Sunday, May 20, 2018

Key Notes for Endoscopic sinus surgeries

Antihistamines have no role in treatment of nasal polyps unless these are associated with Allergic Rhinitis.

Doxycycline can be given as immunomodulator for 3 weeks in pre operative period.

Saline irrigation helps in pre operative period.

Omalizumab has been proven to bring down IgE levels significantly especially in severe resistant Asthma. (Targeted therapy).

Keep the heart rate low around 60 and blood pressure normal during surgery.

Topical decongestant with Adrenaline for 5-10 mins espl in a young patient reduces overall surgical time..

Maxillary antrostomy types

Type 1: normal opening
Type 2: where posterior Maxillary wall is flushed with Maxillary sinus opening.
Type 3: where antrostomy opening is flushed down till level of inferior turbinates
Type 4: Medial Maxillectomy

Ringer Lactate is more physiological than normal saline for nasal irrigation.

Frontal ostium boundaries are

Medial : Middle turbinate
Lateral: Orbit
Anterior : Frontal beak- safest for enlargement
Posterior : Supraorbital cell

Draft procedure

Type 1: simple opening frontal ostium
Type 2a : removing surrounding hypertrophied mucosa.
Type 2a: also includes drilling frontal beak.

Where supra orbital cell ends, Anterior ethmoidal artery is located.

70degree telescope is also known as skull base blade.

Best treatment of middle turbinates is to respect it.

Maxillary line or Medial orbital angle is very important Landmark as sphenoid opening is never above it.

Sphenoid osteum marks the posterior boundary of posterior ethmoids.

In severe polypsis, it's better to remove antero inferior part of middle turbinates as to deliver more topical steroids.

Sinus surgery is Surgery of landmarks.

Low Vit. D levels are associated with low immunity.

Important Landmark in revision FESS

1. Frontonasal process or frontal beak.
2. Middle meats antrostomy
3. Inferior turbinate
4. Laminar papyracea.
5. Choanae

Selective posterior neurectomy is good for naso ocular symptoms..

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