Basic Principles In Sinus
Endoscopic Surgery
Dr. Bassel Adra
Al-Assad University Hospital
Syrian Society conference
09-11/4/2009
Al-Assad University Hospital - Syrian
Society conference 09-11/4/2009
Al-Assad University Hospital - Syrian
Society conference 09-11/4/2009
Al-Assad University Hospital - Syrian
Society conference 09-11/4/2009
How do you select the patient?
• Diagnostic value of surgery :
– Biopsy from unresectable large mass by
endoscopic surgery, but we can get access
to it by endoscope.
Al-Assad University Hospital - Syrian
Society conference 09-11/4/2009
How do you select the patient?
• Therapeutic value of surgery
– Chronic Sinusitis:
• Sinus drainage and dilation of their ostii or
making them confluent together.
• Attention should be paid to major mucosal
diseases and allergic tendency.
• Correction the anatomic abnormalities
according to the case: eg. inferior and middle
turbinates enlargement, concha bullosa,
inverted middle turbinates, septal deviation,
maxillary sinus ostium occlusion, frontonasal
duct occlusion.
Al-Assad University Hospital - Syrian
Society conference 09-11/4/2009
How do you select the patient?
• Nasal polyposis.
• Antrochoanal polyp.
• Meningeal nasoethmiod or nasosphenoid
fistula.
• Mucocele and pyocele.
• Lacrimal sac and nasolacrimal duct disorders.
• Exophthalmus and lamina papyracea
resection.
Al-Assad University Hospital - Syrian
Society conference 09-11/4/2009
Al-Assad University Hospital - Syrian
Society conference 09-11/4/2009
When you should avoid endoscopic
surgery
• Bad general condition: unfitness to general
anesthesia.
• Malignancy especially large ones.
• Inverted papiloma exceeding lateral wall of
nasal fossa.
• Inflammation of pure allergic origin with
symptoms of strong inflammatory
hypersensitivity.
Al-Assad University Hospital - Syrian
Society conference 09-11/4/2009
Patient preparation
• Careful examination including endoscopy of
nasal cavity by rigid or flexible nasoscope
after mucosal decongesting.
• Radiological study: CT, MRI with axial and
coronal sections (especially coronal).
• Medical therapy: antibiotics, topical and
general steroids, topical saline serums,
hypotensor therapy.
Al-Assad University Hospital - Syrian
Society conference 09-11/4/2009
Surgery
• Patient position.
• Surgeon and assistance doctors position.
• Used endoscopes.
• Decongestion packs 1/5000 (by endoscope).
• Don't start surgery without complete rest.
Al-Assad University Hospital - Syrian
Society conference 09-11/4/2009
Al-Assad University Hospital - Syrian
Society conference 09-11/4/2009
Al-Assad University Hospital - Syrian
Society conference 09-11/4/2009
Surgery
• Excellent knowledge of
anatomy and
identification of
important landmarks.
• Middle meatus, uncinate
process, bullae
ethmoidalis.
• Surgery as needed,
middle turbinates,
uncinate process.
Al-Assad University Hospital - Syrian
Society conference 09-11/4/2009
Al-Assad University Hospital - Syrian
Society conference 09-11/4/2009
Al-Assad University Hospital - Syrian
Society conference 09-11/4/2009
Al-Assad University Hospital - Syrian
Society conference 09-11/4/2009
Al-Assad University Hospital - Syrian
Society conference 09-11/4/2009
Al-Assad University Hospital - Syrian
Society conference 09-11/4/2009
Al-Assad University Hospital - Syrian
Society conference 09-11/4/2009
Surgery
• Assisted by suction rolling and eye ball
observation.
• Don’t take risk with surgery under bleeding.
pack, wait and ask help from the anesthetic staff.
• Don’t work without complete orientation of
important anatomic landmarks.
• Assistance by palpation and proprioception
(deep sensation).
• Trying to get benefit from the presence of cavity
to get into the neighbouring cavities.
Al-Assad University Hospital - Syrian
Society conference 09-11/4/2009
Surgery
• Assisted by
pressing the eye
ball.
Al-Assad University Hospital - Syrian
Society conference 09-11/4/2009
Al-Assad University Hospital - Syrian
Society conference 09-11/4/2009
Al-Assad University Hospital - Syrian
Society conference 09-11/4/2009
Surgery
• Preserving the intact mucous membrane as
possible and avoid trauma to septum or lateral
wall of middle turbinates.
• When you suspect with any complication, move
quickly and don’t hesitate to ask for help.
• Continuous assistance of Radiological
examinations (observing scan during the
operation).
• small packs as needed especially in the middle
meatus.
Al-Assad University Hospital - Syrian
Society conference 09-11/4/2009
Postoperative
• Patient discharge: brief hospitalization,
prescription of antibiotics with or without
steroids and analgesic.
• Packing removal after 48-72 hour or more in
case of CSF leak.
• Instant cleaning with a fine and nontraumatic
suctions.
• Prescription of nasal doushes-saline serum
with or without topical steroids drops.
Al-Assad University Hospital - Syrian
Society conference 09-11/4/2009
Follow up
• Follow up after a week, crusts removal and
suction cleaning.
• Follow up after two weeks and examination
by endoscope after cleaning and crusts
removal.
• Follow up as needed especially in nasal
polyposis.
• Continuous follow up.
Al-Assad University Hospital - Syrian
Society conference 09-11/4/2009
THE END
Al-Assad University Hospital - Syrian
Society conference 09-11/4/2009
