Diseases of the sinus cavity
Acute rhinosinusitis usually begins as virus infection, so that bacteria (Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus) would secondarily settle on inflamed mucosa, and the disease passes through a clinical picture of a bacterial disease. If the defense forces of an organism are not strong enough or if an acute rhinosinusitis is inadequately treated, the disease goes into a chronic phase, and then it is much more difficult to treat it.
The classic forms of surgical treatment of inflammation of paranasal sinuses with complete removal of diseased mucous membranes, today, have made way to the so-called functional endoscopic sinus surgery (functional endoscopic sinus surgery-FESS). The basic principle of this surgery is to achieve maximum effect with as little intervention as possible.
After a detailed endoscopic examination and a detailed CT scan, under the control of a rigid endoscope (optical probe), in general anesthesia, we enter the nasal cavity. The largest part of the intervention is performed at the level of the structure of the middle nasal corridor, in which there are openings of the greater part of the sinus cavities. It is an ostiomeatal complex.
After removing the processus uncinatus and ethmoid bulla, as well as hyperplastic mucous membranes, access to the cavities of the maxillary and lower part of the frontal sinus, as well as the front ethmoid cells, is enabled. Two principles of endoscopic sinus surgery are essential: to enable as much ventilation of the synovial cavity as possible and to provide conditions for the best secretion of the drainage.
By fulfilling these two principles, conditions for the recovery of chronic mucous membrane of the sinus are created.
Also, the anatomical variations that were the predisposing factor for difficult ventilation and drainage of the sinus can be removed or corrected by endoscopic route. After surgery of the sinus performed in the endoscopic way, small tampons from the gauze or other natural materials are placed in the nasal cavity. They need to prevent nose bleeding, as well as developing the outgrowths. They are removed from the nose after two, or after four days, depending on the severity of the operation. After removing the tampon, in the nose is put or saline or preparation of artificial sea water for the purpose of the nasal cavity toilette and acceleration of the epithelial mucosal healing process. During surgery, when they are in general anesthesia, patients do not feel pain. After wakening up from anesthesia, the pain is lower intensity and short duration.
Application of endoscopic surgery in the treatment of chronic inflammation of the sinus also has some limitations. These are primarily severe fungal infections of the sinus cavity with a predominant penetration to the cranial cavity or eye socket. Then it is then necessary to completely eliminate not only the fungus accumulation, but also completely remove the chronic mucous membrane of the sinus. Severe chronic inflammation of the mucous membrane of the frontal sinuses, which cannot be accessed by the endoscopic route, is also an indication for the application of external and radical surgical procedures. After endoscopic surgery, patients are ready to work after two weeks. After radical surgery, the recovery lasts from three weeks to a month.
Word of doctor
PhD Milica Čelebić
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