Surgical treatment chronic sinusitis
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Transcript of Surgical treatment chronic sinusitis
SURGICAL TREATMENTSURGICAL
TREATMENT
Dr. Ghulam Saqulain
E.N.T Surgeon, Capital Hospital
SURGICAL TREATMENT
“Surgical treatment should be withheld as far as possible. However, if conservative treatment does not succeed in curing the patient in due course of time, or if external signs of sinusitis or intracranial complications threaten, surgical treatment should become an urgent necessity”.
SURGICAL OPTIONS
Surgical Options
Procedures on the maxillary sinuses
to treat disease.
Procedures to correct causative anomalies
Procedure to deal with obstructive pathologies in a hope
to remove cause of disease:
Procedures on the osteomeatal complex
Procedure on SeptumProcedures on the turbinates
Functional endoscopic sinus surgery.
•Septoplasty•SMR
•Turbinectomy•SMD•E/C•SMR
Procedures on neighboring structures.
•Adenoidectomy•tonsillectomy
…SURGICAL OPTIONS
…SURGICAL OPTIONS
Procedures to deal with
Sinus disease
Antral LavageIntranasal antrostomy Sinoscopy
Cald- well luc procedureDenkersJensen-Horgan
procedure
…SURGICAL OPTIONSPROCEDURES ON THE MAXILLARY SINUSES
• Antral Lavage (Proof Puncture):
– It may open the sinus ostium at least temporarily and clear any mucopurulent material (alsoprovide sample for C/S or H/P)
– Concomittant medical treatment is necessary or otherwise the saline left in the sinus will merely reinfect
– An indwelling polythene tube fed throughthe cannula into the sinus allows relpeated washouts .
Transnasal approach via. Medial wall of maxilla.
Sublabial approach via. anterior wall of maxilla.
….PROCEDURES ON THE MAXILLARY SINUSES
– Principle: The principle of the treatment is to restore normal mucosa to the sinus linning. This allows the cilia to waft out through the osteum any residual infection. If this is not possible ie., when the mucosa has become irreversibly changed then mucosa needs to be removed.
• Sinoscopy• Intranasal antrostomy:
– A large dependent opening in the medial wall of the antrum is made in the inferior meatus.
– This allows good aeration of the maxillary sinus. It allows ciliary motion to be restored but adequate removal of all irreversibly changed antral lining is not possible.
• CALDWELL-LUC or RADICAL ANTROSTOMY OPERATION:– Sublabial approach to maxillary antrum– Intranasal inspection and disease clearance– Antrostomy
• DENKER’S– Sublabial approach to the anterior angle between bony nose and antral
walls.– Partial removal of bony pyramidto provide common opening into the
antrum and nasal passage.• JANSEN-HORGAN
– Caldwell-Luc operation– Opening and exanteration of posterior and middle ethmoid cells via the
antrum– Intranasal exanteration of anterior and agger ethmoidal cells.
….PROCEDURES ON THE MAXILLARY SINUSES
INDICATIONS:• Radical cure of chronic sinusitis• Removal of F.B, usually the root of a molar or premolar
tooth, from the sinus lumen.• Inspection and biopsy of suspected neoplasm.• Surgery for dental and other cysts involving antrum• For adequate removal of antrochoanal polypus.• To approach to adjacent structures.
CONTRAINDICATIONS:• Should not beperformed until after the teeth of
secondary dentition have erupted.
….PROCEDURES ON THE MAXILLARY SINUSES CALDWELL-LUC’S APPROACH
…CALDWELL-LUC’S APPROACH
ANAESTHESIA:
•General anaesthesia with oro-tracheal intubation or naso-tracheal intubation on unaffected side and cuff inflated.
• A throat pack to avoid spillage of blood and secretions into the larynx
OPERATION:
•Supine positon with head and neck flexed on trunk
•Local anaesthetic with 1:200,000 adrenaline solution infiltrated to soft tissues under upper lip
•Lip retraction and sublabial incision 4 cm above the canine teeth.
•Removal of anterior wall with electric drill.
…CALDWELL-LUC’S APPROACH
•Antrum cleared of disease and mucosa removed
•Antrostomy opening developed.
•Wound packed with BIPP impregnated pack brought out via nasal cavity.
•Nasal packing done.
•Dressing done.
Fromthe Doctors Forum Of
E.N.T Department