ENDOSCOPIC SINUS SURGERY (ESC)
What is Endoscope and Endoscopic Sinus Surgery (ESC)?
The endoscope is an instrument with light and optical lenses at the end, allowing you to see the image directly from one end to the other. Endoscopes of different thickness and length are used in many branches such as ENT, Gastroenterology, Urology, Orthopedics, General Surgery, Gynecology and Thoracic Surgery. In ENT, 4 mm and 2.7 mm diameter endoscopes are generally used. There are endoscopes with 0º, 30º, 45º, 70º, 90º and 120º angles depending on the placement of the lens at the end of the endoscope. Endoscopes provide a clear view of dark cavities, normal anatomical structures and pathological tissues that we cannot see directly in the nose. Endoscopes are combined with a camera system, the image is simultaneously transferred to the computer and monitor. Images can be enlarged and recorded in HD quality when necessary. Endoscopic sinus surgery using endoscopes for the sinuses around the nose is called surgery. It has been widely applied all over the world and in our country for many years.
When are Endoscopy and ESC Applied?
Endoscopes are used in the diagnosis and surgical treatment of many diseases of the nose, sinus and their neighbors. These; has been widely applied all over the world and in our country for many years.
Endoscopes are used in the diagnosis and surgical treatment of many diseases of the nose, sinus and their neighbors. These;
. Chronic Sinusitis (Unresponsive to medication)
. Recurrent Sinusitis
. Nazal Polip
. Antrochoanal Polyp
. Concha Reduction (Nasal meats reduction)
. Sinus Mucocele
. Nasal and Sinus Tumors
. Brain-Spinal Fluid Leakage (Cerebrospinal Rhinorrhea)
. Orbital Decompression (Recovering from oppression in thyroid ophthalmopathy)
. Optic Nerve Decompression
. Dacryocystorhinostomy (Opening of the obstructed tear duct)
. Koanal Atresia Repair
. Removal of Foreign Bodies in the Nose
. Nose Bleeding Control
. Pituitary Gland Tumors
. Skull Base Surgery
. Septal Crest (Endoscopic Septoplasty)
. Eustachian Tube Problems
What are the advantages?
Endoscopes can be performed completely through the nose without any incision in the nose and face. In addition, endoscopes can be reached more easily in areas that we cannot reach or do not see well by classical methods. It provides surgical intervention only for diseased tissues without damaging healthy tissues. Endoscopic surgery reduces the risk of complications and shortens the recovery time.
How To?
Operation; general anesthesia, local anesthesia or sedation can be performed without a complete anesthesia. The duration, scope, risks and preference of the patient is important in the selection of anesthesia. For example, in case of generalized nasal polyp or tumor, general anesthesia is applied, while nasal foreign body or septal crest can be treated with local anesthesia. Before the operation, an anesthesiologist's examination and some tests are used to determine whether there is an obstacle or risky condition. Before the operation, the patient's sinus tomography is taken and suppressed and hung in the operating room where the surgeon can see at any time. If necessary, tomography is performed during surgery to check our position in the nose and to avoid complications. In the operation, the endoscope is entered through the nostril and the necessary procedures are performed by seeing the tissues directly with the sensitive instruments developed for endoscopic surgery. The scope of the procedure depends on the disease and its extent. For example in chronic sinusitis; clogged sinus canals are opened, diseased tissues are cleaned without damaging intact tissues. In the nasal polyp; All polyp tissues that fill the nose and sinuses are cleaned without touching the healthy mucosa. In tumors, tumor tissue is removed with some intact tissue. Duration of surgery varies according to scope. For example, surgery for chronic sinusitis lasts approximately 1.5 hours. In endoscopic surgery, systems other than classical instruments can be used to shorten the duration of the surgery and increase the safety. Of them;
In microdebrider system; the tissues are shaved on the one hand and vacuum removed on the one hand. It is frequently used especially in common nasal polyps because it reduces both the operative time and the bleeding.
Surgical Navigation (Image Guidet Surgery); We can think of it as a navigation device used in vehicles. Just as the navigation device shows where we are constantly, we can see the location of the surgical instruments used in the nose in endoscopic sinus surgery in three dimensions. Electromagnetic and optical (infrared) system, there are two systems. In surgical navigation system; Before the operation, the patient's sinus tomography (to be more than 1 mm sensitive) is taken and loaded into the system, a special cap is placed on the patient's head during the operation. This allows us to monitor the position of our surgical instruments more accurately than 1 mm on the monitor during surgery. The most important advantage of surgical navigation is to reduce the risk of damaging these structures while cleaning diseased tissues close to the skull base and brain, eye and visual nerve, and large vessels, and therefore reducing serious complications. Surgical navigation is not required in routine endoscopic sinus surgery. Personal surgical navigation; I use it when necessary for recurrent nasal polyps, skull base and near the eye sinus tumors, repair of cerebrospinal fluid leakage, optic nerve decompression, and pituitary surgery (with brain surgery). The disadvantage of surgical navigation is that it prolongs the time and increases the cost due to preoperative preparation.
What happens after the recovery and what should be considered?
There may be slight pain after the operation and can be easily relieved with painkillers. In endoscopic surgery, there is no change in nose shape, swelling or bruising. At the end of the operation, self-melting pads are placed on the operation site and the nostrils remain open. However, if one or more procedures such as rhinoplasty (nasal esthetics), septoplasty (deviation surgery) and turbinate surgery are performed together with endoscopic surgery, flexible pads made of soft silicone are put into the nose (doyle splint). The middle of these pads are tubular, and if they are not obstructed by dried slime or clot, they can be breathed through the nose while buffered. If only septoplasty has been performed, tampons are removed after 2-3 days, if interventions to the nasal flesh (turbinate surgery) or if performed with nasal esthetics. Removal takes 10-15 seconds and is painless. You can stay in hospital for 1 day according to your follow-up. There may be bleeding from the nose for 1-2 days after the operation, the next few days mixed with slimy currents, followed by crusting in the nose. Depending on the scope of the operation, it may take 2-6 weeks. These shells can be cleaned by softening with saline. Frequent control and intranasal dressings in this process are crucial for a healthy recovery. Resting 7-10 days postoperatively is recommended. However, if you do a job that does not require effort and did not experience any postoperative problems, you can work after the 5th day, you can travel.
What are the results?
The results of endoscopic surgery vary according to the disease. Success in chronic or recurrent sinusitis is between 80-90%. Nasal polyps tend to recur, only 20-30% in polyps and 70% in polyp + asthma + aspirin allergy (sampter syndrome). Repetition time varies from person to person. In some patients, polyps may recur within 6 months after surgery, while in others it may recur after 5 years. The mean success rate of antrochoanal polyp is 95%. In addition to the disease, the experience of the surgeon is very important.
What Complications Can Be Seen?
The nose and its surrounding sinuses are anatomically adjacent to the eye and tear canal on the sides, the brain membrane and brain tissue on the ceiling, the carotid artery leading to the brain and the optic nerve leading to the eye. Because of these neighborhoods, there is a possibility of damage in endoscopic sinus surgery. The complications are divided into major and minor according to their severity. The probability of complications varies depending on the extent of the disease and the experience of the surgeon.
Major Complications:
. Orbital hematoma (accumulation of blood in the eyeball), Optic nerve (visual nerve) damage; loss of vision and blindness
. Damage to the eye muscles; Double sight
. Tear drainage due to tear duct damage (Epifora)
. Damage to the brain or brain tissue; Cerebrospinal fluid leakage (CSF fistula) (the most common major complication), Meningitis, Brain abscess, Cerebral hemorrhage, Air leakage into the brain (Pneumocephalus)
. Major vascular injury and bleeding
Minor Complications:
. Edema around the eyes, bruising, air leak
. adhesions; most common minor complication
. Nose bleeding
. Odor loss
. Infection
What is balloon synuplasty and when is it applied?
Balloon synuplasty is the procedure of opening narrowed sinus canals with the help of a catheter like balloon angioplasty applied to open the vascular occlusions. The balloon at the end of the catheter is placed in the sinus canal and inflated to expand the canal and allow the sinuses to drain. The procedure can be performed endoscopically with general or local anesthesia. However, general anesthesia is preferred. It can be combined with traditional endoscopic sinus surgery techniques. It can be applied in chronic sinusitis affecting the frontal (forehead), maxillary (cheek) and sphenoid (skull base) sinuses. There is no activity interaction in polyps or other diseases affecting the sinuses. After the procedure there is not much bleeding, you can go home on the same day and return to work the next day. Crusting, which occurs after endoscopic sinus surgery and lasts for several weeks, does not occur in this application. The disadvantage of balloon sinuplasty is that it can be applied only to certain sinuses and sinusitis cases and it brings additional cost. I personally prefer this method for isolated frontal sinusitis that does not respond to medication.
34AXX
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