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SURGICAL TREATMENT Dr. Ghulam Saqulain E.N.T Surgeon, Capital Hospital

Surgical treatment chronic sinusitis

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Page 1: Surgical treatment chronic sinusitis

SURGICAL TREATMENTSURGICAL

TREATMENT

Dr. Ghulam Saqulain

E.N.T Surgeon, Capital Hospital

Page 2: Surgical treatment chronic sinusitis

SURGICAL TREATMENT

“Surgical treatment should be withheld as far as possible. However, if conservative treatment does not succeed in curing the patient in due course of time, or if external signs of sinusitis or intracranial complications threaten, surgical treatment should become an urgent necessity”.

Page 3: Surgical treatment chronic sinusitis

SURGICAL OPTIONS

Surgical Options

Procedures on the maxillary sinuses

to treat disease.

Procedures to correct causative anomalies

Page 4: Surgical treatment chronic sinusitis

Procedure to deal with obstructive pathologies in a hope

to remove cause of disease:

Procedures on the osteomeatal complex

Procedure on SeptumProcedures on the turbinates

Functional endoscopic sinus surgery.

•Septoplasty•SMR

•Turbinectomy•SMD•E/C•SMR

Procedures on neighboring structures.

•Adenoidectomy•tonsillectomy

…SURGICAL OPTIONS

Page 5: Surgical treatment chronic sinusitis

…SURGICAL OPTIONS

Procedures to deal with

Sinus disease

Antral LavageIntranasal antrostomy Sinoscopy

Cald- well luc procedureDenkersJensen-Horgan

procedure

Page 6: Surgical treatment chronic sinusitis

…SURGICAL OPTIONSPROCEDURES ON THE MAXILLARY SINUSES

• Antral Lavage (Proof Puncture):

– It may open the sinus ostium at least temporarily and clear any mucopurulent material (alsoprovide sample for C/S or H/P)

– Concomittant medical treatment is necessary or otherwise the saline left in the sinus will merely reinfect

– An indwelling polythene tube fed throughthe cannula into the sinus allows relpeated washouts .

Transnasal approach via. Medial wall of maxilla.

Sublabial approach via. anterior wall of maxilla.

Page 7: Surgical treatment chronic sinusitis

….PROCEDURES ON THE MAXILLARY SINUSES

– Principle: The principle of the treatment is to restore normal mucosa to the sinus linning. This allows the cilia to waft out through the osteum any residual infection. If this is not possible ie., when the mucosa has become irreversibly changed then mucosa needs to be removed.

• Sinoscopy• Intranasal antrostomy:

– A large dependent opening in the medial wall of the antrum is made in the inferior meatus.

– This allows good aeration of the maxillary sinus. It allows ciliary motion to be restored but adequate removal of all irreversibly changed antral lining is not possible.

Page 8: Surgical treatment chronic sinusitis

• CALDWELL-LUC or RADICAL ANTROSTOMY OPERATION:– Sublabial approach to maxillary antrum– Intranasal inspection and disease clearance– Antrostomy

• DENKER’S– Sublabial approach to the anterior angle between bony nose and antral

walls.– Partial removal of bony pyramidto provide common opening into the

antrum and nasal passage.• JANSEN-HORGAN

– Caldwell-Luc operation– Opening and exanteration of posterior and middle ethmoid cells via the

antrum– Intranasal exanteration of anterior and agger ethmoidal cells.

….PROCEDURES ON THE MAXILLARY SINUSES

Page 9: Surgical treatment chronic sinusitis

INDICATIONS:• Radical cure of chronic sinusitis• Removal of F.B, usually the root of a molar or premolar

tooth, from the sinus lumen.• Inspection and biopsy of suspected neoplasm.• Surgery for dental and other cysts involving antrum• For adequate removal of antrochoanal polypus.• To approach to adjacent structures.

CONTRAINDICATIONS:• Should not beperformed until after the teeth of

secondary dentition have erupted.

….PROCEDURES ON THE MAXILLARY SINUSES CALDWELL-LUC’S APPROACH

Page 10: Surgical treatment chronic sinusitis

…CALDWELL-LUC’S APPROACH

ANAESTHESIA:

•General anaesthesia with oro-tracheal intubation or naso-tracheal intubation on unaffected side and cuff inflated.

• A throat pack to avoid spillage of blood and secretions into the larynx

OPERATION:

•Supine positon with head and neck flexed on trunk

•Local anaesthetic with 1:200,000 adrenaline solution infiltrated to soft tissues under upper lip

•Lip retraction and sublabial incision 4 cm above the canine teeth.

•Removal of anterior wall with electric drill.

Page 11: Surgical treatment chronic sinusitis

…CALDWELL-LUC’S APPROACH

•Antrum cleared of disease and mucosa removed

•Antrostomy opening developed.

•Wound packed with BIPP impregnated pack brought out via nasal cavity.

•Nasal packing done.

•Dressing done.

Page 12: Surgical treatment chronic sinusitis

Fromthe Doctors Forum Of

E.N.T Department