Drug therapy is effective in the early stages of sinusitis. With a running course, when the discharge from the nasal cavity becomes not mucous, but purulent, you can save yourself by puncturing the sinuses. After that, they are washed from the contents. Requires surgical intervention for prolonged inflammation of the maxillary sinuses. Symptoms, the treatment of which is long and ineffective, require a more serious solution to the problem. This requires surgery, and one form of surgical approach is endoscopic sinusectomy.
Sindrotomy - what is it?
The maxillary sinuses are called cavities in the areas of the upper jaw on both sides. Due to their inconvenient location, they are often subject to inflammatory processes, which often end in a chronic course and require surgical intervention. In the early stages, it is still possible to treat the pathology of the maxillary sinuses with medication. In the absence of efficacy or frequent recurrences, the possibility of sinusotomy should be considered for the individual patient. It is best to refer the patient to the endoscopic method.intervention that will be less invasive and as effective as possible. Purulent sinusitis is a direct indication for treatment, because every minute is fraught with the formation of complications.
Questions about what is sinus otomy intended for, what it is, are asked by many patients. During the operation, the maxillary sinuses are opened and all liquid contents are removed. For serious problems, surgical treatment is the only way out of the situation. Patients are sent to it, the inflammatory focus of which cannot be cleared with medication. Therefore, access through an incision or puncture is required. It is not so easy for a patient to understand when a maxillary sinusectomy is performed, what it is.
Indications for surgery
Opening the maxillary sinuses is not advisable for every patient with inflammation. It is assigned:
1) with a cyst in the upper jaw;
2) chronic polypous sinusitis;
3) odontogenic sinusitis;
4) no result after long-term medical treatment and puncture;
5) frequent recurrence of sinusitis;
6) foreign bodies in the sinuses;
7) frequent or recurrent pain on the face, in the infraorbital region;
8) occasional nasal congestion for no apparent reason (allergic reaction, colds);
9) the appearance of an unpleasant smell from the nose, which is felt by the patient himself or noted by others;
10) occasional or persistent painvarying intensity in the area of the upper teeth;
11) feeling the passage of air or liquid through the place where the tooth was previously removed;
12) the appearance of filling material outside the boundaries of the treated tooth, which will be visible on the picture during the X-ray;
13) the appearance of polyps or foreign bodies on a CT scan;
14) unsuccessful sinus lift;
15) refusal to perform a sinus lift due to the detection of pathology in the maxillary sinus.
16) establishing the diagnosis of "purulent sinusitis".
In addition to the endoscopic method of intervention, there is also the classical operation of sinus otomy. The most preferred is the first one. It is less traumatic, and the procedure and recovery times are reduced throughout the entire process.
Contraindications
If there are indications, restrictions on surgical intervention are also taken into account. Endoscopic maxillary sinusectomy is not performed in the following situations:
1) Exacerbation of chronic pathology of internal organs.
2) Manifestation of symptoms of sinusitis, but in many cases, surgery may not be postponed for this reason.
3) Diseases in the organs of severe severity, which can aggravate the course of the condition.
4) Violation of the blood coagulation system.
Many states of the body are relative. For a number of reasons, after agreement with the surgeon, the operation is not rescheduled for another period. Until that timedrug therapy is performed to relieve inflammation of the maxillary sinuses. Symptoms that are difficult to treat with oral drug therapy are treated with intramuscular drugs until the day of the proposed operation.
Examination before maxillary sinusectomy
After establishing the diagnosis and determining the need for surgical intervention, the patient is assigned the necessary studies. For this, laboratory and instrumental methods are used. The patient is referred for general blood tests, urine tests, biochemical studies, and blood coagulation is assessed. Of the instrumental ones, CT scans and X-rays of the paranasal sinuses are required for the operation to assess their condition.
Endoscopic way of sinusotomy
In comparison with the classical technology of the operation, endoscopic maxillary sinusotomy has a number of advantages:
- no incisions at the site of the procedure, which is not accompanied by the appearance of scar tissue;
- exclusion of a cosmetic defect;
- reducing the duration of the operation and the recovery period;
- well tolerated procedure under local anesthesia;
- short hospital stay (up to 3-4 days);
- almost imperceptible edema at the insertion site of the instruments and its rapid disappearance;
- almost complete absence of complications after surgery.
The listed advantages make it possible to use modern methods for the treatment of the pathology of the maxillary sinuses quickly and painlessly.
Preparation for surgery
On the day of the procedure, you can not eat food 6-7 hours before it. Such recommendations should be followed when preparing for local anesthesia. If general anesthesia is planned, then in addition to the above, it is forbidden to drink any drinks 2 hours before the operation.
Access for endoscopic maxillary sinusectomy
In sinusitis, which has an odontogenic origin, the only possible method is used, unlike other conditions. Endoscopic maxillary sinusectomy is performed in all other situations by other accesses, depending on the indications for surgery. These include:
- passing instrumentation through the middle or lower nasal passages;
- inserting an endoscope into the anterior wall of the maxillary sinus;
- through the alveolus after tooth extraction (with odontogenic sinusitis);
- through a tubercle in the upper jaw.
When using the endoscopic technique of surgical intervention, complications can be avoided, and the choice of a specific area for access allows you to reduce them to a minimum.
Procedure progress
The operation is performed under local anesthesia. For the introduction of the solution, preference is given to needles with a diameter of not more than 0.2 mm. If necessary, general anesthesia is performed. Solutions for maxillary sinusectomy have low toxicity andlong duration of anesthesia. Its duration is no more than 30 minutes. The diameter of the endoscope inserted through the passage is no more than 5 mm. Therefore, the puncture is made in the area of the maxillary sinus is minimal. An endoscope tube is installed through it and pathologically altered tissues and fluid are removed. The entire process of the operation is carried out under the control of video recording transmitted to the monitor. This is necessary for the convenience of examining the cavity and its sanitation. After cleansing, the sinuses are washed with antiseptic solutions ("Furacilin", potassium permanganate).
Recovery period after surgery
The success of the procedure depends on the recovery of the patient after it. After discharge from the hospital, the surgeon gives a referral to the ENT doctor to monitor the condition. You need to visit it for at least a month, and if necessary, the period can be extended. The doctor prescribes a course of antibiotics and solutions for washing the nasal cavity. At the same time, antihistamine drugs and drugs to strengthen the vascular wall are added to the regimen, if indicated.
After a maxillary sinusectomy, a slight swelling persists for a short time. A positive effect in this respect has "Cinnabsin". It increases the body's own defenses and reduces swelling of the paranasal sinuses. Due to this, the recovery of the patient after the operation is accelerated.
Within a month, you should refuse to visit the pool, do not eat spicy, cold and hot food. Hypothermia should be avoided and preventive measures should be taken so as not to get sick with the flu or SARS. After 1-2 months, it is advisable to visit a sanatorium or a course of s alt caves for 10 days. The examination necessary to control surgical treatment is carried out 6 months after the maxillary sinusectomy and 1 year.
Consequences of endoscopic maxillary sinusotomy
Like any surgical intervention, endoscopic maxillary sinusotomy can be complicated by conditions of varying severity. Unlike the classical method of treatment, such an operation rarely has unpleasant consequences. They appear in the early recovery period or late. Complications include:
1) Bleeding from the insertion site of the instrumentation or the exposed area.
2) Nausea or vomiting, which is associated with blood entering the stomach or an individual patient's reaction to the injection of anesthetic.
3) Severe pain in the nose.
4) Prolonged healing of postoperative wound.
5) Injury to a branch of the trigeminal nerve, resulting in severe tenderness or numbness.
6) Formation of fistulous passages at the site of insertion of instruments or incision.
7) Neuralgia associated with trauma during surgery.
8) Wound infection and suppuration.
The incidence of complications is much less than the consequences arising from the absence of surgical treatment. In such cases, surgery is the only way out. Endoscopic sinusectomy is a modern technique that allows you to forget about sinusitis once and for all.
Reminder to prepare patients for the procedure
AfterIt is important to tell the doctor about drug intolerance to establish a diagnosis and decide on an endoscopic maxillary sinusectomy. This is important in order to take into account individual reactions to a particular drug and choose the best remedy for the patient in order to reduce the risk of possible consequences.
Feedback on the procedure
Endoscopic maxillary sinusectomy reviews are positive in most cases. Patients report a rapid improvement in their quality of life, and most have no complications. The only thing is the presence of a slight swelling in the nose, which makes it difficult to breathe. The symptom disappears without a trace after a few days.
