelonephritis, etc.) or exacerbation of chronic (decompensation of diabetes mellitus, exacerbation of bronchial asthma) diseases are contraindications.
It is better to carry out planned interventions in the "cold period" of a chronic process - that is, without exacerbation.
Women should also be free of periods on the day of surgery.
It is highly undesirable to perform a planned operation during pregnancy or, if absolutely necessary, to transfer it to the second trimester of pregnancy.

These points do not apply to an acute purulent process associated with the accumulation of pus in the sinus cavity. In this case, the operation in the form of a puncture or sinus puncture is performed in any case.

Types of operations for sinusitis

A patient who is assigned this or that manipulation in the sinuses always worries and thinks: how is the operation done for sinusitis? In this section, we describe the main methods of surgical treatment of sinusitis.

Sinus puncture or puncture

This type of surgical treatment rather belongs to the category of manipulations, since it is quite simple and low-traumatic. In the overwhelming majority of cases, sinus puncture is indicated for acute purulent sinusitis with accumulation of pus in the sinus cavity. With the help of a puncture, pus is evacuated and the sinus cavity is washed with antiseptics. Another advantage of the puncture is that with its help, under aseptic conditions, it is possible to take the sinus discharge for bacteriological analysis, that is, to identify the causative agent of sinusitis and determine its sensitivity to antibiotics for an adequate selection of further treatment.

The essence of the operation:

Before the immediate beginning of the manipulation, the nasal passages and the sinus cavity are washed with an antiseptic solution to remove mucus, pus and other contaminants.
Vasoconstrictor drops are instilled into the nasal passages to reduce mucosal edema and prevent bleeding.
A special ENT examination is carried out, the walls of the nose are examined, and the injection site is selected.
Local anesthesia is performed with solutions or sprays of lidocaine.
A thick needle is punctured. In simple terms, they penetrate into the sinus cavity by breaking through its side wall, bordering on the nasal wall. The bone plate in this place is rather thin, and the needle passes easily.
With the help of a syringe or aspirator, pus is removed and the sinus cavity is repeatedly washed with antiseptic solutions.

Operation Luke-Caldwell

This open maxillary sinus surgery has been in use for over a hundred years. Its name is formed by two surnames of completely different surgeons, who independently described the technique of the operation. Thanks to open access, the surgeon has a large space for manipulation and the ability to qualitatively remove all unnecessary formations.

The essence of the operation:

Preoperative preparation is carried out in the same way as for nasal punctures.
Anesthesia can be local or general - the person will fall asleep and wake up after the end of the operation.
The main point of the operation is to penetrate the sinus cavity. In the case of Luke-Caldwell surgery, the access site is the point on the upper jaw or the maxillary fossa. It is in this natural depression that it is convenient to create a hole.
For this, the mucous membrane of the upper jaw is removed with a kind of flap, exposing the surface of the bone. Further, using special instruments - a chisel, a bur, a drill, the doctor opens the bone plate, penetrating into the sinus.
Further, using similar instruments, the sinus cavity is cleaned, all "plus-tissues", bone ridges and protrusions, and foreign bodies are removed.
The cavity is repeatedly washed with antibiotic solutions.
Most often, in the case of a long course of chronic sinusitis, the natural sinus outlet does not cope with the cleansing of the sinus. Therefore, the doctor can additionally form an artificial canal on the inner wall of the sinus, extending into the nasal cavity, or try to restore the patency of the natural anastomosis.
Then the inlet is closed again with a soft tissue flap.

Intranasal antrostomy

Intranasal antrostomy is a kind of modification of the Luke-Caldwell operation. The objectives of the operations are similar - to clear the sinus from abnormal formations as much as possible and sanitize its cavity. The difference between operations is the access point. For intranasal antrostomy, access to the sinus is not through the upper jaw, but through the inner side wall of the nose.

Endoscopic operations

Surgical interventions using the finest instruments, equipped with a camera and fiber optic system, are the gold standard for maxillary sinus surgery.

Such modern methods have a number of advantages:

Full preservation of the physiology and anatomy of the sinuses, since in the overwhelming majority of cases, the access point to the sinus is its natural anastomosis.
Minimally invasive and bloodless.
The ability to repeat the procedure multiple times as needed.

The disadvantages of the method include:

The high cost of the procedure due to the high cost of optical systems and their maintenance.
There is a shortage of trained doctors, since such techniques require constant improvement of knowledge and skills.

Unfortunately, there are very few ENT departments in public health care institutions equipped with such equipment.

Postoperative period

After surgery on the maxillary sinus, the rehabilitation stage begins. This is a very important period in the patient's recovery. All procedures and manipulations on the operated sinus must be clearly coordinated with the attending physician. Any self-medication is unacceptable!

The main activities in the postoperative period:

Regular visits to the ENT doctor and monitoring the condition of the sinus.
The use of a whole arsenal of medicines: antibiotics, anti-inflammatory drugs, special drops in the nose. It is very important to regularly rinse the nose with saline and antiseptic solutions.
Using the methods of hardware physiotherapy: laser, ultrasound, magnetotherapy and others.
Maximum care of the patient to their health. It is important not to allow hypothermia, avoid colds, and often walk a lot in the fresh air.
Spa treatment, vitamin therapy.
Quitting smoking and alcohol.

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The need for surgical intervention

If a person suffers from sinusitis, the sensations are not pleasant. The presence of inflammation impairs the quality of life. The operation is performed in the following cases:

Chronic sinusitis. This refers to a form that is characterized by frequent exacerbations. A sluggish long course becomes the cause of the formation of various abnormal phenomena in the tissues. These can be adhesions, cysts, or polyps. In the future, neoplasms not only prevent the release of mucus from the sinuses, but also "feed" the chronic course.

A large amount of exudate in the nasal cavity, which begins to rot. The mucus that has no outlet from the sinus begins to gradually accumulate. In turn, this puts pressure on the walls of the nose and provokes headaches. If pus accumulates, it may break through into adjacent healthy walls. The palate, upper jaw, eye sockets, as well as the meninges may be affected.
Surgeons can use this method to treat sinusitis in the presence of various neoplasms in the nasal cavity. They can be both congenital and acquired. Congenital formations - tumor, cysts and pathological changes in the bone septum. Acquired - getting various objects into the sinuses.

Very often the material used in dentistry ends up in the sinuses. It can also be used for dental treatment. Failure to observe this precaution will also cause debris to enter the sinuses. Thus, small foreign bodies become the cause of chronic inflammation.

In what cases it is impossible to carry out the operation

Surgical treatment of sinusitis should be abandoned in the following cases:

the presence of infectious diseases;
blood diseases;
deficiency of the human immune system;
diabetes;
various diseases of internal organs.

It is important to understand that these states of the body are relative. If the cleaning of the maxillary sinuses was successful, according to all the rules, this does not pose any danger to a person in the future.

Before proceeding to the operation, it is necessary to assess the benefits and risks of its implementation.

On the grounds received, a final decision is made.

Types of surgery

If sinusitis does not respond to drug treatment, the patient is prescribed surgery. In this case, one of the existing methods of surgical intervention can be selected.

Operation Luke-Caldwell

With this method, surgeons remove all unnecessary neoplasms in the maxillary sinuses. This technique has been used for over 100 years. It got its name from the merger of the names of two surgeons. Independently of each other, they described a detailed technique. The main feature of the operation is a large space for various manipulations by the doctor.

Puncture of the sinuses

In surgery, another type of surgical treatment is often used - a sinus puncture. The medical term is puncture. This method is simple and low-traumatic. A similar method of treatment is prescribed if the patient has accumulated pus in the sinus cavities. After the puncture, the pus is removed, and the cavities themselves are washed with antiseptics.

The puncture has one more feature. During the lavage of the nasal cavity, the doctor may take mucus from the sinus for bacteriological analysis. This allows you to determine the pathogen that provoked the disease and prescribe the necessary antibacterial agents for therapy. Correct determination of the type of sinusitis will help prescribe an effective therapy.

Endoscope treatment

Endoscopic surgery for sinusitis is a surgical intervention using thin instruments at the end of which there is a camera. This is one of the most popular modern treatments. Differs in a number of advantages:

Lack of blood during surgery.
Operation with an endoscope does not affect the anatomy of the sinuses and preserves their physiology.
If necessary, the procedure can be repeated many times.

Despite all the effectiveness of the treatment, the method has two significant disadvantages:

Lack of specialists. Such a technique requires a person to constantly improve his knowledge and skills. Unfortunately, not every doctor has been trained and ready to perform operations.
The high cost of the operation. Optical systems require expensive maintenance.

Today, government agencies that are equipped with such equipment can be counted on one hand. It is hoped that medicine will continue to evolve and endoscopes will become available to everyone. Despite this, doctors continue to treat sinusitis in patients in other ways.

Efficiency

In some cases, conservative treatment of sinusitis is impossible or does not make sense. This happens when material for filling the teeth enters the nasal cavity. In such cases, surgery is performed using an endoscope. It is the most effective treatment.

Medicine develops in such a way as to cause the patient as little functional and cosmetic damage as possible during the operation. On the basis of this, endoscopic techniques are being developed, after which the patient has no cosmetic defects. Of course, surgical treatment leaves behind scars. If done with an endoscope, the incisions remain inside the nasal cavity and cannot be seen.

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Operation to cleanse the sinuses of the nose

During the operation, the surgeon removes all neoplasms in the sinuses, minimally traumatizing soft tissues. The endoscope camera allows the operation to be performed with high precision.

The surgeon should conduct a preliminary examination of the patient and identify all his individual characteristics before the sinuses are cleaned. The operation is performed by experienced surgeons with extensive practice. Most often, it is required to flush the sinuses in case of acute inflammation. Otherwise, the inflammatory process can move to other vital areas of the body.

By flushing, you can improve the quality of breathing, eliminate the exacerbation of chronic diseases, and prevent the spread of inflammation.

Cleaning the maxillary sinuses by the endoscopic method in the clinic "First Surgery"

With its help, you can get rid of chronic congestion, exacerbation of inflammation and complications caused by them. Thanks to the endoscope, the doctor sees everything that is done inside the sinuses. Based on the individual indications for each individual patient, the surgeon can prescribe a combined cleaning, combining the endoscopic method with subsequent therapy. The clinic offers comfortable conditions. Patients will be able to quickly recover their strength after surgery.

Cleaning the sinuses with the endoscopic method takes different times. The duration of such an operation depends on the complexity of the disease. An experienced specialist will help you to make an accurate diagnosis and choose the right treatment. The clinic employs surgeons with extensive clinical practice, there is everything you need to diagnose and carry out such operations.

How is the operation of cleaning the sinuses of the nose performed?

The patient is placed in a horizontal position with a roller under his head. After that, I make incisions in the most suitable places of the nose or sinuses, a probe with a camera is inserted there, which transmits everything seen to the monitor.

In such a situation, patients are guaranteed the exact execution of all the surgeon's actions. The specialists who perform the surgical cleaning of the sinuses have extensive experience and high medical qualifications. They make an accurate diagnosis, select the optimal treatment options for sinusitis and flushing.

The clinic provides a safe and painless lavage of the maxillary sinuses. The patient does not have to experience pain during the operation. Recovery is usually quick after surgery. Possessing different techniques for making an incision, doctors select the most optimal way to flush the sinuses for everyone who comes to them. People diagnosed with sinusitis and other diseases of the sinuses and nose can always go to the clinic "First Surgery" for effective treatment. They offer affordable prices for such medical services and excellent quality of their implementation.

As a rule, you want to avoid surgery, including a sinus puncture. Some succeed, others can only be saved from deterioration and complications by surgery. Will it be traditional or innovative? The decision is made by the doctor and the patient together - based on the indications, existing contraindications, technological and qualification resources of the medical institution and, of course, the patient's material capabilities.

When surgery is imminent

Sinusitis is an inflammatory process that develops in the maxillary sinuses as a result of infection. Pathology in the maxillary sinuses is manifested by nasal congestion, purulent or watery discharge, headache, nasal voice, fever. This is due to the violation of the outflow of mucus and pus accumulating in the maxillary sinuses.

Uncomplicated sinusitis usually heals well with medication. But there are situations when antibiotic therapy is ineffective. Then you have to produce sinusitis, that is, a surgical opening of the sinus. The purpose of the operation is to sanitize the focus of inflammation, free the sinus cavity from damaged tissues, and prevent serious complications. The main indication is recurrent purulent sinusitis.

Additionally, it is often necessary to remove polyps, cysts in the upper jaw, a bone formation that blocks the mucus outlet, and sometimes a foreign object (most often a filling) that has penetrated into the maxillary sinus. The unprofessionalism of the dentist after several years often turns into an unexpected acquaintance for the patient with the diagnosis of "odontogenic maxillary sinusitis", the treatment of which is extremely prompt.

Preparation for surgical treatment of sinuses

Before starting treatment, the patient must undergo a diagnosis, which includes such research methods as:

computed tomography of the maxillary sinuses;
general analysis of blood and urine;
(including coagulogram);
blood test for syphilis, AIDS, hepatitis C;
fluorography of the lungs.

Surgical methods for sinusitis

A direct indication for surgery is the presence of pus and sinus obstruction for air... Reliable diagnosis is provided only by CT (computed tomography) with its layer-by-layer images. X-rays are capable of misleading, giving off mucosal edema as purulent accumulations. What kind of operation is needed is decided by the doctor based on the picture of the disease of a particular patient:

one or both sinuses are affected and to what extent;
what type of tissue and in what volume should be removed.

Puncture (puncture)

This surgical manipulation is performed on an outpatient basis as an emergency measure. Its purpose is forced drainage of the contents of the sinus, followed by rinsing with an antiseptic.

The bottom line is to puncture the bone septum (cartilage) by introducing a tubular device called the Kulikovsky needle into the nasal passage. Having installed it in the lumen of the sinus, the doctor attaches a syringe to it, through which the washing solution is supplied to the sinus.

The liquefied pus leaves the habitat through the mouth into a chin tray. When, after 2–4 washes, the flush becomes transparent, the procedure is completed. At the final stage, an injection of an anti-inflammatory agent is given. The curious patient will be impressed by the sight of the escaping masses that have recently filled his paranasal space. And, most likely, he will conclude that this "barbaric", in the opinion of some people, the method is worth it.

The procedure is performed under local anesthesia (Lidocaine, Tetracaine), and the patient, apart from an unpleasant crunch at the time of puncture of the bone tissue, does not feel anything. An experienced ENT doctor does everything skillfully and quickly. The operation does not require preparation; to calm down, you can take valerian half an hour before puncture.

The hole in the bone cartilage heals quickly and painlessly. To avoid complications, a course of antibiotics is prescribed for 7-10 days. Usually otolaryngologists prefer amoxicillin (Flemoklav Solutab). On the day of the puncture, bath procedures and hot drinks are not recommended.

Contraindications:

diabetes;
high blood pressure;
congenital anomalies of the nasal cavity;
small childhood.

Pus removal technique using a puncture - video

Endoscopic method

This is a modern method of rhinosinus surgery, however, it originated in the 70s of the last century. Its alternative medical name is maxillary antrostomy. Surgical operation is a minimally invasive (less traumatic) technique with an accelerated recovery period and a minimal risk of complications. Advantages such as the absence of cuts, stitches, severe edema, easy tolerance are combined with a high and lasting effectiveness of the treatment method.

According to the results of long-term studies (data from 1993), all manifestations of sinusitis disappear in 89% of patients after surgery.

Intervention is performed through the nose (or through the socket of the extracted tooth) under general or local anesthesia. An endoscope is inserted into the maxillary sinus through a small puncture (up to 5 mm) into the area of the natural anastomosis or wall - an optical device that allows video monitoring of the operation. A surgical instrument is brought along with him. The shaver system is considered the most perfect. The devices quickly remove and suck out anything that has caused inflammation and nasal congestion. The intervention also involves the removal of the uncinate process, which narrows the place where the maxillary sinus communicates with the nasal cavity.

In private ENT centers, after surgery, a small collagen plate with a substance that relieves swelling and stops bleeding is inserted into the patient's nose.

The operation is performed both on an outpatient basis in a clinic and in a hospital. The duration is 20-40 minutes. Usually, immediately after the operation, the patient begins to breathe freely through his nose, and after a couple of hours he can be released home. In some cases, a hospital stay is required - 2–4 days. Small bleeding is not excluded within 2 weeks. A mandatory measure of rehabilitation is to visit the surgeon once a week, while the nose needs to be cleared of drying mucus and blood. According to indications, nasal hormone-containing agents or antibiotics may be prescribed.

Endoscopic sinus surgery - video

Traditional method

The method is otherwise called classical or radical. Also known under the author's name - Operation Caldwell-Luke. It is performed when new techniques are unavailable and with sinusitis with complications (the brain and facial bones are infected), when it is difficult to extract the pathological contents from the sinus through an endoscope. General anesthesia is used, and food intake is prohibited 6 hours before the operation.

At the first stage, a passage to the sinus is opened. This is done in two ways: through the skin on the cheek or through the mouth. Under the upper lip (in the fossa on the gum), a 3–6 cm incision of the mucous membrane is made, followed by dissection of the soft tissues to the bone. Open access to the anterior bony wall of the sinus. With the help of a drill (chisel), a hole is made in it, through which a tool, similar to a curved sharp spoon, is passed into the sinus.
The next step is to cleanse the sinuses, remove cysts and polyps. At the end of the sanitation, drainage is installed in the middle nasal passage through the anastomosis.
The operation is completed by tamponing the sinus and withdrawing the tampon into the nasal passage. Removable sutures are placed on the wound from the side of the gums for a week. After 2 days after anesthesia, the tampon is removed. After that, the patient is given a nasal lavage, vasoconstrictor drops are prescribed to relieve swelling.

Disadvantages of the technique:

the duration of the operation is about 60 minutes;
long-term hospital stay (up to 14 days);
the risk of injury to healthy tissues, blood vessels, nerves, the possibility of complications, including painful removal of drainage, severe pain in the nose, poor overgrowth of the incision site, fistulas, bleeding, nausea and vomiting due to blood entering the stomach, difficulty in transferring general anesthesia.

The only advantage is that it is free of charge. Well, the otolaryngologist surgeon does not need knowledge of endoscopy.

A gauze bandage may be worn for several days to absorb nasal discharge. Prescribed medicinal antibacterial, decongestant, antihistamines, restorative saline washes, weekly examinations by the surgeon for 1-2 months after the operation, followed by follow-up visits to the ENT.

Trepanation and trepanopuncture of the frontal sinuses

From sinusitis to frontal sinusitis - one step. If there is pain in the forehead, it means that pus has filled the frontal sinuses. Surgical treatment of frontal sinusitis is carried out by trepanation of the anterior wall of the frontal sinus or by puncturing it. Purpose: evacuation of purulent masses and introduction of drugs into the cavity.

The trepanation technique is considered outdated and has many disadvantages:

high invasiveness;
soreness (performed under local anesthesia);
the hole in the bone is not covered with a plate;
a postoperative scar over the eyebrow remains for life.

The puncture point is selected according to the landmarks used when taking the picture. They penetrate under the bone by drilling or punching it in the optimal place. A rigid guide is inserted into the resulting bone hole, through which a cannula (PVC catheter) is inserted. Drainage tubes are fixed on the forehead with an adhesive plaster and left for several days (5-15) to ensure the outflow of exudate, repeated multiple washes and the introduction of medicinal solutions. The drainage system is removed if no pathological contents are observed in the washing liquid for 3 days.

There is an alternative option - video endoscopic. He's more forgiving. For expansion of the anastomosis of the forehead sinus and drainage, a Kassirsky needle is used. This method is almost painless, leaves no marks on the face. The procedure is outpatient and takes 10-15 minutes.

During the recovery period, general antibacterial and hyposensitizing therapy, instillation of vasoconstrictor drops into the nose, and physiotherapy are carried out.

The laser is a quick way to breathe freely

For the treatment of sinusitis with a laser, hospitalization is not required. Usually 7-10 procedures are performed within 2-3 weeks. The therapeutic effect is based on the absorption of light energy by enzymes of the mucous membrane.

The first stage is rinsing the nasal cavity, freeing it from purulent accumulations using the "cuckoo" apparatus.
The second stage - the laser passes along the walls of the sinuses, ridding them of the remnants of pus and at the same time compacting them. The existing adhesions are removed, the edema is removed, the vessels are narrowed, the lumen in the airways increases. The patient feels relief from the first sessions.

The procedure is safe, painless and bloodless. The laser does not burn or overdry the maxillary sinus mucosa, and subsequent antibiotics are not required. The method of treatment is fast, most effective in the initial stages, and prevents recurrence of sinusitis. Contraindication for laser therapy is oncology, as well as blood diseases.

Restrictions after sinusitis

Regardless of the method of surgery, you need to be careful within a month so as not to get sick with ARVI:

do not overcool;
do not visit the pool;
do not eat ice cream;
wear a hat in cool weather.

You can also not eat hot, spicy food, lift weights. A month after the operation, halotherapy sessions (salt cave) or a trip to a seaside resort are useful.

To eliminate inflammation in the nasal cavity and paranasal sinuses, drug therapy, lavage and surgical procedures are used. All these methods are aimed at eliminating edema of the mucous membranes and improving the outflow of secretions. In our article we will talk about the modern surgical method for treating sinusitis - a functional endoscopic operation.

Intranasal drugs, presented by sprays, drops, inhalations, have anti-inflammatory, vasoconstrictor or antibacterial effects. They facilitate nasal breathing, prevent the multiplication of pathogens on the surface of the mucous membranes and relieve inflammation. Astringent preparations coat the nasal cavity and prevent it from drying out. Saline rinsing is a good way to clear accumulated mucus from your sinuses. However, this method is applicable for adults and children over 5 years old (the younger the child, the greater the likelihood of otitis media).

Rinsing the nose

The most inaccessible place for washing can be called the maxillary sinuses.... Due to the anatomical location, conventional manipulations do not affect the mucus accumulated in the maxillary region. In a hospital and outpatient setting, three methods are used:

moving (popular name "cuckoo");
use of a sinus catheter;
sinus puncture (in medical language - puncture).

In most cases, a combination of drug therapy with one or more methods of cleansing the sinuses from mucus is sufficient to significantly alleviate the patient's condition and subsequent complete recovery. However, the hope of many patients on "maybe it will go away by itself" often leads to the fact that the usual inflammation, which with adequate actions and timely medical assistance would have passed in a week, turns into more serious conditions, causing damage to other organs.

Ears (otitis media), mouth (dental diseases), lungs (pneumonia, bronchitis) and even the brain (meningitis, encephalitis) are most often at risk. Missed sinusitis from the acute stage may well turn into a chronic form, providing a person with constant headaches, periodic nasal congestion, snoring and other unpleasant phenomena.

In situations where conservative methods of therapy are powerless, doctors resort to surgical intervention. One of the most common methods of the last century, which is successfully used to this day, is an open operation, which allows you to visually examine the sinuses and thoroughly cleanse them of pus and mucus. But the laboriousness of the process and the need for general anesthesia have led to the fact that an increasing number of surgical interventions in the nasal cavity are performed internally. Such manipulations are called - functional endoscopic operations in the nasal cavity. For the first time such a method was tested in the 50s of the last century, and, since the 60s and 70s, has been successfully used in otolaryngology all over the world.

Advantages of endoscopy

In countries with a high level of medicine, endoscopic practice is considered a kind of "gold standard" in the treatment of chronic forms of inflammation of the sinuses and conditions that are resistant to conservative therapy. One of the clear advantages of such manipulations, especially in comparison with the traditional approach, is no visible postoperative defects since tissue incisions are not required.

Endoscopic surgery

Another advantage is the possibility of detailed diagnostics... An endoscope, inserted into the nasal cavity, is a light-guiding device, with the help of which one can not only qualitatively examine the affected sinuses, but also assess the extent of inflammation, understand the anatomical features and identify "surprises" in advance. And the most important thing is to find and neutralize the focus of the disease, thereby speeding up the recovery time, reducing the risk of trauma and possible complications. After such an intervention, no scar is formed, pain during the rehabilitation stage is less pronounced, although swelling of mucous and soft tissues may persist for several days.

The paranasal sinuses are equipped with thin canals of bone that are covered with mucous tissue. With any inflammation, be it allergies or viral rhinitis, these tissues swell and block the passage. Endoscopic surgery on the maxillary sinus (see the video in the gallery of the site) is aimed precisely at expanding the bone canal. Another plus of this intervention is that even if the patient is faced with lesions in the nasal cavity in the future, the lumen in the sinuses will not close, which gives an advantage in the treatment of subsequent acute conditions... In addition to the main task of enlarging the bone canal, using endoscopic technology, it is possible to eliminate a variety of unnecessary tissues in the nasal cavity: cysts, polyps, growths.

Advantages of endoscopic surgery

Since the surgical field during such operations is located quite close to vital organs, safety and accuracy of manipulation are parameters of paramount importance. In this regard, the endoscopic technique is constantly being improved and studied.

One of the key innovations in recent years is the use of visualization control: a computer program that receives data from CT scans in a special way processes the incoming information and recreates a three-dimensional image of the patient's nasal cavity.

In such a layout, the entire structure of the sinuses and adjacent soft tissues is displayed, moreover, using such a program, it is easy to track each surgical instrument and calculate further actions. A similar technique involving visual control is more often used in difficult cases: with severe damage to the paranasal sinuses, ineffectiveness of conventional operations, with a non-standard structure of the patient's nasal cavity.

Preoperative preparation

The first and one of the most important stage before the intervention is diagnostics, which makes it possible to determine the cause of the development of the disease, the characteristics of the disease, the state of the air passages and outline the therapy plan. For this, X-ray, CT, olfactory analysis, cytology and rhinomanometry data are used, revealing thickened walls of mucous membranes, cysts, polyps, localization of nasal obstruction and other elements of the disease. Exact knowledge makes it possible to determine the treatment tactics in general and the surgical strategy in particular.

Endoscopic procedures

If earlier in the surgical practice of ENT doctors it was believed that complete elimination of the mucous membranes of the nasal sinuses was required for the complete cure of severe and chronic forms of sinusitis, then the modern technique of FECP (functional endoscopic sinus surgery) completely refutes this opinion. The technical base and updated instruments used in endoscopic operations provide a gentle mode of intervention while preserving mucous tissues . At the same time, the outflow of purulent mass and mucus improves, the air passages are restored, and the membranes themselves get the opportunity to regenerate and self-“correct”.

Cleaning the maxillary sinuses

Cleaning the maxillary sinuses - an operation performed under the influence of local anesthesia, which reduces the time of manipulations and speeds up the patient's rehabilitation. First, an endoscope equipped with micro video cameras is inserted into the nasal cavity. It allows surgeons to visually assess the amount of work, structural features of the sinuses and detect the primary focus of the disease. Then, following the endoscope, special microinstruments are introduced into the affected area, ensuring high accuracy of each movement of the doctor. As a result, the affected tissue is removed without any harm to healthy cells, which has a beneficial effect on postoperative recovery.

This method minimally traumatizes the mucous membranes and, since most interventions are performed by access through the nostril openings, does not leave external defects in the form of scars or scars. After endoscopic procedures, there may be slight edema, soft tissue swelling, and minor discomfort.

Foreign body in the nose

Along with pathogens, inflammation of the maxillary sinuses can cause a foreign body to enter the nasal cavity. If in young children this is due to the accidental inhalation of small objects or food particles and the insertion of toy elements into the nostrils with their own hands, then in conscious adulthood, dental procedures are most often the cause. Another way of getting debris into your sinuses is through an open wound. A sign of foreign elements in the nasal passages may be the abundant secretion of mucus from one nostril. But it is not uncommon for an object to fall into the nasal cavity for the first time to cause no inconvenience, but over time it necessarily provokes inflammation.

Removal of a foreign body by endoscopic surgery

With the development of minimally invasive techniques, the operation to remove a foreign body from the maxillary sinus began to be carried out using an endoscope, which allows you to accurately eliminate a stuck object without harm to healthy tissues. In some cases, the extraction of particles is carried out through an access under the upper lip. In this case, the size of the hole does not exceed 4 mm, which ensures the preservation of the anastomosis of the maxillary sinus.

Unfortunately, endoscopic equipment is quite expensive, so such operations are not performed in all medical institutions, moreover, the knowledge and practical experience of a surgeon is required for a flawless intervention.

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The indications for endoscopy of the maxillary sinus today are established by us much less often than a few years ago. Basically, in cases where such a study is necessary to clarify the diagnosis of alleged isolated lesions of the maxillary sinus, that is, mainly when a tumor is suspected. In addition, foreign bodies can be removed from the maxillary sinus under endoscopic control. Pathological changes resulting from inflammatory processes in the maxillary sinus are today in most cases treated by transethmoidal access along the middle nasal passage.

Endoscopic examination is carried out by us almost exclusively through the canine fossa. After the injection of a local anesthetic under the mucous membrane, the anterior wall of the canine fossa is perforated using a trocar for puncturing the maxillary sinus, which is propelled by a uniform alternating left and right rotational motion. The mucous membrane does not need to be cut for this. In no case should you try to "push" the trocar through the anterior wall of the maxillary sinus without rotational movement. One can clearly feel how the trocar penetrates through the mucous membrane of the vestibule of the mouth and "drills" the anterior wall of the maxillary sinus. The advantage of this access route is the large radius of trocar rotation, which creates optimal conditions for examinations and interventions (see Fig. 1 and 2).

Rice. 1. Introduction of the trocar with a rotational movement into the maxillary sinus through the canine fossa.

Rice. 2. Schematic representation of the radius of rotation of the inserted trocar sleeve.

Tissue sampling from the maxillary sinus can be done blindly or with optical biopsy and grasping forceps. To do this, use the 0 ° optics to direct the trocar sleeve to the biopsy site, remove the endoscope and keep the sleeve fixed. Direct biopsy forceps are then inserted, a tissue sample is taken, and the correct biopsy site is checked through the endoscope. Thus, cysts are easily opened. The described way of access through the canine fossa is also optimal for studying the ways of transporting secretions in the maxillary sinus.

Subject to correct execution (perforation is usually performed at the level between the roots of the 3rd and 4th teeth and as lateral as possible), such complications as irreversible dysestisia or paresthesia are extremely rare. At the end of the examination and / or intervention, the trocar sleeve is pushed out with the same gentle rotational movement as during insertion. It is not necessary to sew up the perforation. The patient is only asked to refrain from blowing his nose intensively for a while.

Endoscopy of the maxillary sinus is extremely rare for children. A surgical approach should be chosen taking into account the child's age and the degree of development of the maxillary sinus.

Rice. 3. Right maxillary sinus, the natural opening of which is blocked by a foreign body (filling material for root canals of teeth).

Sinusitis– This is the most common endoscopic ENT operation, which is effective for chronic sinusitis, cysts, antrochoanal polyps, fungal and foreign bodies of the maxillary sinus. The sinus is performed through the natural opening of the maxillary sinus in the nasal cavity: first, it expands by a few millimeters, and then the sinus is examined with an endoscope. The pathological contents are removed from the sinus, and the mucous membrane remains intact.

Hymoroetmoidotomy – this operation is larger in volume than sinusitis, because it affects the adjacent sinuses - the cells of the ethmoid labyrinth. Hymoroetmoidotomy is necessary for chronic purulent and polypous sinusitis.

Polysinusotomy – This is an extensive endoscopic operation in which several or all of the paranasal sinuses are operated simultaneously from two sides: the maxillary sinuses, frontal and wedge-shaped, ethmoid labyrinth. Endoscopic polysinusotomy is most often performed with polypous rhinosinusitis.