Al-Assad University Hospital Syrian Society conference 09-11/4/2009 Al-Assad University Hospital - Syrian Society conference 09-11/4/2009 Al-Assad University Hospital - Syrian Society conference 09-11/4/2009 Al-Assad University Hospital - Syrian Society conference 09-11/4/2009 How do you select the patient? • Diagnostic value of surgery : – Biopsy from unresectable large mass by endoscopic surgery, but we can get access to it by endoscope.
Al-Assad University Hospital - Syrian
Society conference 09-11/4/2009 How do you select the patient? • Therapeutic value of surgery – Chronic Sinusitis: • Sinus drainage and dilation of their ostii or making them confluent together. • Attention should be paid to major mucosal diseases and allergic tendency. • Correction the anatomic abnormalities according to the case: eg. inferior and middle turbinates enlargement, concha bullosa, inverted middle turbinates, septal deviation, maxillary sinus ostium occlusion, frontonasal duct occlusion. Al-Assad University Hospital - Syrian Society conference 09-11/4/2009 How do you select the patient? • Nasal polyposis. • Antrochoanal polyp. • Meningeal nasoethmiod or nasosphenoid fistula. • Mucocele and pyocele. • Lacrimal sac and nasolacrimal duct disorders. • Exophthalmus and lamina papyracea resection. Al-Assad University Hospital - Syrian Society conference 09-11/4/2009 Al-Assad University Hospital - Syrian Society conference 09-11/4/2009 When you should avoid endoscopic surgery • Bad general condition: unfitness to general anesthesia. • Malignancy especially large ones. • Inverted papiloma exceeding lateral wall of nasal fossa. • Inflammation of pure allergic origin with symptoms of strong inflammatory hypersensitivity. Al-Assad University Hospital - Syrian Society conference 09-11/4/2009 Patient preparation • Careful examination including endoscopy of nasal cavity by rigid or flexible nasoscope after mucosal decongesting. • Radiological study: CT, MRI with axial and coronal sections (especially coronal). • Medical therapy: antibiotics, topical and general steroids, topical saline serums, hypotensor therapy. Al-Assad University Hospital - Syrian Society conference 09-11/4/2009 Surgery • Patient position. • Surgeon and assistance doctors position. • Used endoscopes. • Decongestion packs 1/5000 (by endoscope). • Don't start surgery without complete rest.
Al-Assad University Hospital - Syrian
Society conference 09-11/4/2009 Al-Assad University Hospital - Syrian Society conference 09-11/4/2009 Al-Assad University Hospital - Syrian Society conference 09-11/4/2009 Surgery • Excellent knowledge of anatomy and identification of important landmarks. • Middle meatus, uncinate process, bullae ethmoidalis. • Surgery as needed, middle turbinates, uncinate process. Al-Assad University Hospital - Syrian Society conference 09-11/4/2009 Al-Assad University Hospital - Syrian Society conference 09-11/4/2009 Al-Assad University Hospital - Syrian Society conference 09-11/4/2009 Al-Assad University Hospital - Syrian Society conference 09-11/4/2009 Al-Assad University Hospital - Syrian Society conference 09-11/4/2009 Al-Assad University Hospital - Syrian Society conference 09-11/4/2009 Al-Assad University Hospital - Syrian Society conference 09-11/4/2009 Surgery • Assisted by suction rolling and eye ball observation. • Don’t take risk with surgery under bleeding. pack, wait and ask help from the anesthetic staff. • Don’t work without complete orientation of important anatomic landmarks. • Assistance by palpation and proprioception (deep sensation). • Trying to get benefit from the presence of cavity to get into the neighbouring cavities. Al-Assad University Hospital - Syrian Society conference 09-11/4/2009 Surgery • Assisted by pressing the eye ball.
Al-Assad University Hospital - Syrian
Society conference 09-11/4/2009 Al-Assad University Hospital - Syrian Society conference 09-11/4/2009 Al-Assad University Hospital - Syrian Society conference 09-11/4/2009 Surgery • Preserving the intact mucous membrane as possible and avoid trauma to septum or lateral wall of middle turbinates. • When you suspect with any complication, move quickly and don’t hesitate to ask for help. • Continuous assistance of Radiological examinations (observing scan during the operation). • small packs as needed especially in the middle meatus. Al-Assad University Hospital - Syrian Society conference 09-11/4/2009 Postoperative • Patient discharge: brief hospitalization, prescription of antibiotics with or without steroids and analgesic. • Packing removal after 48-72 hour or more in case of CSF leak. • Instant cleaning with a fine and nontraumatic suctions. • Prescription of nasal doushes-saline serum with or without topical steroids drops. Al-Assad University Hospital - Syrian Society conference 09-11/4/2009 Follow up • Follow up after a week, crusts removal and suction cleaning. • Follow up after two weeks and examination by endoscope after cleaning and crusts removal. • Follow up as needed especially in nasal polyposis. • Continuous follow up. Al-Assad University Hospital - Syrian Society conference 09-11/4/2009 THE END