Procedures & Operations on the Nose & Paranasal Sinuses (Prof. Samy Elwany)

8/10/2019 Procedures & Operations on the Nose & Paranasal Sinuses (Prof. Samy Elwany)

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the Nose and Paranasal Sinuses

Prof. Samy Elwany

Maxillary Sinus Puncture(Antral Washout)

Conce t: The maxillarsinus is irrigated withsaline solution by acannula introducedthrough the inferiormeatus. The solutioncirculates inside thesinus cavity and comes

accumulated dischargethrough the naturalostium in the middlemeatus.


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Maxillary Sinus Puncture

(Antral Washout)

(Uncommonly done now)

Diagnostic:

Proof puncture.

Culture and sensitivity study.

Cytological study.

erapeut c:

Chronic infective maxillary sinusitis. Dental maxillary sinusitis.


special trocar and cannula under localsurface anesthesia using sterile salinesolution.


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(Antral Washout)

, ,about 2 cm behind the anterior end of the inferiorturbinate. The trocar is directed upwards and laterallytoward the outer canthus. The sinus is then aspiratedand irrigated.


Difficult introduction: Wrong site.

Thick sinus wall.

Difficult syringing: Needle in close contact with osterior sinus

wall. Obstructed ostium.

Needle inserted into a polyp or cyst.


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(Antral Washout)

False passage into cheek ororbit leading to emphysema orextravasation of fluid into thecheek , the lower eyelid, ororbit. Treatment is by hot

.

Vasovagal attack. Bleeding due to injury of the

inferior turbinate.

Surgery of the Nasal Septum.

(Submucous Resection [SMR] andSeptoplasty)

Definitions: Submucous resection means sub-

perichondrial partial resection of the septalcartilage leaving a thin stripe of thecartilage along the nasal dorsum and theanterior border of the septal cartilage.Spurs (cartilaginous, bony, or mixed) arealso resected.

Septoplasty means straightening and

midline by freeing its attachments andminimal resection of deviated or angledparts while leaving most of the septalcartilage attached to one side of the muco-perichondrium to preserve its blood supply.The resected pieces are usually re-insertedin place to preserve septal support.


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Surgery of the Nasal Septum.(Submucous Resection [SMR] andSeptoplasty)

The usual indication is to correctseptal deviation or dislocationwhen it is causing symptoms orcomplications.

Other indications:

Trans-septal (trans-sphenoid)

hypophysectomy. To improve access to the posterior

part of the nasal cavity.

Surgery of the Nasal Septum.

(Submucous Resection [SMR] andSeptoplasty)

1. The mucoperichondrialflaps are elevated on oneor both sides of the nasalseptum.

2. Resection or septoplasticcorrection of the deviated

the sub-perichondrialplane.


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Surgery of the Nasal Septum.(Submucous Resection [SMR] andSeptoplasty)

1. Septal perforation.

2. Septal hematoma.

3. Septal abscess.

4. Synechiae (adhesions)between the septumand lateral nasal walls.

5. Depressed nasal bridge

and/or nasal tip due toloss of septal support.

Surgery of the InferiorTurbinates

,to hypertrophy of the inferior turbinates, thatcan not be relieved by medical treatment.N.B long term use of decongestant nasal drops is contraindicated.


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Surgery of the Inferior

Turbinates

Cautery and Submucous Diathermy (SMD) of theturbinates: Both of them aim at inducingsubmucosal fibrosis to shrink the inferiorturbinate. SMD has the advantage of preservingthe vitality of the surface epithelium

Surgery of the InferiorTurbinates

parts of the turbinates. Excessive resection may causeatrophic changes (secondary atrophic rhinitis). Excessivebleeding may be a potential complication. If resection islimited to the bony concha the procedure is termedTurbinoplasty


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Surgery of the Inferior

Turbinates

The carbon dioxidelaser is used toinduce fibrosis in thebody of the inferiorturbinate whilereservin the

structure of the

surface epithelium.

Surgery for Nasal Polyps

avulsingnasal snare or a Lucs forceps.


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Surgery for Nasal Polyps

endoscopically together with endoscopicethmoidectomy.

Surgery of the nasal SinusesIntranasal Antrostomy (INA)

the inferior meatusbetween the maxillarysinus and nasal cavity.

It is largely replaced by

Meatus Antrostomy(MMA)


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Surgery of the nasal SinusesCaldwell-Luc Operation (Radical

Antrostomy)

through its anterior wall (Sublabialantrostomy).

Surgery of the nasal Sinuses

Caldwell-Luc Operation (RadicalAntrostomy)

opera on s on y per ormeif endoscopic surgery is not available or cannot resolve the problem, e.g.

Removal of tooth root or foreign bodies.

Removal of the root or recurrentan roc oana po yp.

Access to the pterygopalatine fossa to clipthe maxillary artery.


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Surgery of the nasal SinusesCaldwell-Luc Operation (Radical

Antrostomy)

Injury of the roots of adjacent teeth.

Injury of the infra-orbital nerve.

Oro-antral fistula.

Endoscopic Sinus Surgery(EES)

Chronic and recurrent sinusitis: The concept of theoperation is to clear infection and/or obstruction ofthe middle meatus (ostiomeatal complex) to allowfree drainage and aeration of the sinuses.

Nasal polypi.

Mucoceles.

Fungal sinusitis. Extended indications, e.g. coagulation of

sphenopalatine artey and closure of CSF leaks.


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Endoscopic Sinus Surgery

(EES)

Endoscopic Sinus Surgery(EES)

CSF leak.

Orbital complications: emphysema,hematoma, blindness.

Epiphora due to damage of the

Recurrrence or persistence of symptomsdue to adhesions , incomplete procedure,or allergy.

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Procedures & Operations on the Nose & Paranasal Sinuses (Prof. Samy Elwany)