Treatment of acute sinusitis. Endoscopic sinus surgery: treatment of the paranasal sinuses How is endoscopic sinus surgery performed

Endoscopy - from the ancient Greek "look inside" - is an excellent modern diagnostic method based on the examination of natural cavities with a special device called an endoscope. The basis of the method is a fiber-optic optical system, which in modern endoscopes is equipped with a miniature camera with a monitor output and a set of various surgical manipulators: nippers, scalpels, needles, and others.

In fact, the first endoscope was constructed back in 1806. The instrument was a rigid metal tube with a system of refracting mirrors, and a banal candle served as a light source. Modern endoscopes are flexible tubes with the most accurate optical systems, equipped with computer software and surgical manipulators. Every year, medical technology companies improve endoscopic equipment, opening up the latest opportunities for endoscopy. One of these relative innovations is the endoscopy of the sinuses, including the maxillary sinuses.

Why is endoscopy of the paranasal sinuses done?

The main problem of otorhinolaryngology is that the structures of the nose, ear and paranasal sinuses are extremely narrow structures, compactly hidden in the bone skeleton of the skull. It is extremely difficult to get to them using a standard set of ENT instruments. With the advent of a new generation of the thinnest conductors, it became possible to penetrate the endoscope through the natural fistulas between the nasal cavity and the sinus to examine the internal contents of the sinuses.

Examination of the nasal cavity with an endoscope

What are the purposes of endoscopy?

First of all, endoscopic examination of the maxillary and other paranasal sinuses is a high diagnostic standard. Compared to computed tomography and, moreover, X-ray, the value of endoscopy is colossal. Agree, what could be better than, in the literal sense, to look into the affected sinus with an eye and assess the state of its mucous membrane and the nature of the pathological process? The doctor assesses the condition of the mucosa, the plethora of its vessels, the degree of edema, the presence of fluid or pus in the sinus cavity, notices abnormal tissue growths, polyps, cysts and other “plus-tissues”.
The endoscope can also be used to take samples of the mucosa and its discharge (pus, exudate) for bacteriological examination. With its help, the pathogen that caused sinusitis or other sinusitis is determined, as well as the sensitivity of the microbe to antibiotics. This helps to competently and accurately prescribe a course of antibiotic therapy.
In addition to diagnostic studies, endoscopic techniques are widely used in operations and manipulations on the sinuses. We will discuss these types of operations in the next section.

Advantages and disadvantages of endoscopic interventions

Previously, before the era of endoscopy, ENT doctors in the pathology of the nasal sinus widely used the methods of standard surgery: trepanopuncture and variants of various operations with violation of the bone structures of the sinuses. These operations are quite technically complicated, fraught with bleeding and disruption of the anatomy of the ENT organs.

Endoscopic surgery on the maxillary sinus throughout the civilized world is the gold standard of minimally invasive surgery. Let's list all its advantages:

Safety. Endoscopy rarely causes severe bleeding, does not violate the structure and anatomy of the sinuses, since in the vast majority of cases the instrument is passed into the sinus cavity through its natural fistula.
Physiological. Precisely because it is possible to introduce the thinnest instrument under the control of the eye into the natural anastomosis, there is no need to destroy the bone walls and partitions.
Efficiency. Since the endoscopic technique is equipped with a micro-camera, the doctor does not carry out all the manipulations blindly, as before, but under the control of the eye on a large screen.
Rapid postoperative recovery. It is logical that the low invasiveness of the operation implies rapid healing and tissue repair.

Like any, even the most excellent method, endoscopy of the paranasal sinuses has a number of limitations and disadvantages. Disadvantages of the method:

The endoscopic technique is very expensive and also requires very gentle processing and sterilization methods. Therefore, not every state clinic has such technologies in its arsenal.
Also, the method requires special training and training of specialists.
Sometimes, in case of severe tissue edema or natural narrowness of the anastomosis, it is impossible to insert the conductor into the sinus cavity. It is also impossible to extract a large fragment of a tooth root or a fragment of filling material from the maxillary sinus using an endoscope through a narrow passage of the nasal passage. In such cases, it is necessary to expand the volume of the operation and crush the bone plate, as in a conventional operation. Through a wide opening it is also very convenient to work with an endoscope.

Types of endoscopic interventions for sinusitis

We list the main options for the use of endoscopic manipulations in the pathology of the maxillary sinuses:

Removal of pus, drainage and washing of the sinuses. This technique is also called. It is indicated for the accumulation and increase in pressure of pus in the sinus cavity when the natural anastomosis is closed by inflamed tissues. In contrast to the traditional puncture or puncture, pus is evacuated by expanding the natural anastomosis with a special inflatable balloon. Next, the cavity is repeatedly washed with antiseptics until completely cleansed.
Operation options for . As a rule, a chronic inflammatory process in the sinus is accompanied by the formation of various "plus-tissues": cysts, polyps, growths of the mucous membrane. These abnormal inclusions in the cavity interfere with adequate ventilation and drainage of the cavity and exacerbate inflammation. With the help of surgical attachments to the endoscope, it is possible to quickly, bloodlessly remove these tissues under the supervision of a specialist's eye.
Options for operations to remove various foreign bodies of the maxillary sinus. Such foreign inclusions are filling material, bone fragments, fragments of teeth, pins and other dental paraphernalia. Unfortunately, most often the natural anastomosis is too narrow for the safe removal of large particles, so in such cases the operation is expanded: an opening is created in the bony septa of the sinus with access from the wall of the nose or upper jaw.

How is endoscopic surgery performed?

I would like to note right away that each patient may have his own nuances of the operation, its technique and preparation, so we will only briefly outline the main stages of endoscopic manipulations:

Maximum preoperative preparation of the patient. Of course, in case of acute purulent sinusitis, drainage must be done as quickly as possible. But with a planned intervention, for example, when removing or plasticizing the excretory duct, high-quality preparation is the key to success. Such operations are best done during the "cold period", when swelling and inflammation are minimal.
The patient must take blood tests, urine tests, a blood clotting test to prevent possible complications. In the case of general anesthesia, an electrocardiogram and an examination by a therapist are also necessary.
Operations are performed both under general anesthesia and local anesthesia. Most often it depends on the volume of the operation and the need for transosseous access.
Before the operation, the patient is informed about the potential of surgery, its possible consequences, the course of the operation and the features of the course of the postoperative period are explained. The patient must sign an informed consent for medical intervention.
Before the start of the operation, the patient is washed repeatedly with the nasal cavity and sinuses with antiseptic solutions, then vasoconstrictor drops are instilled to reduce swelling and vasospasm.
Further, depending on the operation plan, either a window is created in the bone walls of the cavity, or the endoscope is inserted into the natural anastomosis.
Once in the sinus cavity, the doctor, looking at the screen, assesses the condition of its mucosa, finds abnormal tissues and proceeds to remove them with special tweezers and scalpels - a kind of cleaning of the cavity occurs.
After removing all excess, the cavity is washed with antiseptics, sometimes antibiotics are injected into it. The doctor removes the instruments. Operation completed. The rehabilitation period begins.
For each patient, the features of rehabilitation are purely individual. As a rule, recovery programs include: taking antibiotics, constant nasal lavages, instillation of vasoconstrictor drops, physiotherapy and regular monitoring by an ENT doctor.

Believe me: endoscopic operations are much safer than those done before for the treatment of similar problems. It is not so traumatic, blood loss is minimal, recovery is 2-3 days. Perhaps your case is not as neglected as mine, and then you should not worry all the more.

If you want everything to go as smoothly as possible:

1. Do not spare time for a complete examination - CT and MRI

2. Consult with different doctors (run away from those who, without looking at the picture, immediately draw conclusions)

3. If you are very worried - do not spare money for a good full anesthesia (But! Only high-quality - more at the end of the review)

4. Ask to be inserted into the nose after surgery hemostatic sponges and not tampons or worse, a bandage!

"Nerves are to blame"

I have never had any special problems with immunity, rarely got sick. But for the past three years, I've stopped recognizing myself. Eternal temperature 37 and red throat. I went around the doctors of all paid clinics in Moscow. They just didn’t say something, including that you see, the nerves are to blame))). Meanwhile, I started having a protracted sinusitis ...

Punctures are not a panacea

Many are prescribed punctures and some even help. BUT, remember! X-rays are not enough to send a person for this procedure. Do an MRI to identify the real cause of sinusitis. The puncture then did not lead to anything, water poured from the nose and that's it. However, the doctor did not guess that complaints about pressure and the absence of mucus are not just signs of sinusitis. Without properly understanding and not taking the appropriate pictures, he sent me for an operation. I refused.

Thank God, I managed to find an adequate doctor when I came to Anapa for treatment. He immediately said that he needed an MRI. The same evening, a large cyst was found in the right sinus. At first there was a shock - the operation is inevitable. But, I learned about endoscopic operations on the Internet and became a little calmer.

A bit of mysticism

I went to Krasnodar for a consultation. All the way I prayed that the doctor would make the right decision. And this must happen. It was on this day that the anesthesia machine broke down, and the doctor called everyone to reschedule the operation for a month.

Barely looking at the pictures, he replied that the reason was the partition. "But please," I replied. She never bothered me before. I had sinusitis six months ago, before that there were no problems. "Yes, and the summary for the MRI clearly states: the curvature is not large. But the doctor said that only septoplasty would help.

Surprise

I was not ready to wait another two months. I was tormented by a headache (more precisely, pressure) and a lack of oxygen. I went to Moscow. At the Institute of Neurosurgery, Burdenko was immediately told that MRI was not enough. CT scan (computed tomography) revealed the filling material in the other sinus. A few years ago, the therapist filled the canals and did not keep track (the therapist, in principle, should not do this), they did not provide me with any pictures then. And then the filling began to overgrow with fungi and bacteria, and eventually turned into a large dense fungus.

About the operation

Let me tell you straight away: I am a terrible coward. She exhausted both herself and her family with excitement. Tenoten helped to restrain her emotions. But my surgeon Marina Vladislavovna helped me finally forget about fear. Not a drop of indifference, only a desire to help and set up for a speedy recovery.

The surgeon explained that even if it is not possible to get a cyst and a filling endoscopically (they are too large), they will make a micro-incision above the lip, which is also not very scary (the tiny scar heals quickly).

They suffered with me for three hours, but EXPERIENCE and ENDOSCOPY won! Managed to get everything.

About anesthesia

Already on the eve of the operation in the evening it is better not to eat so that the next day the stomach is empty. This subsequently helped to avoid nausea from anesthesia. I was anesthetized with propofol. (After reading the ENT forums, I insisted on sevoran) and for three hours in a dream I was engaged in choosing New Year's gifts for relatives))) I woke up from the fact that the nurse called by name and said "breathe". Anesthesia did not give any clouding of consciousness, I clearly understood everything and woke up very quickly, as if from a normal dream. Why general anesthesia is preferable for ENT operations was convincingly expressed by mig17 on the loronline forum.

What to take to the hospital?

The first night was not painful, it was just unpleasant. A friend who went through a similar experience a year ago said that the torments are hellish, but this is not so. You can survive the night with sponges in your nose, although it is unpleasant. For another day I had blood clots coming out of my throat and nose. My throat was swollen and a little sore. This is normal after anesthesia. Ask for painkillers or suck on lidocaine lozenges. A teaspoon of peach oil will also help relieve pain. Edema helped me to remove Telfast from allergies a little.

Hemostatic sponges

The next day, one hemostatic plug was pulled out, and part of the other came out only after weeks of regular rinsing with Dolphin. The hemostatic sponge does not injure the sinuses, unlike conventional tampons. Comes out easy. And even if a particle got stuck in the nose and they could not get it, there is no need to panic - it will come out or resolve (they write that in 3-6 weeks).

Possible Complications

I read reviews, many have numbness of the lips or teeth. I had numbness in my two front teeth. But! it was before, but not as strong. They say it was because the cyst was pressing on a nerve. The numbness decreased after half a month, now I almost don’t feel it - everything is in order.

Almost a month after the operation, I can say that the improvement has certainly come. The constant fever and headaches are gone. Although the nose sometimes gets clogged (not all the pus has come out yet), but not for long - I forgot about the vasoconstrictor drops.

Good luck to everyone, and God bless!

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Endoscopic methods of surgery are associated with the risk of various injuries and complications typical for surgery of the paranasal sinuses. Serious complications occur, fortunately, extremely rarely, but in cases where they occur, they can be dramatic: such complications should include, first of all, damage to the orbit and intraorbital structures, the optic nerve, the dura mater of the anterior part of the base of the skull and adjacent to it periosteum of the cranial cavity, as well as the internal carotid artery and other venous sinuses of the brain.

Intraorbital bleeding caused by retraction of the severed anterior ethmoid artery into the orbit can lead to dangerous bulging and dilatation with vascular compression and possibly local ischemia, whereby patients may be at risk of narrowing the field of vision and deterioration, even loss of vision. Like any method of sinus and skull base surgery, endoscopic methods should be used only after appropriate preparation and careful study of the anatomy and anatomical options. The "single surgeon" must either be able to cope with the complications that arise, or have contact with a nearby clinical institution that has all the necessary prerequisites for this.

In more than 10,000 patients operated on at the Otorhinolaryngological University Hospital in Graz over the past 20 years, only 6 cases developed an iatrogenic cerebrospinal fluid fistula. In all cases, this defect was eliminated, and there were no complications or irreversible damage. In connection with the endoscopic interventions, there were no cases of damage to the optic nerve, impaired eye mobility, not to mention death. The world of specialists has long overcome the initial skepticism. Today, all residents in the 4th year of training attend an introduction to endoscopic surgery, while endoscopic diagnostics is included in the main training program from the very beginning.

Rice. 1. Surgical interventions in the ethmoid bone and in the area of the nasal cavity are associated with the risk of serious complications. This damage to the dura mater with the formation of a cerebral hernia occurred during surgery on the nasal septum.

A thorough knowledge of endoscopic technique and skill in handling endoscopes and instruments should eliminate the risk of injury to the patient. On fig. 2 schematically depicts a case of a serious complication documented in the medical literature: a surgeon with basic knowledge of the anatomy of the nose and its paranasal sinuses should know that a straight, rigid endoscope with a length of approx. 18 cm cannot be simply "immersed" in the nose to the lens.

Summary

The Messerklinger method is primarily an endoscopic diagnostic concept based on an understanding of the pathophysiology of sinusitis. In this concept, the large paranasal sinuses are considered as "subordinate" cavities, the diseases of which in the vast majority of cases are rhinogenic and therefore are of a secondary nature. At the same time, the key role of the bottlenecks of the anterior ethmoid bone in the normal and pathophysiology of PPN is highlighted. This concept also confirms that conventional rhinoscopy, as well as plain radiography of PPN, is in most cases insufficient to identify the cause of acute or recurrent sinusitis. The combination of diagnostic endoscopy of the lateral wall of the nasal cavity using rigid endoscopes with conventional or computed X-ray tomography with coronary reconstruction of the obtained sections turned out to be ideal for diagnosing inflammatory diseases of PPN.

Based on the experience gained in endoscopic diagnostics, the concept of endoscopic surgery was developed, aimed not at eliminating the symptoms, but at treating the diseases that cause them and pathological changes in key places of the ethmoid bone. Sanitation of diseased areas of the ethmoid bone is carried out by small and short-term targeted surgical interventions. At the same time, the frontal and maxillary sinuses themselves are affected only in rare cases. This is not a routine sphenoethmoidectomy, although the Messerklinger method allows it to be performed. and always individual surgical intervention, carried out taking into account this pathology.

In cases where it is necessary to expand the opening of the maxillary sinus, it is carried out at the expense of fontanelles. Thus, we get a wide opening in a physiologically predetermined place, to which the secret will move along genetically determined paths. In addition, the physiological pathways of ventilation and drainage are restored. There is no need to expose the middle turbinate - except when it is pneumatized (bullous) - to surgical intervention, in particular, it does not need to be completely or partially resected

The key to the successful application of the Messerklinger method is accurate preoperative diagnosis and atraumatic surgical treatment under surface and local anesthesia with low bleeding. Any unnecessary damage to the mucous membranes and, above all, the creation of opposing wound surfaces should be avoided. The same care and precision is required as in middle ear surgery. In most cases, the duration of the operation and, accordingly, the burden on the patient is relatively small.

This method can be used in a wide range of indications, not only for massive nasal polyposis, but due to the low burden created by gentle surgery under local anesthesia, also in patients in whom (e.g. due to their advanced age) the intervention under general anesthesia was would be associated with high risk.

The mucous membranes of the paranasal sinuses have a high regenerative capacity, as evidenced by the fact that the frontal and maxillary sinuses, even with massive pathological changes, in the vast majority of cases are completely cured after the sanitation of the ethmoid bone, without being themselves affected.

The Messerklinger method, as the first stage of surgical treatment of inflammatory diseases of PPN, practically does not know indications for radical outside intervention. The Messerklinger method has its limits and specific difficulties. With its help, not all problems arising in connection with inflammatory diseases of PPN can be solved. Although this method can achieve a marked improvement in patients in some cases of allergies, asthma, cystic fibrosis and diffuse polyposis, it does not provide a definitive solution to these problems. But since radical methods of surgery do not bring the best results of treatment over a long period of time, we also prefer the patient-friendly Messerklinger method for these diseases.

Today, using the improved FESS method, low-traumatic endoscopic surgical interventions can be performed for numerous additional indications: from cerebrospinal fluid fistulas and encephalomeningoceles, compression of the orbit and optic nerve to tumors of the skull base, pituitary gland, and in some cases, nasopharyngeal fibromas. In these cases, the concept of endoscopic surgery we present is not new; it uses the possibilities of a less traumatic intervention, based on well-known, well-proven methods of operation, which until now required surgical access from the outside.

The described method requires thorough preparation and proper training. It is associated with the same risk and the same complications. which are also found in other methods of endonasal ethmoid surgery. But clinical results have shown that this method, when used correctly by experienced surgeons, has a very low complication rate.

Heinz Stammberger

Endoscopic diagnostics and surgery for diseases of the paranasal sinuses and anterior part of the skull base

Atheroma (aka cyst) is a benign thin bubble with fluid inside. The size and location may be different, respectively, and the complaints of patients may differ from each other.

If, nevertheless, the suspicion of the presence of atheroma is confirmed, its removal is performed only surgically, that is, endoscopic sinus surgery.

How are atheromas formed in the sinus of the nose?

The lining inside the nose has mucus-producing glands throughout human existence. There are times when, due to some inflammatory process, the iron duct does not function, but despite this, all the glands continue to produce mucus, which as a result does not come out, but accumulates inside under pressure, expands the walls of the glands, which as a result lead to the appearance of the above described sinus atheroma.

It's not easy to recognize a sinus cyst. A person for many years may not know that it exists, and only computed tomography or diagnostic endoscopy of the sinus can recognize atheroma.

The best result for diagnosing a cyst is computed tomography. It is she who makes it possible to accurately name the size of the atheroma and its location, and these are very important factors. Knowing them, it is much easier to choose a method for removing such a cyst.

Diagnostic endoscopy is mandatory to clarify the condition and functionality of all nasal structures.

Complaints.

As mentioned earlier, a person can live a lifetime and not know about a cyst. But symptoms can still be:

1. The first and main symptom is constant or variable nasal congestion. There is no runny nose, but the nasal airways do not let air through.
2. Atheroma, growing, newly created, can cause frequent headaches, because it touches the nerve points of the mucosa.
3. In the region of the upper jaw, there is often a feeling of discomfort, pain.
4. Drivers, or other athletes whose activities are related to water, may experience suffocation, intensify and pain.
5. Frequent diseases of the nasopharynx: tonsillitis, sinusitis and others can occur because atheroma begins to change its location, which disrupts the function of aerodynamics.
6. In the area of the back wall of the pharynx, mucus, possibly pus, can flow variable or always. When the location is modified, the cyst initiates irritation of the mucous membrane, causing inflammatory processes.

The above symptoms are not only related to the cyst, it can be a simple sinusitis. But to confirm the absence of a tumor, additional studies, such as diagnostic endoscopy and computed tomography, must be performed.

The goal of endoscopic sinus surgery is to enlarge the passage of the sinuses. As a rule, the paranasal sinuses open into the microcavity of the nose with a bony canal covered with a slimy layer. The above greatly simplifies the subsequent treatment of irritation of the paranasal sinuses.
In addition, the endoscopic technical tool makes it possible to quite simply eliminate various matters in the sinus cavity, for example, polyps or atheromas.

Recent modernization of endoscopic technical timely interventions in a number of diseases of the paranasal sinuses - the theory of computer navigation. The location makes it possible to form a multidimensional representation of the paranasal sinuses on the computer screen, which completely simplifies the diagnosis and surgical intervention for the doctor.

To eliminate inflammation in the nasal cavity and paranasal sinuses, drug therapy, washings and surgical manipulations are used. All these methods are aimed at eliminating the swelling of the mucous membranes and improving the outflow of secretions. In our article we will talk about a modern surgical method for the treatment of sinusitis - functional endoscopic surgery.

Intranasal drugs, represented by sprays, drops, inhalations, have anti-inflammatory, vasoconstrictive or antibacterial effects. They facilitate nasal breathing, prevent the reproduction of pathogens on the surface of the mucous membranes and relieve inflammation. Preparations with astringent action envelop the nasal cavity and prevent it from drying out. Saline rinsing is a good way to remove accumulated mucus from the sinuses. However, this method is applicable for adults and children over 5 years of age (the younger the child, the greater the likelihood of otitis media).

Nasal lavage

The most inaccessible place for washing can be called the maxillary sinuses.. Due to the anatomical location, conventional manipulations do not affect the mucus accumulated in the maxillary region. In the hospital and outpatient settings, three methods are used:

movement (popular name "cuckoo");
use of a sinus catheter;
sinus puncture (in medical language - puncture).

In most cases, a combination of drug therapy with one or more ways to clear the sinuses of mucus is enough to significantly alleviate the patient's condition and subsequent full recovery. However, the hope of many patients on “maybe it will go away by itself” often leads to the fact that ordinary inflammation, which, with adequate actions and timely medical assistance, would pass in a week, turns into more serious conditions, causing damage to other organs.

The ears (otitis media), the mouth (dental diseases), the lungs (pneumonia, bronchitis) and even the brain (meningitis, encephalitis) are most often at risk. Missed sinusitis from the acute stage may well turn into a chronic form, providing a person with constant headaches, periodic nasal congestion, snoring and other unpleasant phenomena.

In situations where conservative methods of therapy are powerless, doctors resort to surgical intervention. One of the most common methods of the last century, successfully used to this day, is an open operation that allows you to visually examine the sinuses and thoroughly cleanse them of pus and mucus. But the complexity of the process and the need for general anesthesia has led to the fact that an increasing number of surgical interventions in the nasal cavity are performed internally. Such manipulations are called functional endoscopic operations in the nasal cavity. For the first time, this method was tested in the 50s of the last century, and since the 60-70s it has been successfully used in otolaryngology all over the world.

Advantages of endoscopy

In states with a high level of medicine, endoscopic practice is considered a kind of "gold standard" in the treatment of chronic forms of inflammation of the sinuses and conditions that are resistant to conservative therapy. One of the clear advantages of such manipulations, especially in comparison with the traditional approach, is no visible postoperative defects because tissue incisions are not required.

Endoscopic surgery

Another advantage - possibility of detailed diagnostics. An endoscope inserted into the nasal cavity is a light-conducting device that can be used not only to qualitatively examine the affected sinuses, but also to assess the extent of inflammation, understand the anatomical features and identify “surprises” in advance. And most importantly - to find and neutralize the focus of the disease, thereby speeding up the recovery time, reducing the risk of injury and possible complications. After such an intervention, a scar is not formed, pain during the rehabilitation stage is less pronounced, although swelling of the mucous and soft tissues may persist for several days.

The paranasal sinuses are equipped with thin canals made of bone, which are covered with mucous tissue. With any inflammation, be it allergies or viral rhinitis, these tissues swell and block the passage. Endoscopic surgery on the maxillary sinus (see the video in the gallery of the site) is aimed precisely at expanding the bone canal. Another plus of this intervention is that even if the patient encounters lesions of the nasal cavity again in the future, the lumen in the sinuses will not close, which gives an advantage in the treatment of subsequent acute conditions.. In addition to the main task of increasing the bone canal with the help of endoscopic techniques, it is possible to eliminate a variety of unnecessary tissues in the nasal cavity: cysts, polyps, growths.

Advantages of endoscopic surgery

Since the surgical field during such operations is located close enough to the vital organs, safety and precision of manipulations are of paramount importance. In this regard, the endoscopic technique is constantly being improved and studied.

One of the key updates in recent years is the use of imaging control: a computer program that receives data from CT processes the incoming information in a special way and recreates a three-dimensional image of the patient's nasal cavity.

In such a layout, the entire structure of the sinuses and adjacent soft tissues is displayed, moreover, using such a program, it is easy to track each surgical instrument and calculate further actions. Such a technique involving visual control is more often used in complex cases: with severe damage to the paranasal sinuses, ineffectiveness of conventional operations, with a non-standard structure of the patient's nasal cavity.

Preoperative preparation

The first and one of the most important stages before the intervention is diagnostics, which allows you to determine the cause of the development of the disease, the characteristics of the disease, the condition of the air passages and outline a treatment plan. For this, X-ray, CT, olfactory analysis, cytology and rhinomanometry data are used, revealing thickened walls of the mucous membranes, cysts, polyps, localization of blockage of the nasal lumens and other elements of the disease. Accurate knowledge allows you to decide on the tactics of treatment in general and the strategy of surgical intervention in particular.

Carrying out endoscopic procedures

If earlier in the surgical practice of ENT doctors it was believed that the complete elimination of severe and chronic forms of sinusitis requires a major elimination of the mucous membranes of the nasal sinuses, then the modern technique of FEHP (functional endoscopic sinus surgery) completely refutes this opinion. The technical base and updated instruments used in endoscopic operations provide a sparing intervention mode with the preservation of mucous tissues . At the same time, the outflow of purulent mass and mucus improves, the air passages are restored, and the shells themselves get the opportunity to regenerate and self-correct.

Sinus cleaning

Cleaning of the maxillary sinuses - an operation carried out under the influence of local anesthesia, which reduces the time of manipulation and accelerates the rehabilitation of the patient. First, an endoscope equipped with microvideo cameras is inserted into the nasal cavity. It allows surgeons to visually assess the amount of work, structural features of the sinuses and detect the primary focus of the disease. Then, after the endoscope, special microinstruments are introduced into the affected area, ensuring high accuracy of each movement of the doctor. As a result, the affected tissues are removed without any harm to healthy cells, which has a beneficial effect on postoperative recovery.

This method minimally injures the mucous membranes and, since most interventions are performed by access through the nostril openings, it does not leave external defects in the form of scars or scars. After endoscopic procedures, there may be slight swelling, soft tissue swelling and slight discomfort.

Foreign body in the nose

Along with pathogens, inflammation of the maxillary sinuses can cause a foreign body to enter the nasal cavity. If in young children this happens due to accidental inhalation of small objects or particles of food and the insertion of toy elements into the nostrils with their own hands, then in conscious adulthood, dental procedures are most often the cause. Another way for foreign particles to enter the sinuses is an open wound. A sign of foreign elements in the nasal passages can be a copious secretion of mucus from one nostril. But there are cases when an object that has entered the nasal cavity at first does not cause inconvenience, but over time it necessarily provokes inflammation.

Removal of a foreign body by endoscopic surgery

With the development of minimally invasive techniques, the operation to remove a foreign body from the maxillary sinus began to be carried out using an endoscope, which allows you to carefully eliminate the stuck object without harm to healthy tissues. In some cases, the extraction of particles is carried out through an access under the upper lip. The size of the hole does not exceed 4 mm, which ensures the safety of the anastomosis of the maxillary sinus.

Unfortunately, endoscopic equipment is quite expensive, so such operations are not performed in all medical institutions, moreover, the knowledge and practical experience of the surgeon is necessary for a flawless intervention.