Endoscopic paranasal sinus surgery

DEFINITION

Rhinosinusitis is an inflammatory change of the mucosa of the paranasal sinuses (maxillary sinuses, ethmoid, frontal, sphenoid sinuses), accompanied by specific symptoms. If these symptoms are not fully typical, many other local and systemic factors may need to be explored to determine the cause. Less than 10{d20b388198d2e905ee196862917d9f2281b0d18e47ead2dc02216a73d73a39ec} of patients who visit the otolaryngologist with a possible problem in their paranasal sinuses proves to have rhinosinusitis.

Acute purulent rhinosinusitis usually accompanies or follows a common cold. It can also occur due to contaminated water violently entering the nose during swimming or diving. In sinusitis, the pain is localised on the cheek and reflects on the forehead and the teeth of the upper jaw. In ethmoiditis, the pain is localised between and behind the eyes. In frontal sinusitis, the pain is mainly localised on the forehead and is more intense in the morning, as the patient awakens. In sphenoiditis, the pain is mainly localised in the centre of the head and radiates to the temples.

Acute purulent rhinosinusitis is managed by medication, not surgically. The only exception to this rule is when the natural orifice of the paranasal sinuses is completely obstructed by swelling, leading to empyema. Treatment is aimed at relieving pain, decongestion of the nasal mucosa and controlling the infection. The rationale of functional endoscopic paranasal sinus surgery is based on a detailed knowledge of the anatomy and pathophysiology of the region of the paranasal sinuses. This demonstrates the critical role of paranasal sinus obstruction in the pathogenesis of rhinosinusitis. The surgical restoration of ventilation and the normal functioning of the mucociliary epithelium are considered of the utmost importance for eliminating the disease and maintaining a healthy nasal mucosa in all paranasal cavities.

DIAGNOSIS

The essential advantage of endoscopic surgery of the paranasal sinuses concerns its ability to accurately assess the complex system of the paranasal sinuses, with detailed nose endoscopy and a CT or MRI.

SURGICAL TREATMENT

When, despite appropriate medication, rhinosinusitis persists and is documented by endoscopy and imaging studies, this is a direct indication for surgical treatment.

The use of endoscopes during surgery of the paranasal sinuses improves the field of view and allows greater preservation of the normal structures, as only the abnormality of the suffering area is removed. The most important advantages are due to improved diagnostic capability and the understanding of the pathogenesis of rhinosinusitis, which are possible due to the combined use of an endoscopic examination and a CT or MRI. Systematic postoperative care and very thorough cleaning of the operated cavities are of utmost importance for the final surgical result. Functional endoscopic techniques allow the restoration of paranasal sinus diseases that do not respond to medication, with minimal trauma to the normal structures and reduced morbidity. The key is the early detection and removal of the underlying causes of paranasal sinus diseases.

Which patients require endoscopic surgery?

• patients with nasal polyps • patients with rhinosinusitis that does not respond to treatment with antibiotics • patients with benign and malignant paranasal tumours

How are these diseases diagnosed?

•by endoscopic testing • by a CT or MRI

What can the symptoms be?

• headache • cough • dizziness • nosebleed • ear problems • severe stuffiness

What is the treatment?

Initially conservative, with antibiotics and the treatment of other predisposing conditions, such as allergic rhinitis.

What is endoscopic paranasal sinus surgery?

It is a new surgical treatment method, using a camera inserted through the nose, without external incisions. It aims to correct anatomical abnormalities leading to persistent inflammations and remove abnormalities in a minimally amputating manner.

Why should a patient undergo surgery?

• to avoid possible complications from chronic inflammations • for the conduct of a biopsy and definitive diagnosis

How is the operation performed?

• How is the operation performed?

What is required postoperatively?

• patient stay for 24 hours in the hospital • good monitoring and continuous regulation of predisposing factors such as allergic rhinitis • good patient-doctor collaboration

A few words about Sinusitis

What are the maxillary sinuses and where are they located? What role do they play?
The maxillary sinuses are part of the paranasal sinuses, a set of cavities located around the nose (maxillary sinuses, ethmoid, frontal, sphenoid sinuses). They continually produce mucus, which moistens and cleans the nose.

What is rhinosinusitis? What are its symptoms?

Rhinosinusitis, the most common form of which is sinusitis, is the inflammation of one or more sinuses.

Its symptoms can be:

  • nasal congestion
  • catarrh
  • headache
  • olfactory disturbances
  • cough
  • fatigue
  • purulent mucus and
  • frequent low-grade fever.

What can the causes be?

Sinusitis can be caused by viral or bacterial infections, trauma, inflammations of the teeth, anatomical abnormalities in the nasal septum or the middle nasal meatus and turbinate hypertrophy.

Usually, sinusitis accompanies or follows a common cold or flu or a crisis of allergic rhinitis. When it lasts for several days, the intense production of mucus, due to a cold or rhinitis, causes swelling of the nasal mucosa, obstructing the passage of air to the maxillary sinuses, thus generating intense pain in the face, especially in the forehead and eyes.

Furthermore, the maxillary sinuses are infected by bacteria and the mucus produced becomes thick, malodorous and yellow or green. When the obstruction of air passage to the maxillary sinuses persists for a long time, the symptoms persist and get worse, leading to chronic sinusitis.

What effects can it have?

The effects of sinusitis, especially of its chronic form, are many and affect the quality of life, as they cause fatigue and decreased well-being. The most common effects are that it leads to frequent ear infections and tonsillitis, as well as lower respiratory tract infections that can even lead to asthma.
It can be quite dangerous, especially in the form of Chronic Rhinosinusitis, as it can cause complications in neighbouring organs such as the eyes (abscesses) and brain (abscesses or meningitis).

The relationship of sinusitis with otitis

Two tubes, called the Eustachian tubes, which significantly regulate the operation of the ear, are located next to the maxillary sinuses. An intense swelling and frequent inflammations of the nasal area can have permanent effects on the Eustachian tubes.

A patient with sinusitis might be affected by secretory or acute otitis media, with symptoms such as hearing loss, sensation of ear fullness, autophonia, tinnitus, crackling in the ears when swallowing.

Method of diagnosis at the clinic.

Sinusitis can be diagnosed in detail at the clinic, using endoscopic tools. Often, CT or MRI imaging may be necessary. The diagnosis accurately shows the causes and extent of inflammation.

Sinusitis and treatment.

Sinusitis is initially treated with medication: decongestant sprays, nasal washes and often with antibiotics. In cases of chronic inflammation with symptoms that persist despite treatment, as well as in cases of complications, it may be necessary to intervene surgically.

Sinusitis and surgery-Incision-free surgery

Doctors intervene surgically when sinusitis persists despite medication, and when it is documented by endoscopy and imaging studies. Furthermore, in cases of chronic sinusitis, in patients presenting complications, in patients with benign and malignant tumours of the nose and paranasal sinuses, and in patients with nasal polyps.

When the only solution is surgery, it is important for this to be performed promptly, to avoid complications arising from surrounding organs, such as the eyes, brain or ears.

With the development of technology, surgery for sinusitis is now done without incisions, by endoscopy, using a camera allowing high precision in manipulations, thanks to zooming, lighting and the use of neuronavigation. Another advantage of endoscopic surgery is that, at the same time, the same operation can correct a deviated septum, nasal turbinates and polyps (if these exist) painlessly, without swelling and bruising.

Description of the operation

The operation is performed under general anaesthesia, using endoscopes, a camera and a monitor. The endoscopic method is painless, incision-free and offers a radical solution in the treatment of sinusitis.

After surgery

As the operation is effected with a highly functional method, the patient is in excellent condition postoperatively. They return home on the following day, and – in consultation with the treating doctor – can immediately return to their activities. There is a direct improvement in all annoying symptoms (headache, purulent discharges, stuffiness, cough) and the cavities are completely healed one month after surgery.

FAQs about the Operation

How difficult is the operation?

Thanks to new methods, the surgery is not as laborious and bloody as it used to be. Modern equipment ensure many advantages for patients and provide a non-invasive and accurate radical solution to the problem.

Is there a more appropriate season for endoscopic surgery of sinusitis?

No, this is a myth, it can be carried out at any time of year with the same results, provided that the patient follows the postoperative instructions given by the doctor.

Is the surgery expensive?

Because of the special materials and high-tech equipment used to conduct the surgery, there is an additional cost, which is counterbalanced by the benefits of the endoscopic method for patients, which include shorter hospitalisation, direct healing and return to their activities.

Will there be pain?

No, on the contrary, patients will feel better immediately after the surgery, as the annoying symptoms they suffered before surgery, such as intense nasal congestion, headache, runny nose, thick secretions and coughing, will have subsided. Patients feel so well after surgery that they do not even feel as if they had undergone an operation.

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