Endoscopic surgery of the nose and paranasal sinuses. Complications of endoscopic surgery

Due to the intensive development of the medical technical base, endoscopic examination methods have become one of the most informative examination methods that allow making an accurate diagnosis. A similar method appeared in otolaryngology. Nasal endoscopy is performed when complete examination the patient is not enough to conduct an examination of the nasal cavity and nasopharynx with the help of conventional mirrors. The device used for inspection is a thin rigid or flexible tube with a diameter of 2-4 mm, inside which there is an optical system, a video camera and a lighting element. Thanks to this endoscopic device, the doctor can examine in great detail all parts of the nasal cavity and nasopharynx at different magnifications and at different angles.

In this article, we will acquaint you with the essence of this diagnostic method, its indications, contraindications, methods of preparing for the study, and the principles of nasal endoscopy technique. This information will help you understand the essence of this method of examination, and you will be able to ask your doctor any questions that arise.

The essence of the method

When performing nasal endoscopy in nasal cavity and a special endoscope is inserted into the nasopharynx, allowing you to examine the area under study. To perform the procedure, a rigid (non-bending) or flexible (changing its direction) device can be used. After the introduction of the endoscope, the otolaryngologist examines the nasal cavity, starting from the lower nasal passage. During the examination, the device gradually moves up to the nasopharynx, and the specialist can examine the state of the inner surface and all the anatomical formations of the studied cavities.

Nasal endoscopy may reveal:

inflammatory processes on the mucous membrane (redness, swelling, mucus, pus);
violations of the structure of the mucous membrane (hyper-, hypo- or atrophy);
benign and malignant tumor formations (their localization and degree of growth);
foreign objects in the nasal cavity or nasopharynx.

Indications

Nasal endoscopy can be performed for diagnostic purposes or as a therapeutic procedure.

Nasal endoscopy can be prescribed for the following conditions and diseases:

nasal discharge;
difficulty breathing;
frequent;
frequent;
feeling of pressure in the face;
deterioration of the sense of smell;
hearing loss or tinnitus;
suspicion of inflammatory processes;
snore;
suspicion of the presence of tumors;
delayed speech development (in children);
suspicion of the presence of a foreign object;
frontitis;
adenoids;
ethmoiditis;
injuries of the facial part of the skull;
curvature of the nasal septum;
anomalies in the development of the paranasal sinuses;
preoperative and postoperative period after rhinoplasty.

If necessary, during a nasal endoscopy, the doctor can perform the following diagnostic or therapeutic procedures:

fence purulent discharge for bacteriological analysis;
biopsy of tumor tissue;
elimination of the causes of frequent nosebleeds;
removal of neoplasms;
surgical treatment of the nasal cavity after endoscopic operations (removal of crusts, mucus, treatment of wound surfaces).

Nasal endoscopy can be performed not only to diagnose the disease, but also to control the effectiveness of the treatment or as a method of dynamic monitoring of pathology (excluding relapses, identifying threats of complications, monitoring the dynamics of neoplasm growth, etc.).

Contraindications

There are no absolute contraindications for performing nasal endoscopy, but in some cases such a procedure should be carried out with caution or replaced by other diagnostic methods. The risk group includes patients with the following conditions:

allergic reactions to;
disorders in the blood coagulation system;
reception;
frequent bleeding due to weakened blood vessels.

In the presence of allergic reactions to the local anesthetic used, the drug is replaced with another one. And with an increased risk of bleeding, the study is carried out after preliminary special preparation of the patient for the procedure. In such cases, a thinner endoscope can be used to exclude vascular trauma.

Study preparation

In the absence of contraindications, preparation for nasal endoscopy does not require any special measures. The doctor must explain to the patient the essence of the study and assure him that during the procedure he will not feel pain, and discomfort will be minimal. In addition, the patient must be prepared to remain completely still during the examination. And if the examination is carried out on a child, then one of the parents must be present during the procedure.

If necessary, a test is carried out before the study to identify possible allergic reaction to a local anesthetic. If the patient is taking anticoagulants, the doctor may advise you to temporarily stop using the drug or adjust the dosage regimen.

If it is necessary to remove the neoplasm during endoscopy, the patient is recommended to remain after the surgical procedure under the supervision of doctors during the day. In such cases, he should take with him from home things necessary for a comfortable stay in the hospital ( comfortable clothes, slippers, etc.).

How the study is done

A nasal endoscopy procedure can be performed in an otolaryngologist's office. The patient sits in a special chair with a headrest, the position of which may change during the study.

If necessary, before the procedure, it is introduced into the nasal cavity vasoconstrictor(for example, Oxymetazoline spray), which eliminates excessive swelling of the mucosa. After that, for anesthesia, the nasal mucosa is irrigated with a solution local anesthetic- for this, a spray can be used or lubrication of the mucous membrane with a swab dipped in the preparation is performed.

After some time, after the onset of the action of local anesthesia, which is expressed in the appearance of a slight tingling in the nose, an endoscope is inserted into the nasal cavity. The doctor examines the state of the mucous membrane on the image received on the computer monitor and slowly advances the device to the nasopharynx.

Nasal endoscopy examination includes the following steps:

panoramic examination of the vestibule of the nose and the common nasal passage;
the endoscope is moved along the bottom of the nasal cavity to the nasopharynx, the presence of adenoid vegetations, the condition of the arch of the nasopharynx, the mouths of the auditory tubes and the posterior ends of the inferior concha of the nose are specified;
the device is moved from the vestibule to the middle nasal concha and the condition of its mucous membrane and middle nasal passage is assessed;
the upper nasal passage, the olfactory fissure are examined with an endoscope (in some cases, the doctor can examine the condition of the outlet openings of the cells of the ethmoidal labyrinth and the superior nasal concha).

During the examination, the specialist evaluates the following parameters:

color of the mucous membrane;
the presence of hypertrophy or inflammatory processes;
the nature of the discharge (mucous, thick, purulent, liquid, transparent);
the presence of anatomical disorders (narrowing of passages, curvature of the nasal septum, etc.);
the presence of polyps and other tumor formations.

The inspection procedure usually takes no more than 5-15 minutes. If necessary, a diagnostic study is supplemented by surgical or therapeutic procedures. After the procedure is completed, the doctor prints the received photographs and draws up a conclusion. The results of the study are handed over to the patient or sent to the attending physician.

If there are no changes in well-being after completion of nasal endoscopy, the patient can go home. If the procedure was supplemented by the surgical removal of neoplasms, then the patient is placed in the ward and remains under medical supervision for a day. After endoscopy of the nose, the patient is recommended to refrain from intensive blowing of the nose for several days, which can provoke the development of nosebleeds.

Endoscopy of the maxillary sinus

In some cases, the purpose of diagnostic nasal endoscopy is aimed at assessing the condition of the maxillary sinus. Such a study is called sinusoscopy and is prescribed in the following cases:

the need to clarify the diagnosis with an isolated lesion of the maxillary sinuses;
presence foreign bodies in this region;
the need for medical procedures.

Endoscopy of the maxillary sinus is performed as follows:

Sinusoscopy is relieved by local anesthesia blocking the branches of the trigeminal nerve.
Using a special trocar with a sleeve, the doctor performs a puncture of the anterior wall of the maxillary sinus between the roots of III and IV teeth with rotational movements.
The specialist introduces an endoscope with 30-70° optics through the sleeve into the cavity of the maxillary sinus and examines it. If necessary, a tissue biopsy is performed, performed with a curettage spoon with a flexible leg or angular forceps.
After the examination is completed, the doctor rinses the sinus several times with an antiseptic solution and removes the trocar sleeve with gentle rotational movements.

Diagnostic sinusoscopy lasts about 30 minutes. After the procedure, the patient may experience slight discomfort at the insertion site of the endoscope, which after a while is eliminated on its own.

Which doctor to contact

Diagnostic nasal endoscopy may be ordered by an otolaryngologist. If necessary, this procedure can be supplemented by medical manipulations, tissue biopsy or mucus sampling for bacteriological analysis.

Cysts and foreign bodies of the paranasal sinuses

The cyst is benign neoplasm, which is a thin-walled bubble filled with liquid. The size of the cyst and its location can be very different, which suggests that clinical manifestations(complaints of the patient) may differ. The mechanism of cyst formation is quite simple. The mucous membrane lining the inside of the sinus has glands that produce a secret (mucus) throughout a person's life; each gland has its own excretory duct, which opens on the surface of the mucous membrane. When for some reason the duct of the gland ceases to function, the gland does not stop its work, i.e. mucus continues to be produced and accumulates, so the walls of the gland expand under pressure, which eventually leads to the formation of the formation described above in the sinus. A cyst can interfere with the natural flow of mucus from the sinus and cause it to become inflamed.

A person can have a sinus cyst all his life and not know about its existence. The patient can repeatedly visit the ENT doctor, as during preventive examinations, and due to illness, but without additional research, it is impossible to diagnose a cyst. The doctor can only make an assumption about its presence. Foreign bodies penetrate into the paranasal sinuses either as a result of open injury sinuses, or as a result medical manipulations(sealing of the canals of the teeth of the upper jaw). The foreign body usually leads to the development chronic inflammation sinuses.

The most diagnostically significant study - CT scan paranasal sinuses. This method allows you to determine the size of a cyst, a foreign body, and its location in the sinus with an accuracy of up to a millimeter, which is very important for choosing a removal method. A diagnostic endoscopy of the nose is mandatory to assess the condition of the intranasal structures.

Complaints

There may be no complaints at all, and the patient can live a life without treatment from an ENT doctor. Patients who underwent computed tomography or magnetic resonance toiography of other organs (brain, ear) often turn to us and a cyst was found during the examination. It depends on the size and location of the cyst, as well as on the structure of the maxillary or other sinus itself. Otherwise, the following symptoms occur:

Nasal congestion, which may be constant or variable;
Periodic or persistent headaches. They arise due to the fact that the growing cyst presses on the nerve endings of the mucous membrane;
Discomfort in the area of the upper jaw;
In patients involved in water sports, when diving to a depth, pain may appear or increase;
Periodically occurring inflammatory processes in the sinuses - sinusitis, which occurs due to a violation of the aerodynamics of the air flow in the sinus by a cyst;
Drainage of mucus or mucopurulent discharge down the back of the throat, which may be permanent. This happens because when the position of the body changes, the cyst, irritating the mucous membrane, causes increased mucus secretion.

The described complaints are not always a sign of a cyst, therefore, in most cases, an additional study is carried out in a specialized ENT clinic.

Treatment

The cyst or foreign body must be surgically removed. Unlike traditional operations with the creation of a large hole in the wall of the sinus, we perform endoscopic sinus revision through a small hole with a diameter of 4 mm using special micro-instruments

Elimination of inflammatory processes of the maxillary sinus

It is not always possible to get positive result from conservative treatment. The reasons for this: the wrong choice of antibiotic, inaccurate definition of microflora, narrow natural anastomosis, violation of the architectonics of the nasal cavity, ridges and spines of the septum, the presence of polyps, hyperplasia of the mucous membrane.
The emptying of the sinus from the purulent discharge can be achieved by flushing through the natural opening and a trial puncture used as a diagnostic and treatment method. In the latter case, after emptying the sinus, medications are introduced into it.

If conservative treatment fails, there is every reason to apply surgical methods. The operation involves restoring the architectonics of the nasal cavity to create normal nasal breathing and aeration of the sinuses. The patency of the natural anastomosis is restored using the methods of minimally invasive (endoscopic) surgery. To radical operation on the maxillary sinus should be resorted to as a last resort.

Advantages of the endoscopic method

One advantage of endoscopic sinus surgery over the traditional method is that it does not require a surgical incision. It is carried out using an endoscope, which allows you to observe the pathological process occurring in the sinus.

Another advantage of the endoscopic method is that it allows the cause of sinusitis to be treated directly. The doctor can directly see the pathological focus and remove it without resorting to an incision in normal tissues, which significantly reduces unnecessary trauma, speeds up the postoperative period, and reduces the risk of the operation itself and postoperative complications.

The method is characterized by the absence of an external scar, slight swelling after surgery and less pain.

The goal of endoscopic surgery is to widen the opening of the sinuses. Usually, the paranasal sinuses open into the nasal cavity with a thin bony canal covered with a mucous membrane. With inflammation, this membrane swells, and thus the exit from the sinus is closed. Endoscopic surgery allows you to expand the bony canal of the sinus. Therefore, even if the patient subsequently has inflammation of the nasal mucosa and sinus outlet canal or their allergic edema, there will be no blockage of the opening of the paranasal sinus. This greatly facilitates the further treatment of inflammation of the paranasal sinuses.

In addition, the instrumentation of endoscopic technology makes it easy to remove all kinds of tissues in the sinus cavity, such as polyps or cysts.

A recent improvement in the endoscopic technique of surgical interventions for diseases of the paranasal sinuses is a computer navigation system. It allows you to create a three-dimensional image of the paranasal sinuses on the monitor screen, which facilitates diagnosis and surgical intervention.

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 atheroma of the sinus described above.

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. No runny nose, but 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.

A deviated septum and the appearance of cysts or other neoplasms in the sinuses can be corrected with endoscopic surgery. This is a surgical procedure that carried out with the following symptoms:

dizziness;
headaches;
difficulty breathing through the nose;
sensations in the nose and in adjacent areas of discomfort;
with frequent colds;
frequent bleeding;
severe hearing loss.

This is a method of nose surgery that has been proven for decades and helps to improve it. respiratory functions. Clinic "First Surgery". Such an operation is carried out by experienced surgeons who guarantee the accuracy of all manipulations.

The benefits of endoscopy include:

the ability to eliminate defects in bone tissue;
high accuracy of all manipulations;
the expected effect of the treatment;
minimal blood loss;
reduction rehabilitation period.

The operation is carried out using a special flexible cord, at the end of which a camera is put on. During the operation, the surgeon observes the process through the monitor. He sees the inside of the nose well and can accurately remove any neoplasms that have arisen in the nose.

This is a proven technique that has been used since the mid-20th century in various branches of medicine.

When is endoscopic nasal surgery indicated?

An endoscopic nose operation is prescribed, the price of which is always individual, with a curvature of the nasal septum, sinusitis, a cyst found in the nasal sinuses. This is a convenient and effective technique that returns the nose to its inherent respiratory functions.

If a patient has inflammation of the maxillary sinuses or a curvature of the nasal septum, endoscopic surgery will correct these defects. In the treatment of nasal septum, it is one of the most reliable and proven.

At the clinic "First Surgery", doctors will first pass general diagnostics and method of treatment. To use an endoscope that helps the surgeon to see the entire structure of the nasal septum on the screen, where the signal from the endoscope camera is received.

Endoscopic operations of the nasal septum in the clinic "First Surgery"

An endoscopic operation is performed only with a curvature of the bone part of its entire skeleton for patients who have reached the age of 18 years. At this time, the bones of the facial part of the head stop growing, so it will be possible to eliminate emerging or congenital defects. Endoscopic surgery of the nasal septum has been performed for a long time and is constantly being improved.

An endoscopic method for eliminating curvature or other diseases has been known to doctors for more than half a century. This is a proven method of treatment that can return people to comfortable normal breathing and health.

Endoscopic surgery in the nasal cavity

On the website of the First Surgery clinic operating in Moscow, you can find out the cost of nasopharyngeal endoscopy. The price list indicates the approximate cost of such a medical service.

During the operation, the patient is in a supine position, the resection sites are processed local anesthesia. Endoscopic surgery of the nasal septum is performed at the clinic "First Surgery" for various indications:

the appearance of cysts and polyps;
development of sinusitis;
inflammation of the paranasal spaces.

Doctors of the clinic are ready to provide qualified assistance to each patient suffering from the above diseases.

The client is injected with local anesthesia, placed in a special horizontal chair, an incision is made in the right place and an endoscope is inserted. This is a small medical device that has a camera at its working end, from which an image is transmitted to the doctor's screen.

Operation on maxillary sinus(sinus rhinoplasty) - rhino surgical intervention, carried out for the purpose of rehabilitation, elimination of pathological contents and foreign bodies from the maxillary sinuses. In addition to eliminating the inflammatory process, this operation is aimed at restoring full nasal breathing. With a successful maxillary sinusectomy, the drainage function of the anastomoses of the maxillary sinus is completely restored.

Kinds

There are various ways of surgical intervention on the maxillary sinus:

classical Caldwell-Luc operation (performed through an incision under the upper lip);
endoscopic maxillary sinusectomy (performed by endonasal access, without incisions);
minor surgical manipulations (maxillary sinus puncture and its alternative — balloon sinusoplasty using the YAMIK sinus catheter).

Indications

Factors and diseases that are direct indications for surgery:

lack of effect from conservative methods of treatment of chronic sinusitis;
cysts of the maxillary sinus (formations in the form of vesicles filled with liquid);
the presence of polyps inside the sinus;
the presence of neoplasms (if there is a suspicion of malignant tumor a biopsy is performed)
foreign bodies of the maxillary sinus, which are a complication of dental interventions (fragments of the roots of the tooth, particles of dental implants, particles of filling material);
the presence of blood clots and granulations in the cavity;
damage to the walls of the maxillary sinus.

Most common cause, according to which an operation on the maxillary sinuses is prescribed, is sinusitis - inflammation of the mucous membrane of the maxillary sinus, as a result of which there is an accumulation of purulent exudate and the formation of hyperplastic changes in the mucous membrane.

Main symptoms

nasal congestion;
mucopurulent discharge;
increase in body temperature;
symptoms of general intoxication of the body (weakness, drowsiness, malaise, headache);
pain in the projection of the maxillary sinuses.

Preoperative preparation

Preparation for surgery on the maxillary sinuses includes a number of instrumental and laboratory research. Before surgery you will need:

computed tomography or radiography of the paranasal sinuses;
rhinoscopy;
complete blood count (including leukocyte formula and platelet count)
study of hemostatic function of blood - coagulogram;
general urine analysis;
analysis for the presence of HIV, syphilis, markers of viral hepatitis;
determination of blood group and Rh factor.

If an operation is planned for general anesthesia, in addition, it is necessary to make an electrocardiogram and consult with an anesthesiologist. It is very important to strictly follow the instructions given by this doctor, as their violation entails serious consequences.

Contraindications to maxillary sinusectomy:

the presence of a serious somatic pathology;
bleeding disorders ( hemorrhagic diathesis, hemoblastosis);
acute infectious diseases;
exacerbation of chronic diseases;
acute sinusitis (relative contraindication).

How is the operation

Small operations: puncture and its alternative - balloon sinusoplasty

The simplest surgical intervention on the maxillary sinus is a puncture (puncture), which is performed through the wall of the nasal passage with a diagnostic or therapeutic purpose. A more advanced method of restoring the drainage of the maxillary sinus is balloon sinusoplasty using a YAMIK catheter. The essence of this method lies in the atraumatic expansion of fistulas by introducing and inflating a flexible catheter. Further, a vacuum is created in the sinus cavity, this makes it possible effective removal accumulated purulent exudate. The next step after cleansing is the introduction of a solution into the sinus cavity medicines. This manipulation is carried out under the video control of endoscopic equipment, but can be performed without it, which makes it accessible to most patients. The undeniable advantages of this method are:

painlessness;
no bleeding;
maintaining the integrity of anatomical structures;
minimal risk of complications;
no need to stay in the hospital.

Endoscopic maxillary sinusectomy

This surgical intervention is performed by endonasal access, without violating the integrity of the wall of the maxillary sinus. Modern endoscopic technique allows highly efficient performance of rhinosurgical manipulations. Thanks to the use of long-focus microscopes and high-quality fiber-optic equipment, high-quality visualization of the surgical field is achieved, which minimizes the risk of injury to healthy tissues.

The sinus cleansing procedure is performed using modern rhinosurgical equipment: a coagulator (performing the function of cauterizing tissues and blood vessels), a shaver (a tissue grinder with a simultaneous suction function), forceps and other surgical instruments. This is followed by washing with antiseptic solutions with the addition of antibacterial drugs broad spectrum of action, proteolytic enzymes and corticosteroid hormones (in case of severe edema).

Classical surgical method

The classic Caldwell-Luc operation is performed by intraoral access. Most often, this method uses general anesthesia.

Main steps:

Formation of access to the maxillary paranasal sinus by excision of soft tissues.
Sanitation of the pathological focus (removal of polyps, granulations, sequesters, foreign bodies).
Collection of material for histological examination.
Formation of a full communication between the maxillary sinus and the lower nasal passage.
Installation of a drainage catheter for irrigation of the cavity with medicinal solutions.

Complications of radical maxillary sinusectomy:

the possibility of developing intense bleeding;
damage to the trigeminal nerve;
fistula formation;
pronounced swelling of the mucous membrane of the nasal cavity;
loss of sensitivity of the dentition and cheekbones on the part of the surgical intervention;
decreased sense of smell;
feeling of heaviness and soreness in the maxillary sinuses.

With minimally invasive interventions (endoscopic maxillary sinusectomy, puncture and balloon sinusoplasty, complications occur quite rarely.

Postoperative period

There are a number of measures to reduce the risk of recurrence of the disease and the occurrence of various complications:

irrigation (irrigation) of the nasal cavity with water-salt solutions;
desensitizing therapy (taking antihistamines);
topical application of topical corticosteroids;
antibacterial therapy;
taking drugs that strengthen the walls of blood vessels.

As a rule, the period of postoperative rehabilitation lasts about one month. Not recommended at this time

eating hot, cold, spicy foods;
perform heavy physical work (especially related to lifting weights);
visiting baths and saunas, swimming in the pool.

You should also avoid hypothermia and contact with patients with SARS. A good end to the rehabilitation period will be a sanatorium treatment at a seaside resort or a visit to a salt cave. Within a year after the operation, you should be observed by an otolaryngologist.