Endoscopic treatment of maxillary sinus mouth_2843

By Rebecca Green,2014-10-30 16:45
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Endoscopic treatment of maxillary sinus mouth_2843

Endoscopic treatment of maxillary sinus mouth

     Abstract Objective: To evaluate the endoscopic sinus surgery in the treatment of maxillary sinus natural ostium and the prognosis. Methods: Chronic sinusitis and nasal polyps in patients with 682 cases of maxillary sinus openings to find a different way and in accordance with the shape and maxillary sinus ostium lesions themselves, decided to open ways and approaches. Results: The follow-up for 6 months and found that

    I developed sinus rate 84.22% (574/682 cases), latch-rate of

    16.88% (106/682). Conclusion: The maxillary sinus mouth of the approach is an important step in endoscopic sinus surgery, but also affect the efficacy and prognosis of the key factors.

     Key words endoscopic maxillary sinusitis

     [ABSTRACT] Objective: To investigate the clinical role of the management of the maxillary sinus ostium on the prognosis in endoscopic sinus surgery (ESS). Methods: A total of 682 cases of chronic sinusitis or nasal polyp had been

    subjected to ESS since 2001. In the operation, the ostium was enlarged or not based on the shape and size of the ostium or ostium maxillary sinus diseases. Results: Followed up for 6 months, maxillary ostia was found in 84.22% (574/682) of the patients and maxillary ostia closure was found in 16.88% (106/682) of the patients. Conclusion: Patency of the

    maxillary ostia is one of the important criterions to evaluate ESS. Suitable management of the ostium and regular follow

    up are the key points to regain the long term patency of

    the ostia.

     [KEY WORDS] Sinusitis; Endoscopy; Maxillary sinus

     Maxillary sinus is a chronic sinusitis, nasal polyp

    disease, the most common lesions, but also after endoscopic sinus surgery, the most common site of recurrence. Recurrent sinus openings are often cause adhesion, stenosis or atresia.

    Sinus mouth open is a matter of endoscopic sinus surgery is one important basis for evaluation. Now we are dealing with experience in the mouth of the maxillary sinus following report.

     1 Data and methods

     1.1 The clinical data from January 2001 to November 2006,

    in the hospital through the line of paranasal sinus CT and nasal endoscopy diagnosed with chronic sinusitis and nasal polyps in patients with a total of 682 cases, of which 452 cases of male and female 230 cases; age of 982 years, mean 42

    years. In accordance with the accounting standards in 1997, Haikou [1], ?-type 1 32 cases, 2 in 95 cases, 3 126 cases, ?

    type 1 in 25 cases, 2 158 cases, three of 96 cases, ? period

    of 150 cases. Only a second operation 69 patients with a history, there are two times or two more times in 52 cases. All patients were given preoperative oral or intravenous antibiotics and hormones 3 5? D, nasal spray to nasal steroids.

     1.2 surgical methods 68 cases of endotracheal general anesthesia, 614 cases of partial nasal topical anesthesia plus local anesthesia. With 2% tetracaine 20? Ml plus 1

    adrenaline 3 4? Ml, respectively, nasal anesthesia Road, butterfly screen recess, olfactory cleft and middle turbinate. Then 1% lidocaine (with epinephrine plus some 1 ) in

    uncinate process, sphenopalatine ganglia and the infraorbital nerve local anesthesia. Surgical approach used Messerklinger. The first complete removal of uncinate process, with particular attention to try to remove the tail bone slices, conventional open sieve bubble disorders in pre-(post) group

    screening room, open frontal recess to expand the maxillary sinus ostium.

     1.3 identify the maxillary sinus ostium at 30 ?

    endoscopic sinus natural openings for the following methods: (1) during the operation directly through the middle meatus can be observed sinus ostium; (2) with suction elbow In between the uncinate process and ethmoid bulla and to explore openings, once into the open, using elbow arc formed when

pulling the barb out the role of the uncinate process and most

    of the drag out; (3) in the suction pressure to push the probe inside wall of maxillary sinus mucosa, and sometimes can be seen from the sinus outflow of purulent secretions or see bubbles overflow; (4) who are still difficult to identify,

    from the inferior meatus puncture and injection of normal saline, to see the middle meatus with maxillary sinus fluid flow shall be; (5) If not successful, need to re-clean sinus

    mucosa or bone around the remaining pieces, with particular attention to whether there uncinate tail bone pieces, and sometimes after the removal of uncinate process hypertrophy of mucous membrane where the mouth to the sinus involvement, affecting sinus drainage. Are available at the edge of uncinate remnant after 1 / 3, with curved sickle-shaped knife

    out exploration under the maxillary sinus mouth, where a sense of frustration that has entered the maxillary sinus; (6) If the sinuses were completely blocked does not recognize, you need to locate whether the Deputy mouth, from the Vice-mouth

    treatment [2].

     1.4 maxillary sinus natural ostium of maxillary sinus after treatment to find, according to the form and open lesions of maxillary sinus openings decision processing. If the opening is smooth, morphologically normal, maxillary sinus

    lesions lighter, may from time to deal with maxillary sinus openings. Otherwise, it should be clear sinus and nasal cavity lesions, while maximizing the maxillary sinus ostium, so that the diameter of> 1? Cm [3]. In order to avoid injury

    nasolacrimal duct, mainly downward, backward expansion of the main. We will only use the sinus polyps sinus ostium area drill excision or biting clamp bite addition, without excessive removal of bone.

     2 Results

     All patients were followed up after 16 months, the

    surgical treatment of assessment standards by 1997 the sea. Cured 538 cases (78.9%), improvement in 96 cases (14.1%), ineffective 48 cases (7%). According to Yan Yongyi, etc. [4] after the classification of maxillary sinus window, the window

    is divided into: (1) Open well: the window diameter ? 5? Mm,

    in this group, 365 cases; (2) narrow one: the window diameter <5? Mm, The group, 209 cases; (3) atresia: local scar or edema, or polyps blocking or closed windows, there are 106

    cases in this group. Open rate (good and narrow the opening and) 84.22% (574/682 cases), latch-rate of 16.88% (106/682).

    Reposted elsewhere in the paper for free download http://

     3 Discussion

     Traditional treatment of chronic sinusitis is mainly taken by maxillary sinus puncture and washing windows, and Caldwell-Luc maxillary sinus surgery. Pain in patients with large, efficacy is poor, mainly due to nasal sinus ostium

    complex causes for congestion are not lifted, failed to improve the drainage of sinus ventilation. Therefore, the

    expansion of maxillary sinus ostium, reconstruction of the maxillary sinus ventilation and drainage is the key to treatment of maxillary sinusitis [5]. Currently, endoscopic sinus surgery in the maxillary sinus natural ostium is need to

    expand, expand to the number of inconclusive. Tan Guo-Lin et

    al [6] that the expansion of the treated sinus ostium opening rate but lower than those who do not expand; Yanyong Yi et al [4] that after I re-closed mainly affected by sinus ostium

    diameter 1? Cm standard is recommended that sinus mouth diameter and should be extended to 1.5? cm or more, less than 1.5? cm high rate of re-closed; Liu Feng et al [3] that the

    situation should be based on flexibility. We believe that the right maxillary sinus disease light, sinus morphologically normal endoscopic sinus is easy to see the mouth that can not handle; right sinus mucosa is smooth, Douqiang smooth, even if the full removal of sinus secretions more as long as the uncinate process in particular its tail bone pieces can no

    longer expand the maxillary sinus ostium; right maxillary sinus lesion weight, sinus mucosal swelling, or bony stenosis, then every effort will be expanded to sinus ostium diameter of 1.5? cm or more; right through the window handle of the

    maxillary sinus lesions such as polyps, cysts, or fungal infection, without causing complications should be under the premise of maximizing the sinus ostium, or even see the openings extend to the next meatus. Open the mouth of the scope of the natural maxillary sinus: the upper edge of the orbital floor and paper templates at the junction of the lower edge of the inferior turbinate on the edge of the rear before the nasolacrimal duct, after sphenopalatine artery [5].

     Fenestration of maxillary sinus narrow, latch mainly

    occurred in the postoperative period of wound healing in the

short term to ensure regular follow-up surgery is to keep the

    mouth open to sinus one important factor. Maxillary sinus caused by the narrow window, atresia of the main reasons are:

    (1) High Deviation of nasal septum is not only impede the operation, an increase of the operative cavity after surgery and the difficulty of cleaning up, but also post-operative

    adhesions and postoperative nasal important reason for poor

    drainage one; (2) operation is not correctly identify the sinus ostium; (3) bone narrow, lack of access to an appropriate size of the maxillary sinus fenestration, the majority of such patients with a history of long, serious

    disease or a history of pre-surgery; (4) maxillary sinus

    inflammation have not been well controlled; (5) surgery by 1.0 1.5? cm ostium open standards [5] the impact of binding and did not try to expand the sinus ostium; (6) postoperative follow-up