Radio wave coagulation of nasal conchas. Laser coagulation of the vessels of the nose. Why you should come to us

When the nose is not breathing due to vasomotor rhinitis or a number of other reasons, it is not uncommon for patients to undergo turbinate vasotomy.

This operation is designed to improve blood circulation and permanently solve the problem of nasal breathing disorders.

Today, there are several methods for performing this type of surgical intervention. All of them have their own characteristics, advantages and disadvantages, therefore, when choosing a specific method, you must first of all listen to the opinion of the surgeon, who will certainly take into account all the wishes of the patient.

Nasal vasotomy: what is it? Indications for surgery

Vasotomy is a surgical treatment chronic diseases nose, involving the destruction of the vessels of the nasal concha in one way or another, due to which their volume decreases.

During the operation, doctors exfoliate the mucous membrane and eliminate the vascular (venous) bundles that provoke a deterioration in the patency of the air stream.

The inferior turbinates themselves are small bony protrusions located on the lateral surfaces of the nostrils.

They are covered with a mucous membrane with a pronounced submucosal layer responsible for moisturizing and heating the air inhaled by a person.

But with a number of diseases, swelling and hypertrophy of the nasal concha occurs due to increased blood supply to the numerous vessels of the submucosal layer.

This provokes a narrowing of the passages and a deterioration in the patency of the air flow during inhalation, up to its complete impossibility.


It is in such situations, when a long conservative therapy did not bear fruit, submucosal vasotomy of the inferior nasal concha is indicated. As a rule, it is performed when:

• vasomotor, including
• chronic runny nose;
• endocrine pathologies that provoke hypertrophy of the turbinates.

For children, the procedure can also be prescribed if indicated. Depending on whether both halves of the nose are affected or only one, bilateral and unilateral vasotomy can be performed.

Contraindications for turbinate vasotomy

For many patients, the only way to restore normal breathing is vasotomy, the operation has few contraindications, however, in their presence, it cannot be prescribed. This is about:

• any acute infectious diseases;
• purulent processes in paranasal sinuses ah, ears and other departments of ENT organs;
• exacerbation of chronic pathologies;
• blood diseases.

Source: site If a patient is diagnosed chronic sinusitis, prior to vasotomy or simultaneously with it, sinusotomy can be performed.

What tests are done for a vasotomy? Preparing for the operation

Before the procedure, patients are required to confirm the need for surgery and identify possible comorbidities. Therefore, patients need:

• take blood tests;
• (endoscopy nasal cavity);
• Ultrasound of the paranasal sinuses (echosinusoscopy);
• sometimes CT or MRI.

2 weeks before the appointed date, and also stop taking anticoagulants (including Aspirin, Phenilin, etc.), if they were prescribed by other specialists to eliminate or prevent certain disorders.

Types of vasotomy: how is the operation performed?

There are several techniques for reducing the volume of the turbinates. Which better fit the patient, the otolaryngologist decides based on the nature of the course of the existing disease, the individual characteristics of the patient, age, etc.


Each technique has pros and cons, so it is impossible to say unequivocally which one is the best.

Nonetheless

AT recent times classical surgical interventions are becoming a thing of the past, giving way to modern minimally invasive manipulations.

Instrumental

open surgical intervention This is a traditional technique for eliminating turbinate hypertrophy. Depending on the situation, the doctor may suggest treatment using one of the following techniques:

Submucosal. The essence of the method is to separate the mucous membrane and destroy the submucosal plexus of vessels with a scalpel.

Lateralization (lateropexy). This technique involves breaking and moving the shell against the wall of the nostril and fixing it in a new position, which allows you to increase the diameter of the passage and make room for the stream of inhaled air.

Vasoconchotomy (conchoplasty)- resection of part of the nasal concha and the mucous membrane covering it.

As a rule, a vasotomy of the nose with sedation is performed, that is, during the procedure, the patient is conscious, able to communicate and follow the commands of the surgeon, but at the same time does not feel pain and is inhibited due to the introduction of strong sedatives. Less commonly, the procedure is performed under local or general anesthesia.


After it, the patient remains in the hospital, the duration of his stay in it depends on the severity of the postoperative period and the presence of complications. In any case, the procedure takes no more than 5-15 minutes.

Do vessels recover after vasotomy over time? Usually not, since scar tissue remains in their place, which is the prevention of relapse.

Turbinoplasty

The method is applied in severe cases and consists in removing part of the nasal concha through a small incision, although the mucous membrane is preserved.

Highly undesirable complete removal these anatomical structures, since this can lead to the development of undesirable consequences, in particular, the inability to breathe through the nose, although there will no longer be objective reasons for such a violation.

Attention

Among all the methods of surgical intervention, it is turbinoplasty that is considered the most effective.

This operation on the turbinates gives the most pronounced and lasting effect, but since it is quite traumatic, complications often arise after it.

Shaver destruction or microdebrider conchotomy

The method belongs to the number of surgical. Its use allows both turbinoplasty or conchotomy, and submucosal vasotomy.

Its main difference from the classical operation is the use of a special tool - a shaver. It is a kind of electric knife: a rotating blade connected to an electric suction, so when it is applied, all cut tissues are immediately removed from the surgical field.

Laser vasotomy of the turbinates

This method is one of the most popular, because it is characterized by low cost, low level of trauma and high efficiency. When removed venous plexuses a laser light guide is inserted into the nasal concha, and the energy of the beam provokes tissue evaporation.


After the procedure, breathing usually recovers fairly quickly, and the risk of relapse is low. At the same time, undesirable consequences are rarely observed.

Radio wave disintegration of the inferior turbinates

This is one of the most modern minimally invasive methods for the elimination of pathologically altered tissues and neoplasms. It involves the introduction of a probe under the mucous membrane that produces radio waves.

They force the cells to actively oscillate, which leads to an increase in temperature to high values, coagulation of vessels and normalization of the size of the turbinates. Often the method is called radio wave destruction, conchotomy or reduction.

Coblation

Coblative vasotomy (cold plasma or molecular quantum reduction) involves the creation of a surgical instrument fields of cold plasma, which leads to the appearance of ions of a certain kind, provoking the breaking of bonds between molecules. It is one of the methods of radio wave surgery.

When using coblation, tissues are heated only up to 40–70 °C. This allows you to solve existing problems with minimal damage to surrounding structures.

Ultrasonic disintegration

The destruction of the submucosal layer occurs due to the action of ultrasonic waves. They provoke gluing of the walls of the affected vessels.

Typically, the procedure is prescribed for mild forms of hyperplasia, that is, when the inferior turbinate or both only slightly increase in volume. In other situations, there is a significant likelihood of recurrence of the disease.

Vacuum resection

This one is relatively new method currently being implemented in medical practice. Therefore, it is too early to talk about its effectiveness and safety.

Its essence lies in the aspiration of the cells of the submucosal layer with a special instrument-pump by creating a negative pressure.

In general, vacuum resection is promising direction in otolaryngology and, possibly, in the future will be no less popular than radio wave or laser disintegration.

Cryosurgery of nasal conchas

The essence of cryodestruction is the treatment of the mucous membrane with a cryoprobe with an extremely low temperature. As a result, large ice crystals form in the cells, which destroy the cell membranes.

The procedure causes thrombosis of capillaries at the site of exposure, as a result of which they are bled and swelling disappears.

electrocautery

This method involves the destruction of vascular bundles by constant electric shock. Cauterization occurs by touching the affected areas with a hot electrode.

The procedure causes the tissues to scar, which leads to compression of the venous plexuses and, accordingly, a decrease in the volume of the turbinates, while instant coagulation (soldering) of the vessels occurs, so the manipulation is not accompanied by bleeding. Sometimes it is also called electrocaustics or galvanocaustics.

Today, electrocautery is used less and less, as it is considered obsolete. There are many other methods that, with less damage to healthy tissues, give a more pronounced effect.

Septoplasty and vasotomy

Often both procedures are combined, since congenital or acquired as a result of trauma (more often in men) septal deformities can also contribute to respiratory failure.

Septoplasty implies that is performed by removing the protruding part cartilage tissue or bone ridge.


it endoscopic surgery Therefore, its implementation is associated with minimal damage to the anatomical structures, which leads to a short rehabilitation period. Both procedures are indicated for patients who have

Price

The cost of vasotomy depends on the type of technique used, the rating of the medical institution, its territorial location and experience of the doctor.

In the departments of otolaryngology, classical surgical intervention can be performed absolutely free of charge, while in private clinics in Moscow and St. Petersburg, the elimination of hypertrophy with a laser or the Surgitron device (radio wave disintegration) can cost from 3,000 to 30,000 rubles.

Rehabilitation after septoplasty and vasotomy

Usually recovery happens quickly enough. Duration rehabilitation period depends on the method of the operation, while often patients receive sick leave for the entire recovery period.

After classical operations, the nose is packed several times. Finally, the tampons are removed only after the formation of dense crusts.


If a surgical intervention was as sparing as possible, that is, methods such as laser, radio wave, ultrasonic disintegration, etc. were used, the patient can leave the clinic already half an hour after the end of the manipulation. In any case, in postoperative period forbidden:

• visit the bath, sauna, swimming pools, gym;
• lift heavy objects;
• run;
• drinking alcohol.

Patients need to carefully care for their nose after any type of vasotomy and follow the recommendations received from the ENT exactly.

Usually, experts recommend washing several times a day. saline solutions(Aquamaris, Physiomer, Marimer, No-salt, Dolphin, Aqualor, Salin, saline) and treat mucous membranes with neutral oil, for example, vaseline, peach, sea buckthorn.

After surgery, antibiotics are often prescribed to prevent infection. a wide range actions. If necessary, patients can take painkillers to relieve pain.

Possible complications after surgery

There is almost always swelling after the procedure. thick snot and crusts. When using a laser, radioknife or similar minimally invasive techniques, the condition returns to normal after about 3-5 days, but after surgery - only after 1-1.5 months.

This explains the fact why, after a vasotomy, the nose does not breathe again or the sense of smell is lost. For the final restoration normal functioning nose it takes time for tissue healing, elimination of puffiness, etc., although sometimes patients in such cases need a second operation.
Most likely complication an infection may become attached, it can be suspected by an increase in body temperature, and also if the runny nose has intensified, no matter what. Also, atrophy of the mucosa is sometimes observed, which is accompanied by dryness and discomfort.

The bone structure of the skull a complex system with a large number of constituent functional elements. These include the inferior turbinates - paired bone formations located in the nasal cavity. Anatomically, they are bone plates that separate the middle and lower nasal passages, and participate in the formation of the latter. The inferior turbinates are formed bone tissue, and are lined with submucosal tissue, which contains glands and plexuses of many small vessels and covered with epithelium. The vessels, expanding and narrowing, regulate the diameter of the lumen of the nasal passages, that is, they take part in the regulation of human breathing.

Anatomical features of the structure of the inferior turbinates

This paired thin bone has a concave lateral and rough medial surface. Rough covered with multiple vascular grooves.

Its upper edge is straight, behind it is attached to the palatine bone, and in front it is attached to the shell ridges. upper jaw, as if throwing itself through its crevice.

The structure of the shell is represented by a body and three processes. The maxillary process and the bone form an acute angle into which the lower edge of the maxillary cleft enters. In the process of opening maxillary sinus this process is clearly visible.

The lacrimal process connects the lacrimal bone and the inferior concha.

The ethmoid exits from the junction of the bone with the jaw process, and ends in the maxillary sinus. Can fuse with the ethmoid bone in its uncinate process.

The anterior part of the shell in the upper edge is attached to the maxillary shell crest. Its posterior section is attached to the shell crest of the perpendicular plate of the palatine bone. A longitudinal slit located under the sink is the lower nasal passage.

The vascular component of the submucosal layer covering these shells is directly involved in the processes of respiration, narrowing and expanding under the influence of external and internal factors. In cold weather, the vessels in the nasal passages expand, due to which the air passes through them more slowly and has time to warm up better before entering the lungs. In general, the lower shells are characterized by a high intensity of blood flow.

However, there are conditions, pathologies and diseases in which normal regulation vascular tone may be disturbed, for example, during pregnancy, due to the curvature of the nasal septum, due to some endocrine diseases and allergic rhinitis. In this case, the vessels located under the mucous membrane are filled with blood, as a result of which the mucous thickens, and breathing becomes difficult. Complications of such conditions are vasomotor rhinitis and hypertrophy of the inferior turbinates.

What are dangerous pathologies of nasal conchas

A dangerous feature of any changes in the structure of the mucous membranes of the shells is that, due to difficult nasal breathing, the affected person is constantly forced to use vasoconstrictor sprays and drops. Application of such medicines, which continues for a long time, can cause a number of complications:

• chronic hypoxia;
• formation of dry rhinitis in chronic form when crusts form in the nasal cavity, and liquid with ichor is separated from the nose;
• damage to the ciliated epithelium;
• chronic spasm of the nose, due to which a person develops hypertension;
• obstruction auditory tubes and pathological processes in the paranasal sinuses and structures of the middle ear.

The essence of the procedure of vascular vasotomy, indications and contraindications for its appointment

Submucosal vasotomy is a process of surgical intervention on the vascular connections lining the turbinate cavities. Thanks to its implementation, it is possible to significantly reduce the size of the mucosa, thereby facilitating the process of nasal breathing for the operated person.

The indication for the appointment of vasotomy is:

• chronic rhinitis in cases where the variant of its allergic etiology is excluded;
• diagnosed hypertrophy of the nasal mucosa;
• curvature of the nasal septum;
• dependence on vasoconstrictor drugs.

In what cases is the operation impossible? Doctors distinguish such contraindications for the implementation of vasotomy:

• blood clotting disorders that cannot be corrected;
• acute infectious lesions;
• atrophic and ulcerative lesions nasal mucosa;
• cardiac, hepatic, kidney failure in the stage of decompensation;
• diabetes;
• period of menstrual flow in women.

Vasotomy techniques: how the vessels of the submucosal turbinate are destroyed

Vasotomy is performed different ways. For each individual patient, the doctor selects the most suitable method. So, they distinguish:

• instrumental;
• laser vasotomy;
• radiocoagulation;
• ultrasonic disintegration;
• vacuum resection.

Instrumental vasotomy suggests that it acts with a scalpel, making an incision in the mucosa.

The laser type of procedure is carried out using a directed laser beam, which destroys the accumulation of blood vessels with minimal tissue trauma.

Radiocoagulation - the process of influencing the vessels of the submucosa through the use of a source of radio waves.

Ultrasonic disintegration is based on the impact of ultrasonic waves on the affected area.

Vacuum resection is carried out by introducing a pump tube with negative pressure into the submucosa, as a result of which the vessels and tissues are destroyed.

Preparation for the procedure, features of the procedure

As a preoperative preparation, the doctor prescribes a preliminary delivery of some tests - coagulograms, general analysis blood, throat swab, and rhinoscopy.

If in the throat, auditory or respiratory tract there are infectious foci or inflammation, special therapy is prescribed to eliminate them. Before the operation, the doctor conducts a sanitation of the oral cavity.

Each type of vasotomy is performed according to a specific scheme. The operation can be bilateral or unilateral.

Instrumental vasotomy. Carried out using local anesthesia. The mucous tissue of the shells is lubricated with a dicaine solution, in addition, the tissue is infiltrated with lidocaine or novocaine. Injection anesthesia is allowed.

When anesthesia begins to take effect, the surgeon makes an incision up to 2-3 millimeters long. In depth, it reaches the bone. A raspator is inserted into the hole, with which the doctor removes the necessary volume of the mucosa. As a result, the size of the epithelium decreases, and scars form in place of the separated tissues.

Instrumental vasotomy with lateropexy implies, in addition to affecting the mucous membrane, also moving the nasal concha towards the maxillary sinus.

At the end of the procedure, the patient is given an anesthetic injection, because after the end of the anesthesia, he will feel significant soreness at the site of the operation. AT nasal cavity gauze swabs are introduced, which cannot be removed during the first day.

The normal condition after instrumental vasotomy is weakness, apathy, increased tearing, dizziness. A mandatory requirement of the rehabilitation process is the need for daily nasal rinsing to prevent the formation of crusts.

Laser vasectomy. Also held under local anesthesia. Usually, cotton swabs moistened with an anesthetic are used - they are inserted into the nose.

To better visualize the changes in the epithelium, it is stained with methylene blue before the intervention.

The patient is placed on the couch, his head is located on the headrest. Protective goggles or a bandage are put on the eyes. While the surgeon will operate the laser, the patient must lie completely motionless. It is necessary to breathe in the process with the mouth so as not to feel the characteristic “scorched” smell.

A surgical mirror is inserted into the nose, thanks to which the doctor has an overview of the operated site. The source is inserted next. laser radiation- a special sensor with which the surgeon continuously drives along the mucosa, or acts on it pointwise.

The effect of cutting off excess tissues is produced due to the introduction of quartz fiber into the submucosa, which forms channels in it. Simultaneously laser ray also produces coagulation of blood vessels, so the operation is bloodless and does not require tamponade, and also does not cause tissue fusion.

The operation can last from 30 to 60 minutes.

radio interference. In this case great importance has a complete immobility of the operated person, so he is often immersed in a state of medical sleep, introducing an anesthetic intravenously. A tube is inserted into the throat to drain blood. Next, a special probe is inserted into the submucosa. A radio wave of a certain length is produced between it and the transmitter. Due to the resulting resistance of the tissues, they are heated and destroyed. A non-thermal effect is considered safer, when a strongly cooled area appears around the inserted probe, which also leads to the destruction of the pathologically altered tissue.

At the end of the procedure, the patient is transferred to the ward. When the anesthesia wears off, the person may feel severe pain in the nose, the appearance of spatial disorientation is also possible.

During next week after surgery, the nasal cavities must be rinsed with disinfectant saline solutions, and the crusts must be removed using Peach oil or vaseline.

The total duration of the process is no more than 40 minutes.

Ultrasonic disintegration. It is performed in the ENT room, that is, there is no need to transfer the patient to the operating room. The doctor puts on a protective apron for him, as bleeding is possible. A conductor of ultrasonic waves in the form of a needle is introduced into the submucosal tissue of the shells, with which the epithelium is pierced.

Due to the ultrasonic effect, stenosis of the vessels occurs, that is, they stick together, and they can no longer provoke the appearance of edema.

At the end of the procedure, sterile gauze swabs are inserted into the nostrils, and the patient can go home.

On the first day, the normal reaction of the mucosa will be the separation of the ichor. After 3-7 days, nasal breathing is completely restored.

If the resulting crusts of mucus cause discomfort to a person, you should consult a doctor to remove them.

The duration of ultrasound vasotomy is from 5 to 50 minutes.

Vacuum resection. This type of operation is carried out under the influence of local anesthesia, as well as with endoscopic control. When the anesthesia begins to take effect, the surgeon makes an external incision with a scalpel and then inserts a vacuum tube into the submucosa. The tube has a sharp edge, and as it moves inside the tissue, it partially cuts them off. The pump, to which the tube is connected, creates a negative pressure in it, and all cut-off tissues, together with blood, enter its cavity.

The surgeon, removing the tube, inserts a cotton swab or ball into the nostril, with which the epithelium is tightly clamped at the incision site in order to prevent the development of bleeding. After 30-60 minutes, the ball is removed.

Vasectomy and nasal septum repair

In cases where the cause of respiratory failure, in addition to problems with the mucous membrane, is the curvature of the nasal septum, the surgeon can also perform septoplasty during the operation. Such a surgical intervention is more complex, is performed only under general anesthesia, and requires the patient to be admitted to a hospital for 1-2 days.

The recovery period after this operation lasts 14-20 days, it may be accompanied by fever, separation of mucus and ichor. At least once in a while postoperative rehabilitation you need to see a doctor.

What happens after surgery: patient reviews and medical practice

Despite the relative safety of vasotomy, the patient is not immune from the development of some complications or unpleasant consequences intervention. So, in the affected person, atrophy of the mucosa can form - a process that is the reverse of tissue hypertrophy, when the cells of the mucosa begin to break down and die.

The risk of infection of blood and tissues during the operation is quite low, but it cannot be completely excluded.

A violation of the sense of smell awaits the patient after any method of vasotomy, but if the intervention was gentle and qualified, the ability to smell smells will return quite quickly.

Some testimonials of those operated on indicate that the tissues of the submucosa have grown after the vasotomy, almost more than before it. Unfortunately, vasotomy can not always affect the cause of tissue hypertrophy and is guaranteed to get rid of nasal congestion, so it is rather difficult to exclude the re-growth of the epithelium.

In addition, at the site of the resection, fusion of tissues and blood vessels - synechiae and adhesions - can form. The only way to get rid of them is to repeat the operation.

Usually, subject to all the rules of asepsis and the technique of intervention, in 93-97% of cases, vasotomy is successful, and a month after it, normal nasal breathing is finally restored. The probability of relapse formation ranges from 25 to 40%.

Vasotomy is an operation aimed at reducing the size of the nasal mucosa. It comes down to the destruction of part of the vascular plexuses located between the epithelium and the bone. The main indication is a chronic runny nose and the resulting hypertrophy of the mucosa.

Indications for the operation

The main disease in which vasotomy is possible is chronic or runny nose. An important condition surgical treatment is to get rid of the underlying infection and exclude the allergic nature of the disease.

Hypertrophy of the nasal mucosa can also be a reason for the appointment of a vasotomy. These two pathologies are related, but not directly. Hypertrophy may be the result of a constant runny nose, taking vasoconstrictor drugs that, by suppressing its function, cause the mucosa to grow to compensate. But it can also occur as a result. Hypertrophy often increases during adolescence.

Vasotomy can help with addiction vasoconstrictor drugs. In this case, the edema does not subside without taking the appropriate drops. For some people, addiction can last for years, and only surgery helps them start breathing on their own.

Operating principle

The operation area is the inferior turbinates. X surgery may affect only the left or right side or be bilateral. The latter option is performed most often, since vasomotor chronic rhinitis affects both nostrils.

The inferior turbinates are bony protrusions that are covered with epithelium with many glands. Because of them, the surface is constantly wetted with mucus and is therefore called mucous. It is characterized by an increased intensity of blood circulation. Therefore, one more layer is usually isolated between the bone and epithelial tissue - submucosal. It consists of vascular plexuses.

They are destroyed during the operation. As a result, the nutrition of this part of the epithelium stops. It dies, scars appear. The total volume of hypertrophied mucosa is reduced. This relieves swelling, reduces the activity of the glands, which ultimately eliminates the runny nose.

Operation types

Vasotomy of the inferior turbinates can be performed by one of the following methods:

• Instrumental. In this case, the surgeon acts directly with a scalpel, making an incision in the mucosa.
• Laser. The action of the beam is directed to the entire surface of the mucosa. The risk of infection is reduced, but the effectiveness does not always correspond to the damage received.
• Radiocoagulation. The surgeon makes punctures, an instrument with a tip is inserted into them, through which radio waves pass.
• Vacuum resection. This is a new method that is currently being actively explored. The destruction of the submucosal layer is carried out by inserting a tube attached to the pump under the epithelium and creating a negative pressure.
• Ultrasonic disintegration. The waves are focused exclusively on the affected area. The risk of additional damage is minimal.

Operation progress

Instrumental vasotomy

The procedure is performed under local anesthesia. It is carried out by lubricating the mucosa with a 5% solution of cocaine or a 2% solution of dicaine. Also carry out infiltration (impregnation) of the entire nasal concha with lidocaine (1%) or novocaine (1-2%). Sometimes they are given by injection. The patient's face is covered with a napkin, leaving a hole for the nose. Thus, the patient does not see the actions of the doctor. The operation time is from 30 to 60 minutes.

After the onset of the action of anesthetics, the surgeon makes an incision 2-3 mm long to the bone. A raspator is inserted into it - a tool for separating tissues. The surgeon separates the mucous tissue in the required volume. As a result, scars appear at the site of the vascular plexuses, the epithelial tissue decreases in size.

Sometimes lateropexy is needed.- shift of the nasal concha towards the maxillary sinus. The patient at this moment can hear a crunch, do not be afraid and try to move your head.

After the operation, the patient is given another injection with painkillers, to reduce discomfort after the anesthesia wears off. Bandages or tampons will be in the nose for a while. In the first day, the condition may resemble the flu - lacrimation, weakness, dizziness. Important! However, the temperature should not be - this is a sign of inflammation, infection. The patient will have to periodically rinse the nose in the morning to prevent the formation of crusts. This procedure is carried out until the mucosa is completely healed and its normal functioning begins.

Laser vasotomy

Before the operation, it is necessary to refuse cosmetics. It is possible that the patient will be asked to change into disposable hospital pajamas. The operation is performed under local anesthesia. The pain medication is in most cases delivered in the form of tudunds soaked in an analgesic that are inserted into the nose. The patient's face is treated with alcohol.

Sometimes, as a result of changes in the mucosa, it loses its color and becomes pale. In such a situation, it is difficult for a doctor to carry out all the necessary manipulations, therefore, before the operation, the epithelium is stained with methylene blue. It also improves the performance of the laser.

The patient is laid on the couch, the head is located on the headrest. Important! It is highly undesirable to move during the operation, so you need to immediately take a comfortable position. If the patient feels overly excited, it is better to ask the doctor to fix the arms and legs with elastic bandages. A bandage is put on the eyes. During the operation, the patient will feel an unpleasant burning smell. It will be optimal if he begins to inhale through his mouth and exhale through his nose.

The doctor inserts a mirror into the nose and with its help controls the process. It is usually painless, but there may be a slight tingling or tingling sensation. Radiation can be carried out pointwise or continuously, when the doctor runs the laser along the mucosa. The first method is the most preferable, since it affects the epithelial membrane of the nose less. Today at medical centers the least traumatic method is used first, and if it is ineffective, they move on to the second.

The actual operation is carried out with quartz fiber. It is introduced under the mucosa and forms channels there, producing tissue separation. The fiber is flexible, which allows you to repeat all the contours of the nasal concha and not go to the surface of the epithelium.

After the operation, tamponade (introduction of tampons into the nose) is not required, since in most cases it is bloodless, because. the vessels are not cut, but “soldered”. This prevents the development of synechia - tissue adhesions. Laser vasotomy has a good record of efficacy and safety. According to doctors from Kharkov (O.G. Garyuk, A.B. Bobrus), who conducted a long-term study of patients with drug-induced rhinitis in the period from 2006 to 2009, a cure occurs in 96.8% of cases.

Video: laser vasotomy

Radio wave vasotomy

The immobility of the patient is one of the key parameters, therefore, in most cases, the patient falls asleep during the operation. The anesthetic is delivered through a vein. A tube is placed in the throat to drain blood. The operation time is from 10 to 40 minutes. If the doctor uses local anesthesia, then the patient should control his reactions as much as possible during the radio wave vasotomy and try not to move even in case of severe pain.

The doctor inserts the probe into the submucosal area. A radio wave is generated between it and the transmitter. Due to wave resistance the surrounding tissues are heated, and their destruction occurs. One of the varieties of the method is the use of non-thermal energy. At certain frequencies, a cooling region appears around the inserted probe, which causes tissue destruction. This method is considered somewhat less traumatic than the standard one, and safer for neighboring tissues.

The patient usually wakes up 1-2 hours after the end of the operation already in the ward. The nostrils contain tampons and tubes through which you can breathe. General state the patient is satisfactory. Usually patients report severe pain in the nose and prefer to breathe through the mouth. Migraines, disorientation in space are possible. Within a week, it is necessary to observe hygiene measures - washing the nose with saline solutions, such as Aquamaris, removing crusts from the nose with vaseline or peach oil.

Ultrasonic disintegration

The operation is performed in the ENT room. She is performed under local anesthesia and lasts from 5 to 20 minutes. There may be some bleeding, so the patient is likely to wear a special apron. A waveguide is inserted into the submucosa of the patient's inferior turbinates. It looks like a needle, with which the doctor “pierces” the epithelium.

The emitted ultrasound causes stenosis (adhesion) of those blood vessels that cause swelling. After the operation is completed, tampons are inserted into the patient's nostrils, and he can go home. In the evening, the separation of the ichor is possible - this is a normal reaction. nasal breathing fully recovered on 3-7 days after the operation. It is necessary to periodically see a doctor to remove crusts of mucus during the recovery period.

Vacuum resection

The operation is performed under local anesthesia and under the strict control of the endoscope. The device for vacuum resection was developed by Russian doctors and put into practice just a few years ago. It is a system of tubes with a pump attached to them.

The surgeon makes an incision with a scalpel after the onset of anesthesia. A tube is inserted into the submucosal layer. Its edge is sharp, and when it is advanced, it cuts off the tissues necessary for removal. Due to the action of the pump, they are sucked into the tube along with the blood.

After removing the device from the nose, a cotton ball is inserted into the nostril, which firmly presses epithelial tissue. This is necessary to prevent bleeding. It stays in the nostril for only 30-60 minutes. Tamponade for vacuum resection is not required.

The removed content is sent for histological examination. This allows more careful planning of further management of patients.

Vasotomy combined with septoplasty

stages of septoplasty

One more common cause respiratory disorders in addition to mucosal hypertrophy is the curvature of the nasal septum. This pathology is also corrected surgically. The operation is called Because chronic rhinitis and deviated septum are related diseases, often suggest that this operation be carried out immediately in conjunction with a vasotomy.

Such a surgical intervention is more difficult than just excision of the submucosal layer of the nose, and lasts longer. Therefore, in this case more practice general anesthesia and hospitalization for 1-2 days after surgery. But still most surgeons recommend that septoplasty and vasotomy be done together rather than in two steps. This reduces trauma to the mucous membrane and discomfort for the patient, which has to be experienced only once.

The recovery period after such an operation lasts longer than with a conventional vasotomy. Perhaps an increase in temperature, prolonged separation of the ichor from the nose. Important! If you feel unwell, you must contact the treating ENT, only a specialist can distinguish the normal reaction of the body from the onset of the infectious process.

Complications after vasotomy

After the operation, the following undesirable consequences may develop:

1. Mucosal atrophy. This is the reverse process of hypertrophy, but also unpleasant. The lowest risk of its occurrence after laser exposure. Atrophy leads to the destruction of functional significant cells nasal epithelium.
2. Inflammation. The risk of infection during surgery is quite low. All tools both in private and in public clinics being sterilized. However, any surgical intervention reduces the protective barrier of the epithelium, which makes the body more susceptible to various pathogens. The more invasive the method is used, the more likely it is to get inflammation.
3. Loss of smell. This is usually a temporary phenomenon associated with postoperative swelling.
4. Nasal congestion. Unfortunately, nasal vasotomy may not always help. It is extremely rare that swelling and congestion not only do not go away, but also become stronger. The reasons may vary from allergic reaction to re-hypertrophy.
5. Formation of synechiae or adhesions at the site of resection. These formations can seriously make breathing difficult. They are formed gradually, so the patient's well-being may not deteriorate immediately. Treatment is carried out only by performing a second operation.

The safety of the effects of physical radiation (radio or laser) on the human body is not considered definitively proven by some authors. Modern research are not grounds for predicting the patient's condition in the more distant future.

Price

Submucosal vasotomy is free of charge, but you will have to queue to receive the service. Patients usually have to wait from 1 to several months. The operation is carried out mainly instrumental method. It is possible, if the polyclinic or hospital has special equipment, to perform vacuum resection along compulsory medical insurance policy however, this practice is extremely rare.

Other types of vasotomy cost approximately the same - from 5,000 to 15,000 rubles. Additionally, you will have to pay for general anesthesia, if such is the indication of the doctor or the desire of the patient. The cost of tests, biopsy of the contents, as well as hospitalization beyond the first day are not included in the indicated price. Clinical price lists usually refer to bilateral vasotomy, although this is not specifically stated.

The most expensive will be the operation combined with septoplasty, mainly because of the hospital stay. average price in Moscow is 50,000 rubles. But the septoplasty itself can be performed free of charge under the MHI policy, however, the combination of this operation with a vasotomy performed by a minimally invasive method using modern equipment should not be expected.

Laser coagulation nasal mucosa is effective method get rid of all the signs of chronic rhinitis.

Contraindications:

• Availability inflammatory process in the body (ARVI, acute respiratory infections, influenza, sinusitis, pharyngitis, tonsillitis, laryngitis, bronchitis, pneumonia, etc.);
• blood clotting disorder.

Used equipment:

• ultrasonic apparatus "Tonsillor - M";
• a modified vacuum nozzle for washing the palatine tonsils;
• vacuum nozzle "Tonsillor" for washing the palatine tonsils;
• syringe for washing the palatine tonsils.

Often patients do not pay due attention to the processes in the body, especially when they are worried the only symptom- runny nose. Advertising offers many means that "facilitate" the condition. And what is the result? The patient himself prescribes therapy, uses sprays, drops. At some point, they stop helping, and a runny nose and shortness of breath do not go away. A person seriously starts the disease, and there is only one way out - surgical. Laser coagulation of the nasal vessels (cauterization) in Moscow is indicated for all types of chronic rhinitis:

• vasomotor (the vessels of the nose lose their tone);
• allergic (when, in response to a certain stimulus, the vessels of the mucosa become clogged);
• medication - occurs with prolonged use of drops;
• hypertrophic - a companion of the rhinitis described above, in which the nasal mucosa increases.

If the doctor made one of these diagnoses, you will be offered a surgical method of treatment - laser coagulation of the nasal mucosa (cauterization). It allows in short term alleviate the condition without resorting to treatment in a hospital.

Our doctors

How is the operation

Coagulation of the mucous membrane with a laser is a non-traumatic and effective method that helps to get rid of all signs of chronic rhinitis and allows you to breathe fully on the day of surgery. During the operation, the doctor uses a special laser to cauterize the vessels, as a result of which the edema disappears and breathing is restored.

The operation itself takes about 15 minutes. Before manipulation, the doctor applies local anesthesia. The patient should not move his head while the laser is working. The laser accurately affects the desired area without touching the adjacent ones. Unpleasant sensations the patient does not experience - only tingling. The doctor controls what is happening with the help of an endoscope. After the operation, the patient receives valuable instructions that must be carefully observed:

• cannot be applied medications for the nasal cavity;
• avoid physical activity;
• baths, saunas, alcohol intake are contraindicated.

If one procedure is not enough, the doctor will prescribe a second session. But this is extremely rare.

A significant advantage of the operation is its long-term effect and affordable price. Patients after it may not remember their illness for many years.

Certificates and licenses

Treatment in Moscow in our clinic is carried out using modern equipment and sterile instruments. Our prices have not changed since 2013 and are the best in town. Laser coagulation - The best way treatment of chronic rhinitis. Before chronic stage it is better not to bring it up, but if the disease is running, be sure to come. We will help you!

Many people with a fair amount of indifference relate to their body when it begins to show the first signs of an onset. serious illnesses. This happens especially often when a runny nose appears. There is an opinion that you can just "sniff" your nose for a couple of weeks, drink well-known pills, you can use some kind of spray, and everything will go away by itself. However, otolaryngologists insist that rhinitis should be taken more seriously, because it can cause the development of such ailments as sinusitis, sinusitis, and even hypertension.

In cases where a person has already thoroughly launched the mechanisms for the development of any infection in his body, drops, sprays and tablets are unlikely to help. Therefore, there is a need for surgical methods treatment. We are talking about laser coagulation, carried out inside the sinuses.

Cause and effect - rhinitis and laser

Chronic rhinitis is a disease in which the mucous membrane of the nasal cavity is affected. It is characterized by the following symptoms:

• stuffy nose;
• labored breathing;
• copious secretion of mucus from the sinuses;
• headache;
• strong snoring;
• general malaise.

In the absence of proper treatment, chronic rhinitis quickly acquires severe form and provokes the development of other diseases that are not so easily treatable. The disease is divided into several types:

• - with it, the tone of the vessels that are in the lower nasal conchas (in the submucosal layer) decreases;
• allergic rhinitis - the cause is individual intolerance to a certain irritant (there is a blockage of the cavity and vasoconstriction);
• drug rhinitis - appears as a result of prolonged use of nasal sprays and vasoconstrictor drugs;
• - is a consequence of any of the above rhinitis and is accompanied by an increase in the volume of connective tissue in the turbinate mucosa.

Photo A - normal vessels, photo B - dilated

If one of these types of chronic rhinitis is detected, the doctor may advise taking antibiotics, which is associated with a certain risk, or performing an operation and cleansing the turbinates and constricting the vessels in a fairly short period of time.

The operation itself belongs to the category of simple and is not associated with any risk to the health and life of the patient (subject to sufficient competence of the doctor).

How is laser coagulation performed?

Laser coagulation is the most gentle and at the same time effective way to eliminate the causes and symptoms of all types of chronic rhinitis. In this case, the patient completely eliminates the dependence resulting from long-term use drugs. During the operation, the specialist uses a laser beam, which destroys (cauterizes) the vessels located under the nasal mucosa. The consequence of this procedure is the disappearance of edema, the restoration of normal breathing and the elimination of the possibility of nasal conchas to increase. Sometimes the operation is called a vascular vasotomy.

Vasotomy is a dissection of the vessels between the periosteum of the turbinates and the mucosa, leading to a decrease in the turbinates, a reduction in the mucosa and full recovery physiologically correct breathing through the nose.

Laser coagulation of the nasal vessels has a number of advantages compared to instrumental surgery. First of all, it is a faster effect. Normal breathing becomes possible immediately on the day of surgery. Also, the advantages are low invasiveness (minimal destruction of tissues and blood vessels) and no risk of injury. The operation takes approximately 15 minutes and is performed under local anesthesia on an outpatient basis (in a clinic or hospital). Another advantage is a stable result - the vast majority of patients who have undergone the procedure do not feel relapses for many years.

The course of the procedure

During the operation, the patient lies on the surgeon's table on his back. Immediately before the procedure, the doctor uses local anesthesia, the effect of which begins to be felt after 3-5 minutes. During the operation of the laser, the patient is absolutely forbidden to move his head in different sides. You need to breathe like this: inhale through your mouth, exhale through your nose. During the work of a doctor, a person feels only a slight tingling sensation, which does not cause any discomfort.

The laser gently acts on tissues and blood vessels without affecting other areas

After the anesthetics have fully begun to act, the specialist uses a laser to form channels along the lower and upper edges of the turbinates. In parallel, the course of the operation is controlled by an endoscope, which will prevent the laser beam from being taken out of the area being treated.

This is how the device looks like, with the help of which laser coagulation of the turbinates is carried out

When the operation ends, the medical staff closely monitors the patient for half an hour, performing procedures such as oropharyngoscopy, anterior rhinoscopy, and endoscopy. If during this period of time bleeding from the vessels or shells as a whole does not open, then the patient is allowed to take a vertical position. In the short postoperative period (several hours), the patient is also under medical supervision. If during this time no abnormalities were found, the patient is released.

Before leaving the clinic, a person receives many instructions. In particular, it is strictly forbidden for a person who has undergone laser coagulation of the nose to use any drugs for the treatment of the nose. Also banned physical exercise, visiting saunas and baths, drinking alcohol (the latter categorically). Nose care is carried out only by means that have been prescribed by a specialist (various oil drops).

Although positive effect achieved on the day of surgery, in most cases one procedure may not be enough. As a rule, a whole course of procedures is carried out, which includes from 2 to 6 sessions. The interval in this case is from 1 week to 5.

Laser nose coagulation is considered a great way to get rid of chronic rhinitis, but it is much better not to bring it on. Therefore, it is necessary to use medications as soon as the disease has been diagnosed. However, if rhinitis has been started, then you should not lean on drugs with double effort. You need to immediately think about more effective and reliable methods of treatment, until the course of the disease initiates the development of another, more serious and dangerous disease.