Endoscopic removal from the sinus. No need to worry. Why do endoscopy of the paranasal sinuses?

Rationale. Surgical correction intranasal structures and sinus surgery with the development of endoscopic technology have reached new level compared with the work of pre-endoscopic rhinology. The founders of endoscopic rhinosurgery, developing various techniques, based on the principle of maximum preservation of the healthy mucous membrane of the nasal cavity and paranasal sinuses.

The concept of the pathogenesis of sinusitis from the prechambers into the large sinuses expands the capabilities of the pediatric rhinologist when choosing the type of operation: from the usual displacement of the middle turbinate medially, sufficient in young children, to extended ethmoidectomy, necessary only for total sinus polyposis, severe syndromic diseases (Kartagener syndrome , aspirin triad, cystic fibrosis).

Target.

Endoscopic operations in the nasal cavity must meet four fundamental principles of sinus surgery:
after surgery, the sinus should retain its physiological mechanism;
If possible, the natural sinus anastomosis should be left intact;
the operation must be performed so that the air stream through the operated anastomosis does not fall directly into the cavity of the operated sinus;
Interventions on the turbinates should not allow air flow into the area of natural openings.

Indications. Spicy and chronic diseases upper respiratory tract, congenital and acquired anomalies of the nasal cavity, lack of effect from conservative therapy, previously undergone surgical interventions on the nasal cavity and paranasal sinuses.

Contraindications. Contraindications to endoscopic operations in the nasal cavity and paranasal sinuses correspond to the general criteria for preparing a child for surgical interventions (blood clotting indicators, previous infectious diseases, hereditary diseases, acute and chronic diseases of internal organs - according to the conclusion of a specialist).

Preparation. The preparation process includes studying the medical history, examination, diagnostic endoscopy, trial therapeutic treatment, imaging methods and preoperative examination (radiography, CT scan, according to indications - magnetic resonance imaging). In the preoperative period, it is necessary to maximally improve the condition of the mucous membrane through the use of topical corticosteroids in combination with decongestants, mucoregulators, antibiotics, topical antihistamines, irrigation therapy drugs.

Methodology and aftercare. Peculiarities of childhood require the rhinosurgeon to comply with four conditions when performing an operation:
surgical interventions should not be performed in areas of active growth of the nasal cavity and development of future sinuses;
only after exhausting all the possibilities of endoscopic functional surgery can surgery be performed through external access with an aesthetic defect;
if classical conservative treatment is insufficient or ineffective for chronic rhinosinusitis, then functional operation must first remove obstacles to mucociliary transport and air flow in the area of the nasopharynx, turbinates, and then you can resort to gentle surgical interventions in the area of the ostiomeatal complex;
by doing surgical interventions it is necessary to spare the mucous membrane of the contacting surfaces, especially in the area of the funnel and formations of the ostiomeatal complex.

Due to anatomical changes in the ostiomeatal complex, damage to the cells of the anterior ethmoid group and the maxillary sinus predominates in children over lesions of other sinuses in all age groups. Both the nasal turbinates (inferior and middle) and elements of the lateral wall of the nose (uncinate process, ethmoidal bulla, less commonly Haller’s cell, nasal shaft cells) are involved in stenosis of the ostiomeatal complex; therefore, surgical interventions for recurrent and chronic sinusitis in children are represented by the following operations:
elimination of postnasal occlusion (adenotomy);
intervention in the area of the nasal concha;
correction of elements of the lateral wall of the nose involved in the formation of natural anastomoses of the paranasal sinuses;
elimination of deformations of the nasal septum.

The endonasal approach to the sanitation of the large sinuses due to limited interventions on the intranasal structures of the lateral wall in the area of the prechambers is optimal in childhood, since the age group of the child being operated on determines the scope of operations. If in adult patients a reasonable and sufficient volume of surgery, even with chronic purulent-polyposis sinusitis, frontal sinusitis, can be infundibulotomy with partial opening of the anterior ethmoid group without maxillary sinus, then in children the volume of operations is dictated by the age capabilities and structure of the ethmoid labyrinth, the level and position of the maxillary sinus .

A number of operations can be performed from resection of the uncinate process to total ethmoidectomy with fenestration of the sphenoid and maxillary sinuses. However, in the vast majority of cases, even with persistent recurrent processes, opening the anterior chambers in the anterior ethmoidal group is sufficient to obtain positive results in the treatment of chronic sinusitis, sinusitis, and ethmoiditis.

Local anesthesia for endoscopic interventions in the nasal cavity is a mandatory step, even if the operation is performed under general anesthesia. Immediately before the operation, it is recommended to treat the nasal mucosa with oxymetazoline, ensuring a long-lasting anti-edematous effect. In the operating room, under endoscopic control, turundas soaked in oxymetazoline or phenylephrine and a topical anesthetic are introduced. Immediately after achieving superficial anesthesia, an injection of 2% lidocaine with a 1:200,000 epinephrine solution is performed using a special needle for endoscopic sinus surgery, or a dental needle and syringe or an insulin syringe are used.

The injection is made in the following areas:
along the attachment of the uncinate process (three injections);
to the place of fixation of the middle turbinate;
to the lateral and medial surface middle turbinate;
further, depending on the volume of surgical intervention (bottom of the nasal cavity, nasal septum, inferior turbinate).

The purpose of the injection and the process of topical anesthesia is to anesthetize the anterior and posterior ethmoidal nerves, supplying the anterior and posterosuperior parts of the lateral wall of the nose and septum, as well as the branches of the sphenopalatine nerve, passing with the main vessels from the sphenopalatine foramen and supplying the lateral wall of the nose. It is important that the process of administering the anesthetic is carried out slowly, and the operation does not begin until the anesthetic has produced the desired effect. The combined action of the topical anesthetic, the injected local anesthetic and the surface action of the decongestant provides a reliable blood-free field in most cases.

Endoscopic surgery Every day it becomes more and more popular among practicing surgeons. Doctors of various specialties are trained in endoscopic surgery techniques, since the undeniable advantages of this type of surgical intervention have already been proven more than once. Endoscopic surgery is widely used in otorhinolaryngology as one of the methods of surgical intervention. Endoscopic surgery sinuses is one of the most effective methods treatment inflammatory diseases nasal sinuses, which wins the love of an increasing number of doctors who prefer this type of surgical intervention.

Indications and contraindications for endoscopic sinus surgery

The very concept of functional endoscopic surgery is based on minimal surgical intervention on the structures of the nasal cavity with maximum restoration of them physiological functions. There are certain indications and contraindications for endoscopic sinus surgery. Indications for the operation are as follows:

acute and chronic, serous and exudative sinusitis;
limited polypous sinusitis;
fungal inflammation of the sinuses;
sinus cysts;
foreign bodies in the nasal cavity and paranasal sinuses;
bullae and hyperplasia of the nasal mucosa;
Dacryocystorhinostomy.

Endoscopic sinus surgery is not recommended for the following conditions:

intracranial and orbital rhinogenic complications;
malignant neoplasms of the nasal cavity and sinuses;
osteomyelitis in the paranasal sinuses;
scar and bone obliteration of the anastomosis area after previous operations on the nasal sinuses.

Technique for endoscopic sinus surgery according to Messerklinger

There are two main techniques for endoscopic sinus surgery. The most widely used technique is the Messerklinger technique. The technique of this surgical intervention consists of step-by-step opening of the structures of the nose in the direction from front to back. The nasal sinuses are sequentially opened and those discovered during surgery pathological changes. Step by step, the structures are revealed in the following order:

uncinate process;
ethmoid bulla;
Anterior cells of the ethmoidal labyrinth;
infundibulum and anastomosis of the maxillary sinus;
frontal bay;
middle grid cells;
rear grid cells;
sphenoid sinus.

Technique for performing endoscopic surgery according to Wiegand

The second most common endoscopic sinus surgery is the Wiegand technique. According to this method surgical intervention It starts from the deep parts of the nasal cavity and moves from back to front. First, the sphenoid sinus is opened, then the posterior and middle cells of the ethmoidal labyrinth, then an infundibulotomy is performed and at the end of the operation the anterior cells of the ethmoidal labyrinth are opened. A feature of the Wiegand method of endoscopic sinus surgery is its great radicality, since a total opening of the cells of the ethmoidal labyrinth is performed and an anastomosis with the maxillary sinus is created under the inferior nasal concha. This is done for almost all forms of sinusitis.

Benefits of endoscopic sinus surgery

Endoscopic sinus surgery has particular advantages over other types of sinus surgery. First of all, only endoscopic surgery guarantees maximum constant visual control of the entire operation, and thereby ensures high accuracy and functionality of all actions performed by the operating surgeon. In addition, endoscopic intervention ensures minimal bleeding and preservation of the mucous membrane pathologically unchanged. The postoperative period for patients is also much faster and painless. Thus, endoscopic sinus surgery is one of the most effective methods for treating sinusitis.

Cysts and foreign bodies of the paranasal sinuses

A cyst is a benign neoplasm, which is a thin-walled bubble filled with fluid. The size of the cyst and its location can be very different, which suggests that clinical manifestations(patient complaints) may vary. The mechanism of cyst formation is quite simple. The mucous membrane lining the inside of the nasal sinuses has glands that produce secretions (mucus) throughout a person’s life; each gland has its own excretory duct, which opens on the surface of the mucous membrane. When for any reason the gland duct stops functioning, the gland does not stop working, i.e. mucus continues to be produced and accumulates, so the walls of the gland expand under pressure, which over time leads to the formation of the formation described above in the sinus. A cyst can disrupt the natural flow of mucus from the sinus and lead to inflammation.

A person can have a sinus cyst all his life and not know about its existence. The patient may visit the ENT doctor repeatedly, both during preventive examinations, and due to illness, but without additional research it is impossible to diagnose a cyst. The doctor can only make an assumption about its presence. Foreign bodies penetrate into the paranasal sinuses either as a result open injury sinuses, or as a result medical manipulations(filling dental canals upper jaw). A foreign body usually leads to the development chronic inflammation sinuses.

The most diagnostically significant study is computed tomography paranasal sinuses nose This method allows you to determine the size of the cyst, foreign body, and location in the sinus with millimeter accuracy, which is very important for choosing a removal method. IN mandatory A diagnostic endoscopy of the nose is performed to assess the condition of the intranasal structures.

Complaints

There may be no complaints at all and the patient can live his life calmly without treatment from an ENT doctor. Very often, patients come in who have undergone computed tomography or magnetic resonance imaging of other organs (brain, ear) and discovered a cyst during the examination. This depends on the size and location of the cyst, as well as on the structure of the maxillary or other sinus itself. In other cases, the following symptoms occur:

Nasal congestion, which can be constant or variable;
Recurrent or constant headaches. They arise due to the fact that the growing cyst puts pressure on the nerve endings of the mucous membrane;
Discomfort in the upper jaw area;
In patients engaged in aquatic species sports, when diving to depths pain may appear or intensify;
Periodically occurring inflammatory processes in the sinuses - sinusitis, which occurs due to a violation of the aerodynamics of air flow in the sinus by the cyst;
Flowing down back wall throats of mucus or mucopurulent discharge, which can be constant. This happens because when the position of the body changes, the cyst, irritating the mucous membrane, causes increased mucus secretion.

The described complaints are not always a sign of a cyst, so in most cases it is carried out additional research in a specialized ENT clinic.

Treatment

Cyst or foreign body must be removed surgically. Unlike traditional operations that create a large hole in the sinus wall, we perform endoscopic exploration of the sinus through a small hole with a diameter of 4 mm using special micro-instruments

Elimination of inflammatory processes of the maxillary sinus

It's not always possible to get positive result from conservative treatment. The reasons for this: incorrect choice of antibiotic, inaccurate determination of microflora, narrow natural anastomosis, violation of the architectonics of the nasal cavity, ridges and spines of the septum, the presence of polyps, hyperplasia of the mucous membrane.
Emptying the sinuses from purulent discharge can be achieved by washing through the natural opening and a test puncture, used as a diagnostic and therapeutic method. In the latter case, after the sinus has been emptied, medications are injected into it.

If conservative treatment fails, there is every reason to use surgical methods. The operation involves restoring the architecture of the nasal cavity to create normal nasal breathing and aeration of the sinuses. The patency of the natural anastomosis is restored using minimally invasive (endoscopic) surgery methods. TO radical surgery on maxillary sinus should be used as a last resort.

Advantages of the endoscopic method

One of the advantages of endoscopic sinus surgery compared to traditional method is that it does not require a surgical incision. It is carried out using an endoscope, which allows you to observe the pathological process occurring in the sinus.

Another advantage endoscopic method is that it allows you to treat directly the very cause of sinusitis. The doctor can directly see the pathological focus and remove it without resorting to cutting normal tissue, which significantly reduces unnecessary trauma and speeds up postoperative period, reduces the risk of the operation itself and postoperative complications.

The method is characterized by the absence of an external scar, slight swelling after surgery and less pain intensity.

The goal of endoscopic surgery is to widen the sinus openings. Typically, the paranasal sinuses open into the nasal cavity through a thin bony canal covered with mucous membrane. When inflamed, this membrane swells, and thus the exit from the sinus is closed. Endoscopic surgery allows you to widen the bony sinus canal. Therefore, even if the patient subsequently experiences inflammation of the nasal mucosa and sinus outlet or allergic swelling, there will be no blockage of the paranasal sinus opening. This greatly facilitates further treatment of inflammation of the paranasal sinuses.

In addition, the instruments of endoscopic technology make it possible to easily remove all kinds of tissue in the sinus cavity, for example, polyps or cysts.

A recent improvement in the endoscopic technique of surgical interventions for diseases of the paranasal sinuses is a computer navigation system. It allows you to create a three-dimensional image of the paranasal sinuses on the monitor screen, which facilitates diagnosis and surgical intervention.

A deviated nasal septum and the appearance of cysts or other tumors in the sinuses can be corrected with endoscopic surgery. This is a surgical procedure that carried out for the following symptoms:

dizziness;
headaches;
difficulty breathing through the nose;
discomfort in the nose and surrounding areas;
for private colds;
frequent bleeding;
sudden hearing loss.

This is a proven method of nose surgery for decades that helps improve it. respiratory functions. At the First Surgery clinic. This operation is performed by experienced surgeons who guarantee the accuracy of all manipulations.

The advantages of endoscopy include:

the ability to eliminate defects in bone tissue;
high precision of all manipulations;
expected effect of treatment;
minimal blood loss;
reduction of the rehabilitation period.

The operation is carried out using a special flexible cord with a camera attached to the end. During the operation, the surgeon monitors the process through a monitor. He clearly sees the inside of the nose and can accurately remove any tumors that have arisen in the nose.

This is a proven technique that has been used since the mid-20th century in various branches of medicine.

When is endoscopic nasal surgery indicated?

Endoscopic nasal surgery is prescribed, the price of which is always individual, for a deviated nasal septum, sinusitis, or a cyst found in the nasal sinuses. It's convenient and effective technique, returning the nose to its inherent respiratory functions.

If the patient has inflammation of the maxillary sinuses or a deviated nasal septum, endoscopic surgery will correct these defects. When treating nasal septums, it is one of the most reliable and proven.

At the First Surgery clinic, doctors will first pass general diagnostics and treatment method. To use an endoscope, which helps the surgeon to see the entire structure of the nasal septum on the screen, where the signal from the endoscope camera is received.

Endoscopic operations of the nasal septum at the First Surgery clinic

Endoscopic surgery is performed only in cases of curvature of the bone part of the entire skeleton in patients over 18 years of age. At this time, the bones of the facial part of the head stop growing, so it will be possible to eliminate emerging or congenital defects. Endoscopic surgery of the nasal septum has been carried out for a long time and is constantly being improved.

An endoscopic method for eliminating curvature or other diseases has been known to doctors for more than half a century. This is a proven treatment method that can return people to comfortable normal breathing and health.

Carrying out endoscopic surgery in the nasal cavity

On the website of the First Surgery clinic operating in Moscow, you can find out the cost of nasopharyngeal endoscopy. The price list shows approximate cost such medical service.

During the operation, the patient is in a supine position, the resection sites are processed local anesthesia. Endoscopic surgery of the nasal septum is performed at the First Surgery clinic for various indications:

the appearance of cysts and polyps;
development of sinusitis;
inflammation of the paranasal pauses.

The clinic’s doctors are ready to provide qualified assistance to every patient suffering from the above diseases.

The client is injected with local anesthesia, placed in a special horizontal chair, and an incision is made in in the right place and the endoscope is inserted. It is small medical device, which has a camera at its working end from which an image is transmitted to the doctor’s screen.

Believe me: endoscopic operations are much safer than those that were done before to treat similar problems. It is not so traumatic, blood loss is minimal, recovery is 2-3 days. Perhaps your case is not as advanced as mine, and then there is no need to worry.

If you want everything to go as smoothly as possible:

1. Don't waste time on full examination- CT and MRI

2. Consult with different doctors (run away from those who, without looking at the picture, immediately draw conclusions)

3. If you are very worried, do not spare money on a good full anesthesia (But! only high-quality - more details at the end of the review)

4. Ask for a nose insert after surgery. hemostatic sponges, not tampons or worse, bandages!

"It's all about nerves"

I have never had any special problems with immunity, I rarely got sick. But for the last three years I have stopped recognizing myself. Perpetual temperature 37 and red throat. I visited all the doctors paid clinics Moscow. They just didn’t say something, including that it was the nerves, you see))). Meanwhile, I began to have a lingering sinusitis...

Punctures are not a panacea

Many people are prescribed punctures and some even get help. BUT, remember! X-rays are not enough to send a person for this procedure. Get an MRI to find out the real reason sinusitis. The puncture did not lead to anything then, water flowed from the nose and that was all. However, the doctor did not realize that complaints of pressure and lack of mucus were not just signs of sinusitis. Without properly understanding it or taking the appropriate pictures, he sent me for surgery. I refused.

Thank God, I managed to find an adequate doctor when I came to Anapa for treatment. He immediately said that an MRI was needed. That same evening, a large cyst was discovered in the right sinus. At first there was shock - surgery was inevitable. But, I learned about endoscopic operations on the Internet and became a little calmer.

A little mysticism

I went to Krasnodar for a consultation. All the way I prayed that the doctor would make the right decision. And this must happen. It was on this day that the anesthesia machine broke down, and the doctor called everyone to postpone the operations for a month.

Having barely glanced at the pictures, he answered that the reason was the partition. “But, if you please,” I replied. - She never bothered me before. I developed sinusitis six months ago, before that there were no problems." Yes, and the summary for the MRI clearly states: the curvature is not large. But the doctor said that only septoplasty will help.

Surprise

I was not ready to wait another two months. Tortured headache(more precisely pressure) and lack of oxygen. I went to Moscow. At the Burdenko Neurosurgery Research Institute they immediately said that MRI was not enough. A CT scan (computed tomography) revealed the filling material in the other sinus. Several years ago, a therapist filled the canals and didn’t keep track (a therapist, in principle, shouldn’t do this), and they didn’t provide me with any pictures then. And then the filling began to become overgrown with fungi and bacteria, and eventually turned into a large dense fungus.

About the operation

I’ll say right away: I’m a terrible coward. I tormented myself and my family with excitement. Tenoten helped me contain my emotions. But my surgeon Marina Vladislavovna helped me completely forget about fear. Not a drop of indifference, only a desire to help and set you up for a speedy recovery.

The surgeon explained that even if it is not possible to remove the cyst and filling endoscopically (their size is too large), they will make a micro-incision above the lip, which is actually not very scary (the tiny scar heals quickly).

They tormented me for three hours, but EXPERIENCE and ENDOSCOPY won! We managed to get everything.

About anesthesia

It is better not to eat in the evening on the eve of surgery so that your stomach is empty the next day. This subsequently helped to avoid nausea from anesthesia. I was given anesthesia with propofol. (After reading ENT forums, I insisted on sevoran) and for three hours in my sleep I was busy choosing New Year’s gifts for relatives))) I woke up from the nurse calling my name and saying “breathe.” The anesthesia did not cause any fog, I understood everything clearly and woke up very quickly, as if from a normal dream. About why it is preferable during ENT operations general anesthesia mig17 spoke convincingly on the Loronline forum.

What to take to the hospital?

The first night was not painful, just unpleasant. A friend who went through a similar experience a year ago said that the torment was hellish, but it was not so. It is possible to survive the night with sponges in your nose, although it is unpleasant. For another day I had blood clots coming out of my throat and nose. My throat was swollen and slightly sore. This is normal after anesthesia. Ask for pain relief or dissolve lidocaine lozenges. A teaspoon of peach oil will also help reduce pain. Telfast for allergies helped me relieve the swelling a little.

Hemostatic sponges

The next day, one hemostatic plug was pulled out, and part of the other came out only after weeks of regular rinsing with Dolphin. The hemostatic sponge does not injure the sinuses, unlike conventional tampons. It comes out easily. And even if a particle is stuck in the nose and they couldn’t get it out, there is no need to panic - it will come out or resolve (they write that in 3-6 weeks).

Possible complications

I read the reviews, many people experience numbness in their lips or teeth. I had numbness in my two front teeth. But! it was there before, but not as strong. They say it was because the cyst was pressing on a nerve. The numbness decreased after half a month, now I hardly feel it anymore - everything is fine.

Almost a month after the operation, I can say that there has certainly been an improvement. The constant fever and headache disappeared. Although the nose sometimes gets clogged (not all the pus has come out yet), but not for long - about vasoconstrictor drops I forgot.

Good luck to everyone, and God help you!