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Functional Endoscopic Sinus Surgery.pptx
- 1. Functional Endoscopic SinusSurgery Jennifer Rager, D.O.
- 2. Outline Anatomy History of sinussurgery Procedure/Instruments Possible Complications Post operative instructions Recovery
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- 10. History of SinusSurgery • Endoscopic sinus surgery was introduced into the United States more than 20 years ago; over that time period it has undergone significant changes, in terms of both surgical technique and our understanding of the disorder of chronic rhinosinusitis. However, the concept of using a transnasal approach is far from novel. The ancient Egyptians used the transnasal route to remove brain tissue prior to mummification. The approach was used surgically but then fell into disrepute with the era of prefrontal lobotomy. • The first attempt at nasal endoscopy is largely credited to Hirschman in 1901. In this early work, a modified cystoscope was used to examine the sinonasal cavity. Subsequently, Reichert performed what would be regarded as the first endoscopic procedure; rudimentary maxillary sinus manipulations with a 7 mm endoscope through an oroantral fistula. In 1925, Maltz promoted use of nasal endoscopes for diagnostic evaluation of the sinonasal cavity and coined the term ‘sinuscopy’. The creation of the Hopkins rod system in the 1960s was perhaps the major turning point in the field of sinonasal endoscopy. • Professor Harold H. Hopkins developed the rod optic endoscope system as well as several other inventions such as the zoom camera lens and fiberoptic gastroscope. The new telescope design resulted in markedly enhanced light delivery and superior optical quality allowing exceptional detailing of the sinonasal cavity. Using this new innovation, Messerklinger subsequently composed a landmark book in 1978 on diagnostic endoscopy of the nose from his work studying mucociliary clearance in fresh cadavers. Given the frequent failures of Caldwell-Luc surgery, the morbidity of frontal sinus osteoplasty and difficulties of performing headlight intranasal ethmoidectomy, there was a strong rationale for trying to improve surgical techniques for chronic sinusitis.
- 12. Procedure • The term“functional” is used because the surgery is done to restore how your sinuses work, or function. • The principle or objective of endonasal sinus surgery consist of the following aspects which may be achieved individually or in combination: • Restoration or improvement of disturbed ventilation or drainage, • Removal of relevant foci of a disease (e.g. polyps, presumably irreversibly pathological hyperplastic mucosal foci, so-called osteitic bone trabeculae, accumulations of mucus, secretory concrements, tumors), • Preservation of the normal or only slightly altered mucosa, • The most possible protection of anatomical landmarks, • Realization of an approach to surgical therapy of a disease located beyond the paranasal sinuses, mostly a tumor or a result of trauma.
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- 26. Recovery • mild bleedingfor 1-2 and a general sense of fatigue for 1-2 weeks • pain can be successfully controlled with narcotic or non-narcotic medications • no nose blowing for 1 week • no bending over, straining, or lifting more than 10 lbs. during the first week • at least one week off from work • resume exercise at 50% intensity after one week and at full intensity after two weeks. • Series of postoperative • nasal endoscopy to check how the sinuses are healing • debridement may be necessary in order to clean blood from the sinuses and prevent early scar tissue formation • usually consist of 2-3 visits over the first 6-8 weeks; then spaced a few months apart, depending on healing
- 27. Thank you Any Questions? JenniferRager, D.O. 570-271-6429 jrager1@geisinger.edu