Ebook Office-Based rhinology: Principles and techniques (Part 2)
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Office-Based rhinology: Principles and techniques (Part 2)
Ebook Office-Based rhinology: Principles and techniques (Part 2)
CHAPTERIn-Office Treatment of Post-Endoscopic Sinus Surgery IssuesRobert T. Adelson James N. PalmerIntroductionEndoscopic sinus surgery (ESS) that pre Ebook Office-Based rhinology: Principles and techniques (Part 2)eserves native anatomy and sinonasal mucosa to the greatest degree possible has become the universally accepted surgical modality by which chronic rhinosinusitis (CRS) is addressed. Inherent to this operation is the understanding, by both patient and surgeon, that operative procedures arc adjunctive Ebook Office-Based rhinology: Principles and techniques (Part 2) to the medical management of an underlying inflammatory disorder. Similarly, the postoperative care of patients undergoing ESS remains akin to a moviEbook Office-Based rhinology: Principles and techniques (Part 2)
ng target. The idealized postoperative sinus cavity can only be achieved by active participation in medical management and office-based minor surgicalCHAPTERIn-Office Treatment of Post-Endoscopic Sinus Surgery IssuesRobert T. Adelson James N. PalmerIntroductionEndoscopic sinus surgery (ESS) that pre Ebook Office-Based rhinology: Principles and techniques (Part 2)moval of material that may predispose to either cicatricial occlusion of sinus ostia or re-infection of a paranasal sinus. Our postoperative procedures are aligned with rhe currentconcept of functional ESS that emphasizes not just improving the patency of sinus ostia to facilitate the egress of mucu Ebook Office-Based rhinology: Principles and techniques (Part 2)s, but, more importantly, to enhance the penetration of medicated topical irrigations.Although ESS is the widely established standard of care for theEbook Office-Based rhinology: Principles and techniques (Part 2)
surgical management of CRS, its postoperative management is less well characterized. There are wide variances between surgeons with regard to both medCHAPTERIn-Office Treatment of Post-Endoscopic Sinus Surgery IssuesRobert T. Adelson James N. PalmerIntroductionEndoscopic sinus surgery (ESS) that pre Ebook Office-Based rhinology: Principles and techniques (Part 2)or surgical interventions to control the underlying disease process. In the absence of blinded, prospective, disease-matched, controlled studies with validated outcome measures at long-term follow-up, there is no substantial evidence to guide postoperative debridements.1’2Our routine postoperative c Ebook Office-Based rhinology: Principles and techniques (Part 2)are involves a regimen of weekly debridements until the endoscopic examination normalizes. Adjustment of rhe riming, degree, and frequency of debridemEbook Office-Based rhinology: Principles and techniques (Part 2)
ents is best relegated to clinical68 Office-Based Rhinology: Principles and Techniquesassessment of patient factors, anatomic findings, extent of the CHAPTERIn-Office Treatment of Post-Endoscopic Sinus Surgery IssuesRobert T. Adelson James N. PalmerIntroductionEndoscopic sinus surgery (ESS) that pre Ebook Office-Based rhinology: Principles and techniques (Part 2)ile maximizing the removal of retained secretions, bone chips, bridging clots, and early synechiae. Patients arc followed over time and both the medical management of the underlying inflammatory disorder is modified according to patient symptoms and rhe endoscopic evidence of disease. Office-based s Ebook Office-Based rhinology: Principles and techniques (Part 2)urgical interventions are introduced when surgically created ostia become critically narrowed or the natural course of healing deviates from desired gEbook Office-Based rhinology: Principles and techniques (Part 2)
oals. Inherent to achieving postoperative success is that rhe goals of the surgeon and patient remain mutually aligned, as postoperative office-based CHAPTERIn-Office Treatment of Post-Endoscopic Sinus Surgery IssuesRobert T. Adelson James N. PalmerIntroductionEndoscopic sinus surgery (ESS) that pre Ebook Office-Based rhinology: Principles and techniques (Part 2) will require a prolonged period for complete healing. Caution should be exerted during routine postoperative debridements to avoid extending an area of epithelial loss. It has been demonstrated that avulsion of epithelium beneath mucous crusts occurs in 23% of specimens studied during the first pos Ebook Office-Based rhinology: Principles and techniques (Part 2)toperative week, yet similar debridement in the second postoperative week did not result in epithelial loss beneath removed crusts.4 Nasal irrigationsEbook Office-Based rhinology: Principles and techniques (Part 2)
are emphasized during the first postoperative week, and crusts that obstruct ostia or may lead to synechiae at critical locations arc gently removed.CHAPTERIn-Office Treatment of Post-Endoscopic Sinus Surgery IssuesRobert T. Adelson James N. PalmerIntroductionEndoscopic sinus surgery (ESS) that pre Ebook Office-Based rhinology: Principles and techniques (Part 2)en epi-thcliazation is more likely to have occurred.Maxillary Sinus Natural OstiumAlthough there remains some disagreement regarding rhe optimal size of a maxillary antros-tomy, the necessity for the surgical antrostomy to connect with the natural ostium is universally accepted. Despite this straigh Ebook Office-Based rhinology: Principles and techniques (Part 2)tforward surgical goal, failure to connect the natural ostium with the surgical antrostomy at the time of operation or as a result of postoperative syEbook Office-Based rhinology: Principles and techniques (Part 2)
nechiae formation is among the most common etiologies for failure at the maxillary sinus.5 Retention of parts of the uncinate process involved with osCHAPTERIn-Office Treatment of Post-Endoscopic Sinus Surgery IssuesRobert T. Adelson James N. PalmerIntroductionEndoscopic sinus surgery (ESS) that pre Ebook Office-Based rhinology: Principles and techniques (Part 2)nor connect with the natural ostium can lead to recirculation and recurrent infection of rhe maxillary sinus as normal mucociliary flow out of the maxillary sinus natural ostium results in re-introduction of mucous through the posteriorly located surgical antrostomy (Figure 8-1). Currently, our pref Ebook Office-Based rhinology: Principles and techniques (Part 2)erence is to perform a large maxillary antrostomy that extends from the natural ostium anteriorly to the posterior wall of the maxillary sinus, includEbook Office-Based rhinology: Principles and techniques (Part 2)
ing the vertical and horizontal portions of rhe uncinate process and the medial maxillary wall superior to rhe inferior turbinate. The general shape oCHAPTERIn-Office Treatment of Post-Endoscopic Sinus Surgery IssuesRobert T. Adelson James N. PalmerIntroductionEndoscopic sinus surgery (ESS) that pre Ebook Office-Based rhinology: Principles and techniques (Part 2)ucociliary flow at rhe natural ostium is a critical step in ensuring good postoperative maxillary sinus outcomes. Scar bands, clots, frayed mucosa, or granulation tissue that could develop into synechiae at this location are visualized and removed in rhe office setting using angled scopes and topica Ebook Office-Based rhinology: Principles and techniques (Part 2)l anesthesia.In-Office Treatment of Post-Endoscopic Sinns Surgery Issues 69Figure 8-1. Recirculation at the right maxillary sinus is a result of an iaEbook Office-Based rhinology: Principles and techniques (Part 2)
trogenic synechiae posterior to the natural ostium. Thick mucopurulence is noted to leave the natural ostium and flow into the more posteriorly locateCHAPTERIn-Office Treatment of Post-Endoscopic Sinus Surgery IssuesRobert T. Adelson James N. PalmerIntroductionEndoscopic sinus surgery (ESS) that pre Ebook Office-Based rhinology: Principles and techniques (Part 2)rument)Postoperative care of the maxillary sinus requires rhe use of rigid sinus endoscopes with angled views. The natural ostium of rhe maxillary sinus cannot be visualized with a O-degree scope and small synechiae in this location will not be detected (Figure 8-3). T he use of a 30-dcgrce scope fo Ebook Office-Based rhinology: Principles and techniques (Part 2)r a complete postoperative examination is required (Figure 8-4), whereas 45-degree and 70-dcgree (Figure 8-5) rigid endoscopes will facilitate postopeEbook Office-Based rhinology: Principles and techniques (Part 2)
rative surgical interventions.Graphic Representation of Idealized Maxillary AntrostomyNatural ostrium of maxillary sinusSurgical antrostomyThe surgicaCHAPTERIn-Office Treatment of Post-Endoscopic Sinus Surgery IssuesRobert T. Adelson James N. PalmerIntroductionEndoscopic sinus surgery (ESS) that pre Ebook Office-Based rhinology: Principles and techniques (Part 2)auma to the mucosa of the anterior half of the ostium and decreasing the risk of postoperative circumferential synechiae.Figure 8-2. Graphic representation of an idealized maxillary antrostomy in which the surgical antrostomy overlaps the posterior 50% of the natural ostium circumference, leaving un Ebook Office-Based rhinology: Principles and techniques (Part 2)interrupted mucosa of the natural ostium at the anterior 50% of the natural ostium.70Office-Based Rhino logy: Principles and TechniquesFigure 8-3. A rEbook Office-Based rhinology: Principles and techniques (Part 2)
igid 0-degree scope allows mucus to be seen entering the surgical antrostomy from an anterior location; however, the natural ostium is not visualized.CHAPTERIn-Office Treatment of Post-Endoscopic Sinus Surgery IssuesRobert T. Adelson James N. PalmerIntroductionEndoscopic sinus surgery (ESS) that pre Ebook Office-Based rhinology: Principles and techniques (Part 2)onsideration for both the patient’s pain threshold and rhe degree of surgical intervention required. Atomized 4% lidocainc/oxymctazo-line is usually adequate followed by application of 4% cocaine solution and, if necessary,Figure 8-5. The angle afforded by a 70-degree rigid endoscope enhances the vi Ebook Office-Based rhinology: Principles and techniques (Part 2)ew of the natural ostium of the maxillary sinus and allows back-biting instruments to remove the scar tissue resulting in iatrogenic recirculation pheEbook Office-Based rhinology: Principles and techniques (Part 2)
nomenon and recurrent infection of the maxillary sinus.injection of 1% lidocaine with 1:100,000 epinephrine into the operative site. Severe discomfortCHAPTERIn-Office Treatment of Post-Endoscopic Sinus Surgery IssuesRobert T. Adelson James N. PalmerIntroductionEndoscopic sinus surgery (ESS) that pre Ebook Office-Based rhinology: Principles and techniques (Part 2)y sinus seekers arc adequate for palpation of the natural ostium, and can confirm rhe presence of scarring that has involved the natural ostium. Backbiting and through-cutting forceps arc vital instruments for cleanly cutting and removing natural ostium synechiae in rhe postoperative setting (Figure Ebook Office-Based rhinology: Principles and techniques (Part 2) 8-6). The avoidance of mucosal stripping at this critical location during postoperative care is emphasized, as in all endoscopic sinus procedures.AtEbook Office-Based rhinology: Principles and techniques (Part 2)
present, the large size of the surgical anrrosromy performed at our institution precludes the use of balloon catheter technology for postoperative dilGọi ngay
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