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Endoscopic sinus surgery operation and postoperative recurrence of_2908

By Richard Wagner,2014-10-30 16:44
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Endoscopic sinus surgery operation and postoperative recurrence of_2908

    Endoscopic sinus surgery operation and postoperative recurrence of

     Abstract Objective: To evaluate the endoscopic sinus surgery operation and sinusitis recurrence relations. Methods: The follow-up of the 2001 in 2005 caused by improper operation

    due to surgical cases of recurrence were analyzed retrospectively. Results: The result of surgery caused by improper operation of the reasons for recurrence of a high Deviation of nasal septum is not corrected, the Department of agger nasi and frontal recess disease treatment is not complete, the ethmoid sinus opening is incomplete, improper handling of middle turbinate, uncinate process residue, maxillary sinus stenosis Atresia , maxillary sinus polyps are not removed inside the clean, nasal mucosa adhesion, marked

    hypertrophy of inferior turbinate surgery is not the same period in surgery. Conclusion: The application of endoscopic sinus surgery are familiar with anatomy, skilled operative technique, especially on a few easily lead to recurrence of

    parts to be properly handled.

     Key words Endoscopy Sinusitis Recurrence

     [ABSTRACT] Objective: To study the correlation between skill and relapse in endoscopic sinus surgery. Method: Relapse induced by improper operative procedures from 2001 to 2005 in

    our hospital was retrospectively analyzed. Result: Factors of relapse were as follows: the exalted deviation of nasal septum was not remedied; the focus between the egger nasi and the frontal recess was not completely operated on; the ethmoid

    sinus was not completely opened; the middle turbinate was improperly operated on; the uncinate process was hung over;

    the ostium maxillary was narrow ; polyp in the maxillary sinus was not completely removed; the nasal mucosa stuck together; hypertrophy of the inferior turbinate was not operated on. Conclusion: Great knowledge of anatomy and operative skill and proper treatment of the easily recurrent focus are important to avoid relapse.

     [KEY WORDS] Endoscopy; Sinusitis; Relapse endoscopic sinus surgery for chronic sinusitis and nasal polyps have been widely carried out, the effect is better, but there are some patients with postoperative recurrence. Is now on my hospital 2001 2005 year due to surgery caused by improper operation of 32 cases of recurrence analysis to explore the recurrence of such operations caused by improper operation of the causes and preventive measures.

     1 Data and methods

     1.1 The clinical data of 32 patients were 20 males and 12 females, 16 61 years old, according to the clinical

    classification of chronic sinusitis and nasal polyps staging criteria (1997 Haikou session): ? type in 6 cases, of which 2

    in 2, 3 4 cases; ? type 17 cases, including one in 1 case, 2 in 6 cases, 3 in 10 cases; ? type in 9 cases. Preoperative

    coronal sinus CT routinely check and nasal endoscopy to determine the degree and extent of disease; preoperative application of 0.9% sodium chloride 250? Ml penicillin, 8 million U dexamethasone 10? Mg, intravenous 3? d.

     1.2 Methods surgery using local anesthesia, starting with intramuscular pethidine 50? Mg, phenergan 25? Mg. Extent of the lesion were selected according to sinusitis ostiomeatal complex surgery, maxillary sinus surgery and opening mouth and frontal recess, ethmoid, sphenoid sinus surgery and opening

    ceremony, if desired, line of nasal surgery and in the partial resection of inferior turbinate . Postoperative follow-up 1

    year, was discharged a month to the hospital 1 week, 2 months, every 2 weeks one time, 36 months, a monthly review of one

    times, six months to a year can be reviewed from time to time. 10 cases reviewed CT.

     2 Results

     Postoperative endoscopic follow-up observation, due to

    surgical operation due to recurrence of the performance and the proportion shown in Table 1, in which 25 routine treatment of secondary surgery and recovery.

     n? 31.3 Variable 12.5 polypoid middle turbinate middle turbinate adhesions outside the maxillary sinus stenosis 25.0 atresia high Septoplasty uncorrected maxillary sinus polyp

    recurrence of inferior turbinate hypertrophy within 3 to discuss

     Endoscopic sinus surgery postoperative recurrence of sinusitis and nasal polyps complicated factors may be related to allergy, sinus anatomical abnormalities, extent of the lesion, the number of pre-surgery, surgical proficiency,

    surgical technique and postoperative management and other factors related to surgery the proper and smooth operation or not, the greatest impact on efficacy. We are focusing on the operative factors that discussion.

     The upper nasal cavity are mainly agger nasi and frontal recess Department, where the highest position, and with the nasal septum gap is small, if not familiar with this anatomy, fear of injury and orbital cardboard sieve while not daring

    remove lesions here would be lead to removal of agger nasi ethmoidal incomplete, the amount of recess in the vicinity of the diseased tissue is not completely clear. Postoperative sinus drainage is not a fundamental obstacle to lifting retention would inevitably lead to inflammation, tissue edema and proliferative inflammatory stimulation, led to a recurrence of nasal polyps in the upper part. Reposted elsewhere in the paper for free download http://

     Deviation of nasal septum and the high incidence of

    sinusitis is closely related to [1]. Deviation of nasal septum caused by nasal airflow dynamics of change in the sinusitis and nasal polyps in the formation of the role played can not be ignored. If we did not correct the increased intra-and

    postoperative right nasal cavity clean up the difficulty, but also occurs after nasal adhesion and poor drainage of the important reasons. Section I of the original song in the uncorrected partial de-interlacing symptoms disappeared after correction, so in endoscopic sinus surgery, the right nasal

    septum should be corrected Deviation high.

     Turbinate in endoscopic sinus surgery on the treatment there has been different views, some scholars believe that middle turbinate has important physiological and anatomical

    features, to retain the middle turbinate sinus surgery is an important functional elements; middle turbinate is to protect the middle meatus and sinus ostium a natural barrier to retain the middle turbinate sinus after resection compared with open mouth good. Another part of scholars believe that the middle turbinate is a sinus ostium atresia, nasal drainage, and poor adhesion of the important reasons [2]. Li Yuan et al [3] that the adhesion sites were mainly seen in the middle turbinate and the lateral wall of the nasal cavity, middle turbinate polypoid degeneration or hypertrophy of the turbinate surgery or the removal of line processing is not enough, easily lead to sinusitis, recurrent nasal polyps and middle turbinate adhesion. We believe that the middle turbinate treatment

    should consider the specific circumstances, the indications for removal of middle turbinate surgery is necessary to focus on the purpose to prevent the adhesion occurs to protect the good ventilation cavity drainage surgery to achieve as soon as

    epithelialization of the situation. Normal middle turbinate should be retained, but the surgery should be to protect its surface during operation to prevent equipment damage. For hypertrophic middle turbinate, middle turbinate polypoid changes occur, or bullous middle turbinate in patients with obstruction in the nasal passages, should be done in the lateral part of the middle turbinate resection, retained within the side part of the middle turbinate, but the removal of the middle turbinate should pay attention to the subject to retain integrity, In particular, the middle turbinate substrate, in order to avoid "drift." Significant hypertrophy of inferior turbinate nasal ventilation, patients are not concurrent partial inferior turbinectomy, nasal congestion

    symptoms after improvement is not ideal, and therefore should be for the hypertrophy of inferior turbinate surgery over the same period.

     Expand the sinus, reconstruction of the ventilation and drainage of paranasal sinuses is very important. Uncinate

    process is located in front of the middle meatus processes, removal of uncinate process is the first step in endoscopic sinus surgery, if the incomplete removal of uncinate process, the upper left, postoperative frontal recess obstruction, poor

    drainage, affecting the amount of sinusitis cured; bottom

    left, making maxillary mouth exposure should not be sufficient, affecting maxillary mouth open. A variety of reasons for the difficulties caused by a natural hole, combined with surgical improper operation, resulting in sinus

    mucosa varus and / or around the sinus mucosa avulsion, leaving bad sinus ostium. Also too much damage to sinus mucosa and bony expansion, not only regeneration of postoperative sinus mucous membrane by fibrous connective tissue

    regeneration to restore, prone to restenosis, or even occlusion, leading to surgical failure. Therefore, surgery in ensuring the smooth clear blocked sinus drainage under the

    premise of mouth as much as possible to avoid unnecessary expansion of mucosal damage and bone. Multiple polyps of the maxillary sinus cavity, single-use endoscopic sinus naturally

    from the mouth can not be completely cleaned up, this time should be carried out Caldwell - Luc joint surgery and

    endoscopic surgery.

     References

     [1] Ma Xiang, Yu Delin. Septal peak Deviation and sinusitis [J]. Otolaryngology - Head and Neck Surgery, 1996,3:218

    219.

     [2] ZHANG Ge-hua, Liu Xian, Geng, et al. Endoscopic sinus

    surgery to retain the possibility of middle turbinate and its clinical significance [J]. Chinese Journal of

    Otorhinolaryngology, 1999,34:30 32.

     [3] Li Yuan, Geng. Complication of endoscopic sinus surgery [J]. Chinese Journal of Otorhinolaryngology, 1998,33:142

    144. Reposted elsewhere in the paper for free download http://www.hi138. com

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