The current technique used in the surgical treatment of sinus diseases is endoscopic sinus surgery (ESC).
During ESC, pathologies in the sinuses are treated with the help of some instruments used next to endoscopes, which are placed in the nostrils without making any external incisions and provide a detailed view of the surgical field.
ESC is currently the current treatment option in the treatment of conditions such as chronic sinus inflammations, sinus tumors, anterior skull base injuries, traumatic eye socket injuries, cerebrospinal fluid (CSF) leaks and optic nerve compression. It is one of the most frequently performed surgeries. At the same time, due to the advantage of creating minimal surgical trauma, it is increasingly preferred in lacrimal sac drainage surgeries (Dacriocystorhinostomy) and surgical treatment of pituitary gland tumors (Endoscopic hypophysectomy).
The areas where the sinuses around the nose are located are narrow and the anatomy is complex. and the neighborhood of important organs such as the brain, eyes, optic nerves, tear ducts, carotid arteries, require training and experience in endoscopic sinus surgeries as well as high technical skills with a low margin of error.
The duration of surgery depends on the extent of the pathology and whether it will be performed in the same surgery. It varies depending on whether there are additional interventions such as correction of nasal curvature, aesthetic nose surgery, nasal flesh reduction, correction of anatomical variations. While intervention in a single sinus takes around 15 minutes, it may take more than two hours to clear the pathology affecting all sinuses.
Except in rare cases, no tampon is placed inside the nose after sinus surgery, and patients can breathe easily through the nose.
At the end of the surgery. Special tampons and various materials placed in the surgical area under the middle nasal meatus to prevent bleeding and tissue adhesions that may occur during healing do not adversely affect nasal breathing.
After Endoscopic Sinus Surgery
There is no serious congestion or pain complaint after the surgery, and simple painkillers are usually sufficient. Patients' surgery day Although it is recommended to stay in the hospital, it may also be possible to be discharged on the same day, depending on the content of the surgery.
After the surgery, it is recommended to continue antibiotic treatment for at least 10 days. If necessary, this period can be extended or additional medications can be added.
After the surgery, sprays that mechanically clean the nose and moisturize the mucosa, usually containing sterile saline, should be used until the crusts disappear.
In patients with allergies and polyps, sprays containing cortisone and medications that reduce the risk of polyp formation are started after surgery. Oral fungal treatment is also recommended after surgery for patients with suspected allergic fungal sinusitis.
After endoscopic sinus surgeries, dressings are applied 3-4 times. At the end of the first week, during the first detailed dressing, the crusts formed in the nose and sinus drainage channels are cleaned, if any anti-adhesion materials have been placed in the sinuses, they are removed and infection control is carried out. Proper initial dressing is very important for the success of the surgery. Depending on the extent of the surgery, patients are required to come for check-ups at 7-10 day intervals until recovery is completed.
In some special cases of ESC, the possibility of failure or complications increases with the degree of difficulty of the surgery. These special situations are;
- Excessive bleeding in the tissues during surgery
- Extreme inflammation in the sinuses
- Especially surgeries of tumors with high vascular content
- Hypertension
- Coagulation disorders (Bleeding diatheses) / Aspirin use
- Anatomy has changed due to previous surgery / trauma
- Hard healing tissue has formed due to previous surgeries presence
- Common polyps that alter normal anatomy
- Tumors inside/outside the paranasal sinus
- Anatomical changes (variations)
- Posterior ethmoid, sphenoid, They can be counted as surgeries for the frontal sinuses.
There are some minor and major complications encountered during or after endoscopic sinus surgeries. The most important of these are
- Active bleeding
- Intraorbital (inside the eye) bleeding
- Carotid (carotid artery) rupture
- Orbital (eye socket) trauma
- Endophthalmitis (backward displacement of the eye)
- Eye movement disorder and double vision (diplopia)
- Nasolacrimal duct (tear duct) trauma
- Cerebrospinal fluid leakage
- Intracranial complications
- Abscess
- Meningitis
- Air leakage into the brain (Pneumocephalus)
- It can be listed as pituitary gland damage.
The most important factor in the occurrence of chronic sinus infections is the blockage of the small channels (ostium) that allow the transfer of mucus secretion produced in the sinuses into the nose and the accumulation of secretions in the sinus, as well as the loss of sinus ventilation.
The principle of the technique called balloon synoplasty is; It is the restoration of sinus ventilation and mucus evacuation function by expanding the blocked or narrowed discharge channels of the sinuses using only a balloon, without cutting the tissues in this area.
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