Endoscopic sphenoid sinus surgery -otolaryngology-healthfrom.com brain anoxia

• contents

• 1. Indications

• 2. Preoperative preparation

• 3. Surgical procedures

• 4. Complications

• 5. Postoperative care

Sphenoid sinus position deep, adjacent to the skull base of anatomical structure, surgery is difficult. With the CT, MRI and endoscopy in the clinical application of the sphenoid sinus disease diagnosis and treatment level has made great progress.

Endoscopic sphenoid sinus surgery has the advantage of simple surgical approach, injury is small; to avoid the nasal ethmoid sinus approach incision. More than the previous nasal cavity directly to the anterior sphenoid sinus surgery has a good lighting, safe.


• departments: ENT

• surgery: other

• surgical site: head

• number of operations: 1 time

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• anesthesia: local anesthesia / general anesthesia

• surgery duration: 1-2 hours / time

• hospitalization: need

• recovery time: 1-2 weeks

Treatment of diseases: sphenoid sinus 1. Indications

1. Isolated sphenoid sinusitis.

Sphenoid mucous cyst.

3. Sphenoid sinus disease.

4 sphenoid cerebrospinal fluid leakage. 2. Preoperative preparation

1. Endoscopic examination to understand whether the nasal cavity abnormalities.

2. Coronal and horizontal CT scan to determine the nature and extent of sphenoid sinus lesions. 3. Surgical procedures

Such as solitary sphenoid sinusitis, no ethmoid sinus disease, or associated with posterior sieve local disease who use nasal approach. If accompanied by ethmoid sinus lesions, can be used through the ethmoid sinus or directly through the sphenoid sinus natural mouth and sieve combined approach.Brain anoxia

1. Sphenoid sinus natural mouth approach

(1) with adrenaline dough to fully shrink the olfactory cleavage mucosa, the application of stripping or aspirator head to the lateral turbinate to the lateral fracture. Such as middle turbinate back is too large, feasible mid-nose partial resection. Such as with the posterior screen limitations of the disease, can be further bite after the sieve gas room, remove the lesion. Place 4mm 30 ° endoscopy from the medial side of the turbinate and insert between the nasal septum to find the upper turbinate. In order to fully reveal the sphenoid sinus opening, the application of turbinate scissors and ethmoid sinus bite the upper part of the upper turbinate resection to expand the surgical field.Brain anoxia accurate positioning of the anterior sphenoid sinus is the key to surgery. The sphenoid sinus opening is located between the upper turbinate and the septum of the butterfly septum, about 1 ~ 1.5cm on the upper edge of the nostril, about 7cm from the anterior nasal spine, 30 ° from the anterior nasal spine.

(2) upper turbinate back end can be used as a sign to find the natural opening of the sphenoid sinus. The sphenoid sinus opening is usually located in the narrow space between the upper turbinate stump and the nasal septum. Can be used to attract a small suction tube or small spatula probe sphenoid sinus opening, inserted into the sinus aspiration of secretions. From the nose to the sphenoid sinus wall, about 9cm or so.Brain anoxia

(3) into the sphenoid sinus, the use of different sizes of the sphenoid sinus bite forceps inward, down the bite of the sphenoid sinus anterior wall, expand the sphenoid sinus opening to the left and right diameter 5 ~ 8mm, if necessary, bite the nasal septum side of the bone quality. Up and down diameter to 10mm to reduce the possibility of re-occlusion. To enlarge the extra care should be careful, so as not to open the sphenoid sinus wall, complicated by cerebrospinal fluid leakage. As long as the upper turbinate stump inside the operation, the damage to the optic nerve and internal carotid artery risk is minimal. Can be inserted into the 70 ° mirror to observe the lateral wall of the sphenoid sinus or with the sphenoid sinus edema exploration sphenoid sinus outside the presence of bone, there can be gradually bite out.Brain anoxia be careful not to damage the optic nerve and internal carotid artery.

(4) in order to prevent the ostium to narrow, can be bitten in the anterior wall of the sphenoid sinus before the first side of the lower edge of the ostium were done on both sides of the incision of about 1cm separation of the ostium below the visceral clothing made in a butterfly the anterior wall of the anterior wall of the visceral flap. Bite the spine outside the anterior wall of the opening of the bone, after surgery with viscose flap into the sinus, covering the bone margin.

(5) if the sphenoid sinusitis, fully open the anterior wall of the sphenoid sinus, do not have to remove the sinus mucosa; if mucous cysts, open the anterior wall of the sphenoid sinus and cyst wall, full drainage of cysts, as far as possible to remove the wall, do not have to remove all cyst wall.Brain anoxia the sinus cavity lesions thoroughly cleaned up, the polyps, fungal clumps, pus, cyst fluid clean. But should be careful when stripping the lateral wall to prevent damage to the internal carotid artery exposed to the wall.

(6) proper hemostasis, fill the nasal cavity as appropriate.

2. After the ethmoid sinus approach in the endoscopic group before and after the completion of ethmoid sinus resection, you can reach the anterior sphenoid sinus. However, the ethmoid sinus approach usually can not directly reach the sphenoid sinus anterior wall of the natural opening of the site, but slightly on the side. Can be identified butterfly angle (sphenoethmoid angle, that is, after the group of sinus top and forefront of the sphenoid sinus was 90 ° intersection), the anterior wall of the sphenoid sinus is usually light blue, suggesting that there is a gas gap behind the bone wall.Brain anoxia after the group of ethmoid sinus on the inside of the dura mater, usually pale yellow or white. Open the front of the sphenoid sinus, should be as much as possible by the next, under. Find the sphenoid sinus cavity, and then down, inward expansion of the anterior sphenoid sinus.

If the anterior wall of the sphenoid sinus is not easy to identify, can be in the middle of the middle of the turbinate, in the sphenoid sinus to find the sphenoid sinus natural opening, and then through the sphenoid sinus natural opening down the front of the sphenoid sinus. 4. Complications

The incidence of complications of endoscopic surgery varies from 0.4% to 6.4%. The main reason is unskilled operation and unfamiliar to the anatomy, lack of full understanding of the anatomical variation, resulting in significant anatomical damage, resulting in a variety of different complications.Brain anoxia the most common are:

1. Eye complication

(1) orbital periosteal injury: orbital orbital orbital fascia integrity of the general will not appear intraorbital complications; if with orbital fascia injury, the formation of eyelid ecchymosis, intraorbital hematoma, eyeball, eye movement disorders, diplopia , periorbital subcutaneous emphysema, orbital infection and lead to optic neuritis caused by blindness and other obstacles may be blind.

(2) visual impairment: gasification of the posterior ethmoid sinus and sphenoid sinus lateral wall and the optic nerve is closely related to the treatment group after the ethmoid sinus and sphenoid sinus can easily damage the optic canal uplift or optic nerve caused.Brain anoxia but also due to posterior hematoma, increased intraocular pressure, leading to omental vascular occlusion and ischemic visual decline, or even blindness. In addition, there are local anesthesia drugs to the eye arterial spasm leading to blindness.

(3) nasolacrimal duct injury caused by tears: nasolacrimal duct of the bony wall is relatively hard, as one of the characteristics of the forward expansion of the maxillary sinus when careful not to damage the nasolacrimal duct. Open the nasal qiqi room, pay attention not to damage the dacryocyst.

Intracranial complications

(1) cerebrospinal fluid rhinorrhea: sieve top of the bone and other parts of the ethmoid sinus compared to the color yellow. Local anesthesia surgery, the screen top is sensitive to pain, is an important feature to identify the top of the screen.Brain anoxia ethmoid sinus polyps or cysts compression sieve plate becomes thin, defect, removal is very easy to damage the sieve plate, dural caused by cerebrospinal fluid leakage.

(2) intracranial hematoma: department of intraoperative damage to the internal carotid artery and anterior cerebral artery caused by.

(3) intracranial infection: multiple skull base injury late complications.

(4) intracranial nerve tissue injury: occurred in the meningeal brain bulge, skull base tumor surgery. The literature has been reported nasal endoscopic surgery caused by meningitis, intracranial hemorrhage or direct brain injury and other serious complications.

3. Nasal complications

(1) bleeding: injury before the injury sieve before the artery can cause more violent bleeding.Brain anoxia sarcoplasmic reticulum near the end of the retraction of the eyes, can cause intraorbital hematoma. Therefore, the operation should pay attention to identify the anterior sarcema artery, careful not to damage. Treatment of sphenoid sinus lesions when the bleeding should be admitted to the internal carotid artery rupture bleeding.

(2) nasal adhesions: the most common middle turbinate front and lateral wall and inferior turbinate and nasal adhesions. Mostly due to nasal stenosis, mucosal injury, intraoperative retention of tissue too much, especially in the nasal surgery postoperative mucosal reactive swelling, easy to make contact with the wound mucosa caused by adhesion, adhesion in the olfactory cleft or nasal meatus. 5.Brain anoxia postoperative care

1. After the sphenoid sinus mouth, olfactory fill filled with sponge or antibiotic oil gauze.

2. After surgery, as appropriate, fill the middle of the nose, stuffing materials have swelling sponge, can absorb bleeding ling, gelatin sponge and oil gauze.

3.24 ~ 48h after the removal of stuffing.

4. Apply antibiotics as appropriate.

5. 1 ~ 2d after cleaning the nasal cavity 1 times.

6. Remove the nasal packing after the addition of nitrofurazone ephedrine ephedrine nasal drops nasal drops 5 to 6 times / d, a total of 5 ~ 7d.

7. Rinse the nasal cavity with saline every day.

8. Apply hormones (systemic or local) as appropriate.

9. Oral dilute mucin 300mg, 3 times / d.

10. At least half a year after follow-up, in case of small polyps or scar formation, should be promptly treated.Brain anoxia