Endoscopic operations on the paranasal sinuses. Endoscopic sinus surgery

Endoscopy - from the ancient Greek "look inside" - this is a magnificent modern method diagnostics, based on the examination of natural cavities with a special endoscope device. 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 with computed tomography and, moreover, an 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 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 carried out as 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 potentials of surgery, its possible consequences, explain the course of the operation and the features of the course postoperative period. 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 irrigations, instillation vasoconstrictor drops, physiotherapy and regular monitoring by an ENT doctor.

For the treatment of such ailments, an operation on the maxillary sinus is often prescribed. Despite the fact that this is an extreme measure of therapy, it is still quite common due to the specifics of the disease. Let us consider in more detail the features of the conduct and consequences of such an operation.

They got their name in honor of the English surgeon anatomist Nathaniel Gaymore, who studied the pathology of the paranasal sinuses. It was he who first described the disease, which was later named sinusitis.

The sinuses in question, as previously mentioned, are the largest and occupy almost the entire cavity of the upper jaw. For each person, the indicators of their shape and volume are individual. They depend on anatomical features skull structures.

The structure of the paranasal sinuses

The paranasal sinuses are connected to the nasal cavity with the help of a narrow channel - fistula.. The sinuses are lined with a mucous membrane that ensures the elimination of pathogenic microorganisms, and in healthy condition filled with air.

Reference. If fistula long time clogged, this contributes to the accumulation of mucus and its thickening, after which it turns into pus. This process is fraught with inflammation of the walls of the sinuses, which leads to the development of various diseases.

It consists of internal, anterior and posterior, upper and lower walls, and any violation in each of them leads to certain health complications.

The maxillary sinuses perform the following functions:

cleansing the air while breathing- the air mass, before entering the lungs, is cleaned, heated to the required temperature and increases the humidity index;
odor recognition- a feature of the surface of the sinuses is that they are able to enhance the functioning of the olfactory receptors;
protective function- lies in the fact that all harmful microbes and viruses settle on the mucous membrane, which are subsequently excreted from the body.

In addition, the paranasal sinus is involved in the formation of voice and timbre. It is the voids of the nasal sinuses that are responsible for the implementation resonance function.

The mucosa of the sinuses contributes to the speedy entry medicines due to rapid absorption into an extensive system of blood vessels located in it.

When is an operation necessary?

Before prescribing an operation, the doctor analyzes all the characteristics of the disease and the need for the procedure in each case.

Without a justified need, endoscopic surgery on the maxillary sinus is not performed.

This is an extreme method of treatment, which has to be resorted to by specialists in such reasons:

With a chronic pathology, that is, long-term treatment of the patient is ineffective, while various inflammatory processes in the nose do not stop.
Availability in maxillary sinuses various neoplasms and growths which can only be removed mechanically.
Inflammatory processes in the maxillary sinuses are provoked by various jaw pathologies or other dental diseases.
When complications of sinusitis, for example, with the threat of purulent masses entering the skull, which leads to more serious consequences.

Based on the foregoing, it can be concluded that endoscopy is performed only when necessary, mainly in a situation where there is a threat to acquire more serious health consequences.

Performing endoscopic surgery

Endoscopic or intranasal surgery- type of surgical intervention related to the group minimally invasive, because after its implementation there are no obvious tissue damage or serious violations in the anatomical structure of the nose.

Negative consequences with this type of surgery develop much less frequently than with abdominal surgery. Among other things, this type of treatment is suitable for most patients because it is less expensive.

This procedure can be performed as stationary conditions as well as in outpatient clinics.

Reference. Endoscopic surgery duration is from 30 min. up to 1 h 30 min. The duration depends on the anatomical features of the maxillary sinuses of the patient and the experience of the doctor.

The order of the surgeon during the operation is as follows:

an endoscope is placed in the nose(special optical instrument). With its help, the doctor visually controls the progress of the operation;
a surgical instrument is inserted into the nose, with which the procedure itself is performed. The choice of instruments depends on the type of disease. Usually applied: laser- tissue burning scalpel or burrs- removal of formations.

This operation is performed without anesthesia, as it is painless. In some cases, when a patient has a low pain threshold, then the procedure is carried out under local anesthesia .

Scheme of endoscopic surgery on the maxillary sinus

After endoscopic surgery, as well as after abdominal surgery, observation of the patient for several weeks. This is necessary so that the specialist can monitor the patient's condition and remove blood clots and mucous masses in time. During this period, the patient must comply special diet necessary to increase the recovery capabilities of the body.

Endoscopic surgery on the maxillary sinus: consequences

The consequences of refusing surgery can be much worse than possible complications postoperative period

After the operation, it is worth preparing for the fact that in the first few days breathing through the nose will be impossible, and on the first day after removing the tampons, tears will flow uncontrollably.

But such phenomena pass very quickly.

Attention! It is strictly forbidden to use nasal drops with a vasoconstrictive effect after surgery without the permission of a doctor.

Practice shows that endoscopy in rare cases causes any complications. However, such a factor cannot be completely excluded, since sometimes there may be observed the following consequences:

Bleeding from the nose. The phenomenon is not terrible and is easily stopped by the doctor with the help of an ordinary swab.
Blood in the eyelids. Sometimes blood enters the eye sockets, but leaves it on its own and does not cause any problems.
The occurrence of inflammation in the sinuses. In the event that there is obvious discomfort, then this should be reported to the doctor immediately.
Nose crust formation.
Re-formation purulent cyst , which leads to another operation.
Adhesion formation between the wall and septum of the nose.
Headache, in case of nerve damage during surgery.

The above effects are extremely rare., but if this happened, then a timely appeal to a specialist will help eliminate the problem.

Of course, any operation for the body is stressful, and specialists do not prescribe surgery without special need. However, there are cases when such a procedure cannot be dispensed with.

In this regard, endoscopy is the most gentle method of treating various diseases of the maxillary sinuses.

Optical methods for examining the paranasal sinuses in last years are becoming more widespread. In combination with other diagnostic methods, they help the doctor to make an accurate diagnosis and carry out the necessary treatment. Endoscopy is indispensable in complex diagnostic cases, with discrepancies in clinical picture disease and results.

Despite the fact that the procedure is relatively safe and minimally invasive, it is still traumatic (for the insertion of the endoscope, the sinus wall is punctured, as with a conventional puncture), and general anesthesia is often used for its implementation. That is why there are certain indications for endoscopic examination, which the doctor takes into account when prescribing this type of examination. Currently, otorhinolaryngologists perform endoscopy of the maxillary and frontal sinuses.

Modern devices are complex technical devices equipped with special optics with a wide viewing angle, video recorders, digital video signal converters, and various auxiliary tools. Thanks to this device, the doctor can directly examine the sinuses by receiving an image on the monitor screen. In otorhinolaryngology, rigid endoscopes are commonly used to examine the paranasal sinuses, which retain their shape during the procedure.

Goals of endoscopic examination of the sinuses

The paranasal sinuses are located in the human body in such a way that it is impossible to examine them without the help of special devices. It is endoscopy that helps to solve this problem. Typically, a specialist performs this procedure to achieve the following goals:

early detection of the pathological process in the sinuses;
resolving issues differential diagnosis and taking the contents of the sinus for analysis (to isolate the pathogen and determine its sensitivity to antibacterial drugs);
biopsy of suspicious areas and morphological examination;
preparation for surgery or control of treatment after it.

Indications for use

Endoscopy of the sinuses allows the doctor to examine the mucous membrane of the paranasal sinuses and timely diagnose the pathological process.

When prescribing an endoscopic examination, the ENT doctor carefully examines the patient and studies the history of the disease, and then determines the need for the procedure. Indications for diagnostic endoscopy are limited, consider the main ones.

Clarification of the diagnosis in case of damage to the sinuses of the unknown origin (when using simpler methods it is not possible to establish the cause of the disease).
Sinus injuries.
Anomalies in the development of the paranasal sinuses.
Polyposis.
Carrying out various medical procedures.

Methodology

Preparation of the patient for endoscopic examination includes the toilet of the nasal cavity and anesthesia. Penetration into the paranasal sinuses can be performed under general intubation anesthesia or local anesthesia in combination with low-dose tranquilizers or barbiturates.

For endoscopy maxillary sinus in most cases, access through its front wall is used. This is due to the peculiarities of its structure.

To do this, using a special trocar, a hole is drilled between the third and fourth teeth with rotational movements.
Then, an endoscope with an optical resolution of 0 to 70 degrees is inserted into the resulting hole through the trocar sleeve.
The specialist examines the walls of the sinus, evaluates the color and relief of the mucous membrane, identifies the affected area (if any) and performs all the necessary manipulations (tissue sampling for analysis, opening of the cyst, etc.).
At the end of the procedure, the trocar is carefully removed.
The perforation site is not sutured.

The doctor also receives important information during the examination of the anastomosis of the sinus with the nasal cavity. At the same time, its size, the presence or absence of polyposis growths and other pathological changes in the mucous membrane of the anastomosis. The data thus obtained make it possible to determine the tactics of managing the patient. If during endoscopy there is an opportunity to eliminate a limited pathological process or to free and expand the anastomosis, then the procedure ends there. If the specialist reveals extensive changes, then this may be an indication for a wider surgical intervention.

Conclusion

Endoscopic examination of the paranasal sinuses is an original diagnostic method, which makes it possible to inspect with an increase in all details of a complex configuration. By conducting a study from different angles of view, the doctor receives information about all hard-to-reach or anatomically narrow places of the sinuses and can assess not only their condition, but, if necessary, perform microsurgical intervention.

Endoscopic nose surgery- one of the methods of treatment of diseases of the sinuses and nasal cavity.

According to statistics, the risk of various diseases of the nasal cavity begins to increase dramatically in people aged 25 years and older.

The specialists of our clinic have many years of successful experience in the treatment of various pathologies of the nose and paranasal sinuses. We will tell you in detail what endoscopic surgery of the paranasal sinuses is, how and why it is performed, how postoperative rehabilitation takes place, we will select a comprehensive and effective method treatment individually for each patient.

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How is endoscopic nasal surgery performed and what are its advantages

The main instrument of the endoscopic method for the treatment of nasal pathologies is the endoscope and special micro-instruments. An endoscope is a device consisting of a tube filled with fiber optics and equipped with an eyepiece on one side and a camera on the other. There are about 15-20 microinstruments for each operation, each of which allows for a low-traumatic action on one or another structure of the nasal cavity. The smaller the injury, the faster and safer everything will heal.

The endoscope is inserted into nasal cavity the patient, which allows the specialist to personally observe the state of the tissues of the nose, sinuses and mucous membranes, determine the source of infection, and also remove pathological formations.

Endoscopic sinus surgery has many advantages over traditional sinus surgery. surgical treatment. In order to remove the focus of pathology, the specialist does not need to make external incisions. As a result, the period of rehabilitation of the patient after endoscopy is much shorter (1-2 days of hospitalization), and his mucous membrane heals much faster. In addition, this technique is less painful. After such an operation, there are no stitches, which means that there are no scars. The risk of infection is also minimal, because there are no open wounds. It should be noted the absence of postoperative edema or their insignificance, so you can quickly return to your normal lifestyle, go to work.

Endoscopic nasal surgery has another important advantage. Most of these operations are performed without anesthesia. This means that you don't have to think about possible allergies on anesthetic drugs and the damage they cause to the patient's body. Often the price of endoscopic operations is lower than the cost of interventions using laser radiation.

Endoscopic surgeries are performed only under general anesthesia , but the latter is well tolerated by all age groups without exception.

The endoscope does not change the shape of the nose, as, for example, a viewing mirror, and therefore is an accurate diagnostic tool. Examination with its help delivers minimal discomfort to the patient, even if it is a child, because this instrument almost does not come into contact with the mucous membrane. Initially, the nasal cavity is examined with an endoscope with direct optics, and then with an instrument with the possibility of angular vision. Modern endoscopes are computer-navigated, which makes it possible to obtain a three-dimensional image of the nasal valve and increase the accuracy of the operation.

Indications for endoscopic sinus surgery

One of the reasons when surgery may be needed is the proliferation of mucosal tissue, or hypertrophy. That is why polyps appear in the nasal cavity and sinuses, and if they are large and protrude into the nasal cavity, a person practically cannot breathe through the nose. Since polyps grow slowly, nasal breathing is also broken slowly, and its violation often attracts attention when the process is seriously started.

Also, the need to use endoscopic surgery can cause infections. The paranasal sinuses communicate with the nasal cavity through thin bony canals that are covered with a mucous membrane. The mucous membrane expands with any infections respiratory tract and blocks sinus ventilation. That is why we feel nasal congestion, and the process of breathing through the nose is difficult, headaches also appear, pain sensation in the sinus area, snoring may occur.

The purpose of endoscopic surgery is not only to treat any pathology of the nasal cavity, but, more often, to widen the bony canal of the sinuses. If in the future the patient develops infections of the cavity, including allergic edema, the sinus canal will be opened and ventilation will be maintained.

Contraindications for endoscopic surgery are chronic diseases airways, disease of cardio-vascular system and epileptic pathologies in the stage of decompensation.

If you feel pain or discomfort in the paranasal sinuses, experience problems with nasal breathing, this may indicate a pathology of the nose or paranasal sinuses. The specialists of our clinic will complete diagnostics, will accurately determine the cause of these symptoms and say whether there is a need for an operation on the paranasal sinuses. Remember that nasal pathologies in the initial stages are practically asymptomatic! Be attentive to your health!

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Complications after endoscopic sinus surgery

In rare cases, endoscopic operations may have complications, such as bleeding. As a rule, to prevent them, the operated area is plugged. However, if the patient has poor blood clotting or is taking drugs that affect this factor, bleeding will be due to this. In any case, before the operation, it is necessary to tell the doctor about the characteristics of the body and the medications taken.

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 of the 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 treated with 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.