Endoscopic examinations and manipulations on the maxillary sinuses. Operation on the maxillary sinus: who needs it and how it is performed What is the operation on the maxillary sinus dangerous

Sinusitis is a very common problem in ENT practice. In one form or another, a tenth of the adult population suffers from it. And half of the cases among all the pathology of the nose is sinusitis - inflammation of the maxillary sinus. Given the mass of unpleasant moments that the disease delivers to patients, increased attention is paid to its treatment. But often conservative methods are powerless, and the issue can only be resolved surgically. What kind of operations are there, when they are carried out, how exactly and what they give later - these are the main questions that should be discussed.

The maxillary sinuses are paired sinuses that communicate with the nasal cavity. They are the largest among the rest, occupying almost the entire volume of the upper jaw. From the inside, the sinuses are covered with a mucous membrane and filled with air. The main functions of the sinuses are: participation in nasal breathing, warming the air, creating resonance (voice formation).

If their mucous membrane of the sinus becomes inflamed, then a disease develops - sinusitis. It occurs with the participation of the microbial factor and against the background of related problems (anomalies in the structure and injuries of the nose, pathology of the dentition, a decrease in the body's immune reactivity). Exudate (often purulent) begins to accumulate inside the cavity, or hyperplastic processes form. This leads to a violation of all sinus functions and the appearance of a number of unpleasant symptoms:

• Difficulty in nasal breathing.
• Discharge from the nose.
• Headache.
• Temperature rise.
• Weakness and malaise.

Such signs are characteristic of an acute process or an exacerbation of a chronic one. And in a state of remission, the clinical picture becomes not so bright, although nasal congestion and discharge persist. Sinusitis can occur with complications, in which the inflammatory process passes to neighboring areas (otitis media, frontal sinusitis), infectious pathology of other organs (pneumonia) and neurovegetative reactions develop.

Indications and contraindications

Inflammation of the maxillary sinus can be treated conservatively. Antibiotics are prescribed, vasoconstrictor nasal drops are drained and washed with antiseptics using a special catheter (YAMIK-therapy), physiotherapy is used. And the surgical treatment of sinusitis is used when the above remedies have shown their ineffectiveness. In addition, indications for surgery include:

• Chronic sinusitis (polypous, caseous, necrotic, cholesteatoma or mixed forms).
• Secondary purulent complications (orbital, intracranial).
• Structural anomalies of the sinuses or nasal cavity (with a violation of the outflow of exudate).
• Foreign bodies in the nasal passages and sinuses.
• Odontogenic nature of the inflammatory process (problems with the dental system).

Each case is considered individually. The doctor forms the most optimal treatment program for the patient, which will suit him, taking into account all the characteristics of the organism. After all, it should be understood that surgical intervention has certain limitations. Contraindications to surgical manipulations can be:

• General infectious diseases.
• Refractory arterial hypertension.
• Blood diseases (coagulopathy).
• Immunodeficiencies.
• Diseases of internal organs in the stage of decompensation.
• Endocrine disorders (severe diabetes mellitus).

But these conditions are relative, because after the appropriate correction of violations, the intervention does not pose a danger to the body. But in any case, you need to carefully evaluate the benefits and risks, making an informed decision.

When conservative correction of sinusitis is ineffective, a decision is made on surgical intervention.

Methods

There are several techniques that can be recommended to patients. What kind of operation for sinusitis is necessary in a particular case, only the doctor decides. But the general essence is the same - the cleansing of the maxillary sinuses from pus and pathological growths, the elimination of anatomical defects and the normalization of the outflow of natural secretions. All invasive interventions can be divided into internal (endonasal) and external (extranasal) methods.

Sinus puncture

Semi-surgical methods include puncture of the maxillary sinus. It remains a widespread and effective treatment for sinusitis. Before the procedure, the puncture site (the side wall of the middle nasal passage) is lubricated with a local anesthetic for pain relief. Then the doctor makes a hole with a puncture needle, penetrating into the sinus.

The contents are aspirated and taken for examination, and the sinus is washed with antiseptic solutions (furacillin, Dimeskid, Chlorophyllipt). Additionally, broad-spectrum antibiotics (Augmentin, Cedex) are injected into it, if the exudate is thick, then proteolytic enzymes (trypsin, chymotrypsin), and with severe edema, glucocorticoids (dexamethasone, hydrocortisone). In total, no more than 7-8 punctures are recommended. If the purulent discharge persists, then a more radical treatment of sinusitis is required.

Endoscopic method

The maxillary sinus can be penetrated through endoscopy. Then the wall of the sinus of the nose is not disturbed, everything happens through natural openings. The endonasal method is the most gentle and is carried out through the use of modern fiber-optic technology, long-focus microscopes and special instruments. To cleanse the sinuses, various nozzles are used: a coagulator, a shaver, forceps, etc. The operation is carried out under constant visual control, which allows you to remove pathological formations within healthy tissues without causing major damage, which reduces the risk of adverse consequences.

Within two weeks after the endoscopic operation on the maxillary sinus was performed, the patient should be observed by an ENT doctor. He will prescribe a prophylactic course of antibiotics and will monitor how the healing is going. To improve the discharge of crusts and secretions, the maxillary sinuses can be washed with antiseptics and saline. And within six months, you will have to instill drops with topical corticosteroids to prevent the inflammatory process.

Traditional operation

The most radical method of surgical treatment is the traditional operation for sinusitis (according to Caldwell-Luc). It is performed in a hospital under local or general anesthesia. Access for maxillary sinusectomy is carried out from the vestibule of the oral cavity, above the alveolar process of the upper jaw (right or left). In this place, a small hole is made through which the sinus cavity is inspected and the pathological formations are eliminated.

In chronic sinusitis, the cells of the ethmoid labyrinth are also changed, which are also removed. For adequate drainage, an anastomosis is applied between the sinus and the lower nasal passage, and a gauze swab moistened with an antiseptic or antibacterial ointment is left in the cavity. A day later, it is removed. With odontogenic sinusitis, the operation may be accompanied by a plastic defect in the lower wall of the sinus. The patient stays in the hospital for a week. He is given washings, antibiotics, anti-inflammatory and antihistamines are prescribed.

Radical surgery gives more freedom to surgeons and allows you to clean the sinuses well, but at the same time it is more traumatic for the patient.

Effects

When deciding on a surgical intervention, one should be prepared for its consequences. But it is not at all necessary that they will occur. It all depends on the technique of performing the operation, preparation for it, rehabilitation measures, qualifications and experience of the doctor. The most common complications are the following:

• Bleeding.
• secondary infection.
• Loss of sensation in the nose and upper lip.
• Decreased sense of smell.
• visual disturbances.
• Fistula formation.

To avoid negative consequences after surgery, it is important to follow the doctor's recommendations in everything. Great importance is given to oral hygiene and rinsing with antiseptics (especially with radical maxillary sinusectomy). In addition, it is necessary to take all prescribed medications and be on time for examination.

Thus, operations for sinusitis can be different. What treatment is indicated in a particular case, only the doctor will say. After an appropriate examination, he determines the type and extent of surgical intervention in order to cure sinus inflammation as efficiently and with minimal risks.

Sinusitis is by far the most common type of sinusitis and is an inflammatory process in the maxillary paranasal sinuses. They are paired, so the disease can affect both each of them individually, and two at once. At the same time, complications of sinusitis can affect the nasopharynx, orbit, skull bones and even the brain due to the fact that there are a lot of different passages in the skull that connect almost all the structures in it. It should be noted that with a high risk of such complications, as well as with a severe course of the disease, surgical treatment of sinusitis is often used.

Treatment of sinusitis in adults and children implies an integrated approach, that is, the effect on the purulent inflammatory process occurs from different sides. The following treatments are commonly used:

• etiological, aimed at the causative agent of the process or the elimination of factors in the development of the disease;
• symptomatic, allowing to deal with the main clinical manifestations;
• prophylactic, fixing the effect of the therapy.

Complex treatment can be carried out conservatively - with the help of drugs. In severe cases, it can be surgical - a puncture of the maxillary cavity is performed or an antrectomy - an operation to remove the mucous membrane. The name lies in the process of opening the sinus. It can be performed both traditionally and endoscopically. Endoscopic surgery for sinusitis eliminates the need to open the sinus through the mouth. It allows you to normalize aeration (air enrichment) of the sinuses and other structures of the respiratory system.

The operation on the maxillary sinus involves the removal of structures such as:

• soft tissues that have undergone inflammatory processes, infection and damage;
• foreign bodies that served as a starting factor for the disease. These may also include carious teeth, in which case the operation should be performed in conjunction with the maxillofacial surgeon;
• destroyed bones or sections of bones to create artificial connecting passages in order to improve the outflow of mucus and aeration;
• cysts and polyps in cavities.

Sinus puncture

In addition to surgical treatment by maxillary sinusectomy or endoscopic surgery, it is widely used, which is called puncture. It can be prescribed for both therapeutic and diagnostic purposes, and is a very effective method of treating pathology. The puncture allows you to effectively treat purulent sinusitis if it is performed correctly.

Manipulation is done under local anesthesia. In addition to eliminating the contents of the cavity, it is washed and irrigated with antibacterial and antiseptic solutions. After the puncture, a course of antibiotic therapy with drugs with a wide spectrum of action is prescribed. This is due to the fact that pathology can develop due to the introduction of various microorganisms.

Local anesthesia is done by introducing a turunda with an anesthetic into the nasal passage. It eliminates pain and discomfort. Sometimes sensations of having a foreign body in the nose may develop during the procedure. It should be noted that the doctor relies solely on his tactile sensations and experience during manipulation, and his wrong actions can lead to undesirable consequences.

An ordinary syringe can be used as equipment for removing the contents of the sinus. He also introduces antibacterial agents and antiseptic solutions into the maxillary sinus.

Endoscopic surgery is a minimally invasive technique and allows intervention with minimal consequences. After performing such treatment, there are no visible consequences of the intervention, since the endoscope (device for performing the operation) is inserted through the nasal opening and does not damage the mucous membrane of the nasal passages. Video images are usually displayed on a monitor connected to the instrument.

According to medical statistics, sinusitis after such an operation is much less likely to be complicated or aggravated. It should also be noted that the price of this method of treatment is much lower than the traditional sinusotomy. This allows it to be used much more frequently. However, there is also a negative point - not all hospitals are equipped with devices for endoscopic surgery, which means that sometimes you have to treat sinusitis with a conventional operation, and the patient will have to pay the full cost of such treatment.

The duration of the intervention takes from half an hour to one and a half hours, depending on how strongly the inflammatory process has developed. The role and individual characteristics of a person play a role. How long the operation will last - only an experienced specialist will say, but not always, and he will be able to predict the exact time the patient stays on the operating table.

More often, this method of treatment is used in adults, which is due to the anatomical and psychological characteristics of the child's body.

The procedure consists in conducting an endoscope, an optical instrument, into the nose. Using this device, the doctor can see the condition of the mucous membranes, the presence of pus, foreign objects and other defects. The device can be equipped with cameras that allow you to display video on a special monitor, as well as take photos and record the progress of the operation. This allows you to save information for the purpose of using it for study.

With the help of an endoscope, you can enter instruments for the treatment of sinusitis into the maxillary sinus - a laser, a scalpel and scissors. Such an intervention usually proceeds without any pain, so it does not require additional anesthesia. Local anesthesia may be used if the patient's pain threshold is low.

Maxillary sinusectomy

In the case of low efficiency of conservative therapy, as well as the absence of effects from the puncture of the maxillary sinus and endoscopic treatment of sinusitis, surgical treatment of the disease is usually prescribed - maxillary sinusectomy. Very often it can be called the most effective, but also the most dangerous method of treating pathology. The essence of such an operation is to open the maxillary sinuses through the oral cavity and eliminate the inflammatory focus and affected soft tissues, foreign bodies. Very often such an operation is required.

It consists of two stages: opening access and cleaning the sinus. Depending on where the inflammatory focus is located, two methods are used - through the oral cavity (it is used much more often) and through access on the face. It should be noted that such an operation is very difficult to perform, since the site of intervention is very limited by external structures, and the walls of the cavity itself are lined with a mucous membrane, which can be very easily damaged, provoking a complication of the disease.

To date, access through the oral cavity is in the first place, which is associated with its cosmetic viability. The second option can be done if it is necessary to better examine the contents of the sinus. Combined treatment is also possible, when an endoscope is inserted into the maxillary sinus through external access or through the access of the oral cavity.

The operation is performed under anesthesia.

The contents of the affected maxillary sinuses are removed using surgical instruments - a Volkmann spoon, which looks very similar to an ordinary spoon.

Since the surgical treatment is performed under anesthesia, it is absolutely painless. The sinus is completely open to the doctor, which allows him to perform all the necessary procedures to treat the disease and prevent the development of relapse processes. It is also possible to carry out medical procedures on other parts of the respiratory system, which are located in close proximity to the maxillary sinus.

In severe cases, surgical treatment of sinusitis is the only way to get rid of the disease. Health workers try to resort to surgery very rarely. If a person suffers from sinusitis, doctors select an individual treatment using medications. These can be antibacterial agents, sprays and nasal drops.

Sprays and liquids for washing the nasal cavity have a good effect. Such methods of therapy are indicated if surgery is contraindicated for the treatment of sinusitis.

The need for surgery

If a person suffers from sinusitis, the sensations are not pleasant. The presence of inflammation impairs the quality of life. The operation is carried out in the following cases:

• . This refers to a form that is characterized by frequent exacerbations. A sluggish long course causes the formation of various abnormal phenomena in the tissues. It can be adhesions, cysts or polyps. In the future, neoplasms not only prevent the release of mucus from the sinuses, but also "feed" the chronic course.

• A large amount of exudate in the nasal cavity, which begins to rot. Mucus that does not have an exit from the sinus begins to gradually accumulate. In turn, this puts pressure on the walls of the nose and provokes headaches. If pus accumulates, it may break into neighboring healthy walls. The palate, upper jaw, eye sockets, and also the meninges can suffer.
• Surgeons can use this method to treat sinusitis in the presence of various neoplasms in the nasal cavity. They can be both congenital and acquired. Congenital formations - a tumor, cysts and a pathological change in the bone septum. Acquired - getting various objects into the sinuses.

Very often, the material that is used in dentistry gets into the sinuses. It can also be devices used for dental treatment. Failure to be careful leads to the fact that fragments of the teeth also fall into the paranasal sinuses. Thus, small foreign bodies become the cause of chronic inflammation.

In what cases it is impossible to carry out the operation

From surgical treatment of sinusitis should be abandoned in the following cases:

• the presence of infectious diseases;
• blood diseases;
• deficiency of the human immune system;
• various diseases of the internal organs.

It is important to understand that such states of the body are relative. If the cleaning of the maxillary sinuses was successful, in accordance with all the rules, this does not pose any danger to a person in the future.

Before proceeding to the operation, it is necessary to evaluate the benefits and risks of its implementation.

Based on the findings, the final decision is made.

Types of surgery

If sinusitis is not amenable to medical treatment, the patient is scheduled for surgery. In this case, one of the existing methods of surgical intervention can be selected.

Using this method, surgeons remove all unnecessary neoplasms in the maxillary sinuses. This technique has been used for 100 years. It got its name from the merger of the names of two surgeons. Independently of each other, they described the detailed technique. The main feature of the operation is a large space for various manipulations by the doctor.

Sinus puncture

In surgery, another type of surgical treatment is often used - sinus puncture. The medical term is puncture. This method is easy to carry out and less traumatic. A similar method of treatment is prescribed if the patient accumulates pus in the sinus cavities. After the puncture, pus is removed, and the cavities themselves are washed with antiseptics.

The puncture has another feature. While washing the nasal cavity, the doctor may take mucus from the sinus for bacteriological analysis. This allows you to determine the pathogen that provoked the disease and prescribe the necessary antibacterial agents for therapy. Correct, will help prescribe effective therapy.

Treatment with an endoscope

Endoscopic surgery for sinusitis is a surgical intervention using thin instruments, at the end of which there is a camera. This is one of the most popular modern methods of treatment. It has a number of advantages:

1. Absence of blood during surgery.
2. The operation with an endoscope does not affect the anatomy of the sinuses and preserves their physiology.
3. If necessary, the procedure can be repeated many times.

Despite the effectiveness of the treatment, the method has two significant drawbacks:

1. Lack of specialists. Such a technique requires a person to constantly improve knowledge and skills. Unfortunately, not every doctor has been trained and is ready to perform operations.
2. The high cost of the operation. Optical systems require expensive maintenance.

To date, public institutions that are equipped with such equipment can be counted on the fingers. It remains to be hoped that medicine will continue to develop and endoscopes will become available to everyone. Despite this, doctors continue with patients in other ways.

Efficiency

In some cases, curing sinusitis with conservative methods is impossible or does not make sense. This happens when material for filling teeth enters the nasal cavity. In such cases, surgery is performed using an endoscope. It is the most effective treatment.

Medicine is developing in such a way as to cause as little functional and cosmetic harm to the patient as possible during the operation. Based on this, endoscopic techniques are being developed, after which cosmetic defects are absent in the patient. Of course, surgical treatment leaves scars behind. If this is done with an endoscope, the incisions remain inside the nasal cavity and cannot be seen.

Postoperative period

Patients who need surgical treatment are interested in how operations are performed for sinusitis. As a rule, everything goes well. Recovery of the body after surgery proceeds without complications. After the operation, the patient is prescribed a treatment that contributes to a speedy recovery.

Postoperative treatment includes drugs that are prescribed for conservative therapy:

• vasoconstrictor nasal drops;
• antibacterial agents;
• antihistamine medicines.

If the operation was successful and the patient tolerates the postoperative period well, that's not all. To avoid the recurrence of the disease, you must carefully monitor your health. In winter, dress warmly. If you have sinusitis, immediately consult a doctor for help. Only a specialist can prescribe an adequate treatment.

If the patient suffered from chronic sinusitis, it is recommended to periodically undergo sanitary treatment. Physiotherapy that is carried out in such institutions is a kind of prevention.

The elimination of sinusitis can be carried out using various operations. The type of surgical intervention is chosen by the doctor in each individual case. For this patient is sent for examination to determine the type of sinusitis. The effectiveness of the operation and the speed of recovery of the body depend on this.

A cyst in the maxillary sinus is a common occurrence and it requires a certain type of treatment. This is due to the fact that the cyst is a hollow neoplasm with liquid contents. It is often formed due to blockage of the glands of the mucous surfaces of the maxillary sinus. As an internal secret, it can be simple, as well as a purulent or serous component.

Removal of a cyst of the maxillary sinus

A cyst in the maxillary sinus does not yet have conservative methods of therapy.

There is an opinion among doctors that with an asymptomatic course of this neoplasm, it can remain unchanged for many years. In some cases, resorption or reduction of the cyst was observed.

In asymptomatic cases, doctors usually offer dynamic monitoring. If, over time, the neoplasm grows, then it must be removed by one of the methods practiced in the hospital or clinic. Medicines cannot cure this disease.

With a false type, the neoplasm can completely disappear if the root cause is eliminated, for example, if it is caused, then when it is eliminated, this cyst will also disappear without a trace.

Indication for surgery

If in the picture this peculiar tumor has increased by more than 1.5 cm in diameter, and there are also symptoms of inflammation (pain, discomfort and pressure, decreased visual function) - this is a direct indication for surgery.

A cyst in the maxillary sinus, with further growth without surgical intervention, can lead to:

• Purulent processes inside the neoplasm;
• Pressure on the optic nerves, which leads to the development of diplopia;
• The development of permanent due to pressure on the nerve endings;
• Blockage of the mucus ducts between the sinus and nose, leading to a severe form with a high risk to life;
• To increase pressure on the bones of the skull, which leads to their deformation.

In rare cases, when exposed to bones, their death was noted. Most often, a disease such as a cyst does not show symptoms and is on examination in order to identify other pathologies. But if the cyst began to grow, then it can fill the entire space of the sinus and clog it.

Examination before surgery

The examination before the operation consists of:

• (blood donation is of a general type, for biochemistry, coagulogram, hepatitis and other items);
• X-ray examination (does not always give accurate data);
• genimorography;
• biopsies.

Endoscopy, MRI and CT are considered the most accurate methods for diagnosing cysts in the maxillary sinus. A biopsy is taken of tissue from the neoplasm to determine the type of tumor and its contents.

Methods of carrying out

The type of operation depends on a number of factors, including the type of neoplasm, the availability of endoscopic equipment and the required experience of doctors. In private, less traumatic and safer endoscopic removal of the cyst is usually offered.

X-ray of maxillary sinus cyst

Radical maxillary sinusectomy

In public hospitals, the most commonly used classic or radical maxillary sinusotomy according to the Caldwell-Luc technique. Radical maxillary sinusotomy involves a serious intervention in the face. The incision itself is made under the upper lip, after which the anterior part of the sinus wall is opened and the cyst is removed through the hole formed.

If we talk about the pros, then this is the complete removal of the neoplasm with the elimination of the main symptoms. Also, the operation under the MHI policy is free.

The disadvantages of such a procedure are already more:

• Local anesthesia during such an operation does not always give the proper result of anesthesia, judging by the reviews;
• The consequences after this type of operation are more pronounced: the face swells, pain, bleeding and much more are observed;
• The rehabilitation period is longer than other methods;
• Due to the overgrowth of the hole in the place where the bone is opened, scars disrupt the functionality of the tissues, which leads to the development or.

Those who have tried both classical and endoscopic maxillary sinusectomy always prefer the latter. But with the laser here is a moot point.

laser

Some clinics offer laser removal of cysts in the maxillary sinus. But here you need to take into account a number of nuances:

• The diameter of the laser beam is 600 microns, and therefore the removal of even a small cyst takes a long time, which is simply unprofitable and inefficient;
• To get to the cyst with a laser, you need to puncture the sinus, but even this will not guarantee that the equipment can reach the neoplasm;
• The beam heats up to 300 degrees, and therefore the procedure is extremely painful even with anesthesia;
• In the process of manipulation, there is a sharp burnt smell.

Therefore, laser removal of a cyst is a method that is used even less frequently than radical maxillary sinusotomy, with all its shortcomings.

Endoscope

Endoscopic surgery is the most effective and least traumatic method for removing a cyst in the maxillary sinus.

There are no scars from cuts, and rehabilitation takes place in an abbreviated version, since the main postoperative symptoms are not so pronounced.

The endoscope is inserted through the nose through the anastomosis (natural drainage hole) directly to the sinus. So with the help of an instrument, the cyst is removed and the tissue is removed in the same way.

If the neoplasm is caused by a diseased tooth, then a classic one is performed with access through a hole of 4-5 mm under the upper lip.

Carefully! On the video, the operation to remove the maxillary sinus cyst by endoscopic method (click to watch):

[hide]

Puncture

A puncture is not so much the removal of a cyst as its emptying. With a puncture, it is possible to partially or temporarily remove the symptoms, puncture the neoplasm. The contents accordingly flow out through the needle, but the walls of the tumor themselves remain. Therefore, sooner or later they will again be filled with liquid in the same amount. Therefore, this is not a replacement for the operation, but only a temporary measure.

Recovery and rehabilitation

Rehabilitation depends largely on what type of operation was performed. With classical maxillary sinusectomy, patients for a long time (up to several weeks) feel the effects of side effects from manipulation.

But with the endoscopic method, the symptoms usually disappear within a week after the intervention. The basic rules for recovery to prevent the development of complications are:

• Scheduled doctor visits
• Apply appropriate medications;
• Refusal for the recovery time from places with temperature changes (saunas, baths, solarium, and so on);
• Compliance with the temperature regime for food and drink (only warm);
• Refusal of alcohol.

It is important to understand that it is impossible to clean the sinuses from the formed crusts on your own, as this is fraught with infection and other complications.

Possible complications and consequences

The main consequences of the operation:

• bleeding;
• Swelling of the face (or one half of it);
• Numbness of the tip of the nose and cheeks;
• Leakage of cerebrospinal fluid from the nasal passages.

If we talk about complications, they appear most often:

• secondary infection;
• Deterioration of the general condition;
• Voice change.

Some factors are temporary and go away on their own, and some require adequate and timely treatment according to the situation.

Many patients are wondering what types of interventions there are, what are their advantages and disadvantages. Let's try to answer these questions.

Indications and contraindications for surgery

Like any medical procedure, surgery for the treatment of sinusitis has its own indications and contraindications.

The indications include:

• lack of effect from the use of sprays, anti-inflammatory drugs, physiotherapy methods;
• the appearance of complications of the secondary type, which are caused by a chronic infectious process in the paranasal sinuses;
• the formation of cysts containing infected exudate;
• the appearance of complications of the intracranial type;
• closed sinusitis in;
• active spread of infection throughout the body;
• the presence in the nasal passages of foreign objects that prevent normal breathing.

Manipulation has a number of contraindications. They are determined on an individual basis, while assessing the general condition of the patient, the presence of diseases of the circulatory, endocrine, hematopoietic systems, recent surgical interventions in history, the presence of active infectious processes in the body. Contraindications can be both temporary and permanent. Many patients cannot decide whether it is worth doing surgery for sinusitis at all? The decision regarding the advisability of surgical intervention in a particular case should be taken by the attending physician.

Puncture

A puncture or, as it is also called, a puncture is one of the classic operations performed with sinusitis. It is often regarded by doctors as a therapeutic and diagnostic manipulation, since during its implementation it is possible to obtain material for bacteriological examination and the choice of further therapy tactics.

The intervention is performed under local anesthesia or under general anesthesia, depending on the general condition of the patient and the presence of additional diseases. In most cases, local anesthesia is preferred. During the manipulation, the doctor makes a puncture in the maxillary sinus and removes the purulent contents.

Basically, the operation bears fruit after the first time, but sometimes it needs to be repeated. If after 5-6 manipulations recurrences of sinusitis still develop, they resort to more serious ways to solve the problem.

After the suction instrument is removed from the sinus, it is mandatory to wash it. Basically, a solution is used, with which you can neutralize a significant part of pathogenic microorganisms and significantly reduce the risk of relapse.

Balloon sinusoplasty

A technique that has recently become actively used for sinusitis. The principle of intervention is very simple: it is necessary to expand the sinuses of the nasal cavity, which are in a narrowed state due to the disease.

The doctor, using special flexible conductors that prevent trauma to the nasal cavities, introduces special balloons into the sinuses. When the balloon is in the right place, it is inflated with air using a cuff, which allows you to expand the diameter of the anastomoses and eliminate pus and accumulation of microorganisms by washing. After the expansion of the sinuses, it is also possible to increase aeration, which has a positive effect on the healing process.

The intervention has become especially popular due to the absence of trauma to the natural structures of the nose, as well as the almost complete absence of complications.

Yamik catheter

Another minimally invasive method that helps with sinusitis. The device consists of three tubes of various lengths, two of which have special cuffs.

The catheter is inserted through the nasal passages, the cuffs are inflated, creating a small vacuum, thanks to which accumulations of pus can be easily removed from the sinus affected by the disease. To facilitate the introduction of the catheter and reduce swelling, mucous membranes can also be treated with an antiseptic. After removal of pus, mandatory washing of the sinuses is carried out.

The operation itself is so simple that it can be performed even in a clinic. There is no need for anesthesia, as the intervention is completely painless.

Endoscopic surgery

Unlike previous methods, endoscopic intervention for sinusitis is referred to as a radical way to solve the problem, even despite its low trauma. It is mainly resorted to in the event that previous methods of treatment have been ineffective. For the intervention, it is necessary to use an endoscope, therefore, in outpatient conditions, its implementation is impossible.

The device, equipped with a camera, allows you to control the course of the intervention from the inside. Thanks to this, it is possible to preserve the maximum amount of healthy tissue and cope with pathological changes. In this case, the doctor will clearly understand what he is doing, not acting blindly. During an endoscopic operation, usually not only pus is sucked out of the sinuses, but also the overgrown epithelium, which is no longer able to fully perform its main functions, is removed.

Laser

Laser therapy for sinusitis is a type of endoscopic intervention. Laser exposure is understood as the action on the mucous membranes of specially focused beams of light with a certain frequency and high intensity. During irradiation, a microburn of the mucous membranes of the nose appears, which allows you to destroy the pathogenic microorganisms that led to the development of sinusitis.

It is important to understand that the intensity of the burn during laser treatment is so small that the patient does not feel anything at all. In most cases, strong anesthetics are used only if the patient is very sensitive to pain.

Such an intervention has several advantages:

• several consecutive sessions of laser treatment can reduce the thickness of the mucous layer, which improves the aeration of the sinuses, reduces the intensity of reproduction of pathogenic microorganisms in them;
• thanks to external influences, it is possible to improve the processes of blood circulation and, as a result, regeneration;
• due to the presence of a foreign object, local immunity is activated, which also contributes to the destruction of pathogenic microorganisms.

Operation Caldwell-Luc

The Caldwell-Luc operation, used for severe sinusitis, is the most radical of all types of interventions. It is carried out only if the mucous membranes of the sinuses are so affected by the disease that other methods of treatment have been ineffective. Such changes occur most often with odontogenic, cystic or fungal sinusitis.

Manipulation is performed under general anesthesia. The patient is in the supine position. The doctor, moving the upper lip, makes an incision under it from the side on which the diseased sinus is located. Then, using a chisel or drill, the doctor is able to examine the maxillary sinus through the bone tissue and remove pus and pathologically altered mucous membrane from it. Intervention is considered the most traumatic and complications are usually associated with it, ranging from intolerance to anesthesia and ending with purulent inflammation of the postoperative wound.

Postoperative care

The specificity of most operations performed with sinusitis is such that very little external damage is caused to the body. Thanks to this, postoperative care for the patient is minimized and does not present any difficulties.

A person who has undergone an operation to remove sinusitis is allowed to go home a few hours after the end of the manipulation. Rarely, if unforeseen complications develop, you have to stay in the hospital for a longer period.

After discharge, the patient is prescribed the same drugs that were used during the main therapy of sinusitis.

These include:

• broad-spectrum antibiotics (penicillins, macrolides, cephalosporins, fluoroquinolones);
• vasoconstrictor drugs (,);
• antihistamines (Zodak, Zirtek);
• local glucocorticosteroids ().

Sinusitis is a disease that often requires surgery if conservative methods of therapy are ineffective. The decision on which of the intervention methods is suitable for a particular patient is best left to the doctor. Only a specialist will be able to determine the presence of indications and contraindications for surgery based on the individual characteristics of the patient and the stage of the disease. It is not recommended to refuse surgical intervention if the doctor raises the question of its necessity.

Useful video about the treatment of sinusitis