Endoscopic surgery technique
Several authors such as Stammberger and Kennedy have modified the original ideas about surgical techniques and endoscopic sinus procedures based on Dr. Messenklinger’s work on the mucociliary flow and nasosinusal pathology. They suggested modifications ac
- PDF / 1,352,404 Bytes
- 9 Pages / 612 x 794 pts Page_size
- 118 Downloads / 233 Views
Endoscopic surgery technique
Several authors such as Stammberger and Kennedy have modified the original ideas about surgical techniques and endoscopic sinus procedures based on Dr. Messenklinger's work on the mucociliary flow and nasosinusal pathology. They suggested modifications according to their personal experience and ability in a manner of "the way I do it". Currently the trend is to do minimal surgery to remove the maximum amount of pathology. The problem with current surgical tendencies is that we have not been able to determine how much is "enough" and what the "limits" of our dissection should be to eliminate the pathology, maximize the patient's benefits and minimize the damage. This has made an anatomical model necessary to determine the correct progression of the dissection so we don't interfere with the physiology of the structures. The objective is to protect the natural trajectories of the mucociliary flow, as is the case of the final common pathway, which will lead to adequate mucociliary transport from the natural ostium of the maxillary sinus. By doing this we guarantee the best functional results in each case. Marsupialization of the transitional spaces is also an important step in modern surgery to minimize the damage from the procedures. The final objective of all sinus surgeries is to create direct drainage from the paranasal sinuses into the nasal cavity, and to resolve obstructive processes of key sites without necessarily modifying each individual cavity affected by the disease as it has been established throughout history (Fig. 1).
Recommendations for patient selection The ideal patient from our perspective, is one with recurrent infection and/or whose symptoms reappear 2 or three weeks after finishing adequate medical treatment. These symptoms may be headache with or without facial pain, sensation of periorbital pressure, persistent nasal obstruction, tubarian dysfunction, epiphora associated to obstruction and pain, as well as clinical symptoms that seem like nasal allergies but are due to chronic nasosinusal pathology. Because of this, it is important to stress adequate history taking, an integral physical exam and a systematic endoscopic evaluation. Although the physical exam may be normal, if the patient's symptoms persist albeit adequate medical therapy, it is useful to obtain a CT to obtain the diagnosis. We evaluate our patients with a tomographical
Fig. 1. Endoscopic surgical technique. Surgical equipment used during endoscopic procedures
C. Yañez, Endoscopic Sinus Surgery © Springer-Verlag/Wien 2003
32
Endoscopic surgery technique
Fig. 2. Endoscopic surgical technique. Note the septal deviation that partially obstructs the middle meatus. In this case the septum is initially displaced so as to obtain free surgical access
evaluation that includes three or four coronal cuts and two or three axial cuts that are 3 mm thick in the meatal ostium and 5 mm cuts elsewhere. These elements help us determine the best approach in each patient. Those with deformities or anatomical var
Data Loading...
