In the early stages of sinusitis, drug therapy is effective. With a running course, when the discharge from the nasal cavity becomes not mucous, but purulent, you can be saved by a sinus puncture. After that, they are washed from the contents. Surgery requires prolonged sinus inflammation. Symptoms, the treatment of which is carried out for a long time and ineffectively, require a more serious solution to the problem. Surgery is necessary here, and one of the forms of the surgical approach is endoscopic sinusotomy.
Sinorotomy - what is it?
The maxillary sinuses are the cavities in the areas of the upper jaw on both its sides. Due to the inconvenient location, they often undergo 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 medical methods. In the absence of effectiveness or frequent relapses, the possibility of conducting a sinusotomy for a particular patient should be considered. It is best to direct the patient to an endoscopic method of intervention that will be less invasive and most effective. Purulent sinusitis is a direct indication for treatment, because every minute is fraught with the formation of complications.
Many patients are asked questions about what a sinusotomy is intended for, what it is. During the operation, an opening of the maxillary sinuses is performed and all liquid contents are removed. With serious problems, surgical treatment is the only way out. Patients are sent to it, the inflammatory focus in which it is impossible to clear medication. Therefore, access through an incision or puncture is required. It is not so easy for the patient to figure out when a sinusotomy is performed, what it is.
Indications for surgery
Autopsy of the maxillary sinuses is not advisable for every patient with inflammation. It is assigned:
1) with a cyst in the upper jaw;
2) the chronic course of polypous sinusitis;
3) odontogenic sinusitis;
4) the lack of result after prolonged drug treatment and puncture;
5) frequent relapses of sinusitis;
6) the ingress of foreign bodies into the sinuses;
7) frequent or periodic pain on the face, in the infraorbital region;
8) the periodic occurrence of nasal congestion for no apparent reason (allergic reaction, colds);
9) the appearance of an unpleasant odor from the nose, which is felt by the patient himself or noted by surrounding people;
10) a periodic or constant sensation of pain of varying intensity in the region of the upper teeth;
11) the sensation of the passage of air or liquid flows through the place where the tooth was previously removed;
12) the appearance of filling material beyond the borders of the tooth that has undergone treatment, which will be visible in the image during the radiograph;
13) the appearance on the CT scan of polyps or foreign bodies;
14) unsuccessful sinus lift;
15) refusal to perform sinus lift due to detection of pathology in the maxillary sinus.
16) the diagnosis of purulent sinusitis.
In addition to the endoscopic method of intervention, there is also the classic operation sinusotomy. Most preferred is the first. It is less traumatic, and the duration of the procedure and recovery are reduced throughout the process.
Contraindications
If indicated, restrictions to surgical intervention are also taken into account. Surgery endoscopic sinusotomy is not performed in the following situations:
1) Exacerbation of chronic pathology of internal organs.
2) The manifestation of sinusitis symptoms, but in many cases the operation for this reason may not be delayed.
3) Diseases in organs of severe severity, which can aggravate the course of the condition.
4) Violation of the blood coagulation system.
Many conditions of the body are relative. For a number of reasons, after consultation with the surgeon, the operation is not postponed for another period. Until this time, drug therapy is performed to relieve sinusitis. Symptoms, the treatment of which is difficult to drug therapy by oral medication, are stopped by drugs administered intramuscularly before the day of the proposed operation.
Examination before sinusotomy
After establishing a diagnosis and determining the need for surgical intervention, the patient is prescribed the necessary studies. For this, laboratory and instrumental methods are used. The patient is sent for general blood tests, urine tests, biochemical studies, and blood coagulation is evaluated. Of the instrumental ones, CT images and radiography of the paranasal sinuses are required for the operation to assess their condition.
Endoscopic method of sinusotomy
Compared to the classical technology, the operation of endoscopic sinusotomy has several advantages:
- the absence of cuts at the site of the procedure, which is not accompanied by the appearance of scar tissue;
- the exception of a cosmetic defect;
- reduction in the duration of the operation and recovery period;
- good tolerance of the procedure performed under local anesthesia;
- short hospital stay (up to 3-4 days);
- almost imperceptible swelling at the injection site and its rapid disappearance;
- almost complete absence of complications after surgery.
These advantages make it possible to use modern methods for treating 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 observed in preparation 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.
Endoscopic approaches for maxillary sinusotomy
With sinusitis, which is of odontogenic origin, the only possible method is used, unlike other conditions. Endoscopic sinusotomy is performed in all other situations with other approaches, depending on the indications for surgery. These include:
- conducting instruments through the middle or lower nasal passages;
- the introduction of an endoscope into the anterior wall of the maxillary sinus;
- through the alveoli after tooth extraction (with odontogenic sinusitis);
- through the hillock 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 them to be minimized.
Procedure
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 sinusotomy have low toxicity and a long period of anesthesia. Its duration is no more than 30 minutes. The diameter of the endoscope introduced through the course is not more than 5 mm. Therefore, a puncture is made in the maxillary sinus. An endoscope tube is installed through it and pathologically altered tissues and fluid are removed. The entire operation process 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 rehabilitation. After cleansing, sinus lavage is performed 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 an ENT doctor to monitor the condition. You need to visit him 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, antihistamines and drugs are added to the circuit to strengthen the vascular wall if indicated.
After sinusotomy, a small edema persists for a short time. A positive effect in this regard is provided by Cinnabsin. It increases the body's own defenses and reduces the swelling of the paranasal sinuses. Due to this, the patient's recovery after surgery 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 the flu or SARS. After 1-2 months, it is advisable to visit a sanatorium or a course of salt caves for 10 days. An examination necessary to control surgical treatment is performed 6 months after a sinusotomy and 1 year.
The consequences of endoscopic sinusotomy
Like any surgery, endoscopic sinusotomy can be complicated by conditions of varying severity. Unlike the classical method of treatment, such an operation is less likely to have unpleasant consequences. They appear in the early recovery period or late. Complications include:
1) Bleeding from the injection site of the instrumentation or site that has been exposed.
2) Nausea or vomiting, which is associated with blood entering the stomach or an individual patient's reaction to the administration of an anesthetic.
3) Severe pain in the nose.
4) Long-term healing of the postoperative wound.
5) Damage to the trigeminal nerve branch, which leads to severe soreness of the innervated area or numbness.
6) The formation of fistulous passages at the injection site of the instrument or incision.
7) Neuralgia associated with trauma during the operation.
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 sinusotomy is a modern technique that allows you to forget about sinusitis once and for all.
Instruction for preparing patients for the procedure
After establishing a diagnosis and resolving the issue of sinusotomy with an endoscopic method, it is important to tell the doctor about intolerance to drugs. It is important 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.
Reviews about the procedure
Endoscopic sinusotomy reviews are in most cases positive. Patients report a rapid improvement in quality of life, and most have no complications. The only thing is the presence of a small swelling in the nose, which makes breathing difficult. Symptom after a few days leaves without a trace.