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Endoscopic polysynusotomy

Endoscopic polysinusotomy is a modern method of treatment of chronic sinusitis used in otolaryngology. The procedure is a minimally invasive surgical procedure that is performed under the supervision of an endoscope.

What is a sinusotomy

Sinusitis is a common name for inflammatory processes in the paranasal sinuses caused by various factors: infection, allergies, and a violation of the structure of the nasal passages. Symptoms of sinusitis can include many unpleasant signs, from a prolonged runny nose, to difficulty breathing, loss of sense of smell, and headaches.

Endoscopic sinusotomy is a minimally invasive surgical procedure that is used to treat chronic sinusitis. During surgery, the doctor inserts a thin, flexible instrument called an endoscope through the nasal passages into the sinuses. This allows the surgeon to see and remove any pathological formations that cause unpleasant symptoms.

Indications for surgery

Sinusotomy may be recommended when conservative treatments for sinusitis do not bring the expected result. The method is used for both adults and children. The doctor may suggest this procedure in the following cases:

  • chronic sinusitis that cannot be treated with medication;

  • polyps in the sinuses that cause sinusitis symptoms;

  • abnormalities in the structure of the nasal passages that prevent the normal outflow of mucus from the sinuses;

  • recurrent sinusitis, which often returns despite treatment;

  • maxillary sinus injuries in which blood clots or tissue fragments enter the cavity;

  • foreign bodies in the sinuses of the nose.


In some cases, surgery is the only possible treatment option. For example, polyps and cysts cannot be conservatively removed.

Contraindications

Like any surgical procedure, endoscopic sinusotomy has its own contraindications. These include:

  • severe systemic diseases in which surgery poses a risk to the general condition of the patient;

  • blood clotting disorders;

  • individual intolerance to anesthesia.

Acute infectious diseases and exacerbation of chronic diseases are also relative contraindications.

Preparing for a sinusotomy

Preparation for surgery begins with a consultation with an otolaryngologist. The doctor performs an endoscopic examination of the nasal structures. CT scans of the paranasal sinuses may also be required to clarify the diagnosis and preoperative planning.

In addition, the patient is required to undergo standard preoperative examinations:

  • take blood tests – general, biochemical, coagulogram;

  • perform chest X-ray;

  • take an ECG;

  • consult an anesthesiologist before using anesthesia.

If the patient is taking medications that affect blood clotting, it is necessary to discuss with the attending physician the possibility of their withdrawal before surgery.

How the operation works

The operation is usually performed under general anesthesia, since the patient must be motionless during all manipulations. During the procedure, the doctor inserts an endoscope into the sinuses through the nasal cavity. A device with a video camera projects an image onto a monitor, which allows you to see the condition of the mucous membrane. Using special instruments, the surgeon removes polyps, other neoplasms, and foreign bodies.

The whole process usually takes about 1-2 hours, but may take longer depending on the complexity of the case. Then the patient stays in the wake-up ward for a while, where he wakes up after anesthesia, and then is transferred to a hospital.

Due to the endoscopic access, the operation is low-traumatic. Manipulations do not cause severe swelling of tissues or significant pain. In addition, there are no scars or other cosmetic defects after the intervention. Most people can return to normal life the very next day.

In the postoperative period, the patient may experience nasal congestion, spotting, discomfort in the nose, and a feeling of swelling in the sinuses. These symptoms go away within a few days.

Restoration

Depending on the complexity of the operation and the individual characteristics of the body, the recovery period may vary. Here are the recommendations that must be followed in order for the rehabilitation to be successful:

  • A gentle regimen for two weeks after surgery. Exclusion of physical exertion, overheating, too hot or spicy food, alcohol.

  • Performing a nasal toilet according to medical recommendations.

  • Taking medications. The patient may be prescribed antibiotics or pain medications.

It is important to remember that recovery after an endoscopic sinusotomy is a process that requires time and patience. On average, nasal breathing is restored within 10 days.

Advantages of treatment at the EMC clinic

At the EMC Clinic of Otorhinolaryngology, Head and Neck Surgery, we strive to provide patients with high-quality medical care. Our team of specialists is highly qualified in the treatment of ENT diseases of any complexity, which allows us to work effectively with any pathological conditions, including emergencies and chronic diseases.

One of our advantages is our expertise in endoscopic surgery. This treatment method provides high accuracy, which reduces the risk of complications and speeds up the patient's recovery process. Our surgeons have all the necessary skills and knowledge to perform such operations

In addition, the EMC Clinic for Otorhinolaryngology, Head and Neck Surgery is located in a multidisciplinary hospital with a 24-hour laboratory and a radiology department. This allows you to quickly and accurately establish a diagnosis and start treatment, which is very important for a successful outcome. We are proud to be able to offer our patients high-quality, modern and effective medical care.

List of sources and references

  1. D.E. Zhaisakova, S.F. Kudaibergenova, M.B. Kaltaeva Functional endoscopic rhinosinusosurgery is a surgical method for treating pathology of the paranasal sinuses // Bulletin of KazNMU. 2015. No.2. URL: cyberleninka.ru
  2. Berdnikova Nadezhda Georgievna, Yekaterinchev Vyacheslav Alexandrovich, Pushkina Svetlana Leonidovna Problems of treatment of inflammatory diseases of the nose from the standpoint of evidence-based medicine // Consilium Medicum. 2018. №3. URL: cyberleninka.ru
  3. Alibekov Imankarim Magomedovich, Guz Dmitry Gennadievich, Khudin Alexander Grigorievich, Moskalev Vasily Alexandrovich. Controlled hypotension in endoscopic rhinosinusosurgery in outpatient settings // RO. 2013. No.4 (65). URL: cyberleninka.ru
  4. Shirokaya Anna Vadimovna, Svistushkin Valery Mikhailovich, Shatokhina Svetlana Nikolaevna, Shabalin Vladimir Nikolaevich. Evaluation of the effectiveness of treatment of patients with polypous rhinosinusitis and prognosis of its course // RO. 2013. №2 (63). URL: cyberleninka.ru

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Questions and answers

Lump in my breast
I have noted the lump in my breast periodically appeared following breastfeeding my first child (as a result of plugged duct). I did an ultrasound, but it revealed nothing, as if everything was normal. I knead my breast periodically and feel pain at those moments. Now I am pregnant, due date is on 20th. What should I
do?? When to examine my breasts, is it possible to perform the examination during pregnancy and lactation?
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The "lump" in the breast cannot occur after feeding, even if it was the plugged duct. You should not "knead" the breasts. If there is a problem or even if you think it is – the breast should be examined. Pregnancy and breastfeeding are not contraindications for this. Under normal conditions for pregnant women we
recommend a breast examination during 1 and 3 trimester (before childbirth). There are no contraindications for breast examination in your case. You are welcome at any convenient time for examination and advice on breastfeeding.
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Benign disease
I have a benign lump in one breast size of 12.0*9.9 mm. Puncture or a biopsy will be done next week. I was told by mammologist that surgery is needed. As far as I know, concerning the surgery, axillary lymph nodes are to be removed together with the tumor. I also know that in Europe lymph nodes are testes for
specific markers and only affected ones should be removed; if lymph nodes are no affected, they are not to be dissected and the surgery is minimally invasive. So what is your approach? Does it make sense to do it or you have the same methods and the same equipment?
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If histological examination of the sample reveals fibroadenoma of basic type or tissue hyperplasia without atypia, or nodular type fibrocystic condition of the breast tissue, the question of surgical treatment should not arise. If biopsy reveals giant fibroadenoma sectoral resection is indicated, i.e. mass excision
within the healthy tissues and lymph nodes will be removed. In case of non- benign histological result, i.e. carcinoma is detected, subsequent immunohistochemical examination is required as well as a clinical oncologist and surgeon consultation; and the decision on complex treatment will be taken by case management team. With regard to the diagnosis and treatment methods in our center, each case is addressed individually. Sometimes we remove a benign area (for example, the area of hyperplasia with atypia) using the vacuum-needle technique through 3-4 mm incision. As for the surgical procedure protocols for benign breast tumors, benign simple fibroadenoma is not removed in America, Europe, Israel, etc. I would like to discuss your case with you in more details and perform some additional tests if needed, so I would be glad to see you at EMC’s Breast center.
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Melanoma
My mom had a mole (suspected for melanoma) removed in November 2015. Histology revealed lentigo melanoma in situ. We checked the slides back in the Netherlands, and the diagnosis was a superficial spreading melanoma of Clark 3 Т1а Beslow 0,8 stage; re-excision with capture of 1 cm of healthy skin is recommended. Is
it possible to make re-excision and subsequent histology in your hospital? If so, how soon?
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We absolutely agree with the opinion of the European colleagues: re-excision with a wider offset is required; according to the Russian Protocol it is necessary to move 2 cm from the peripheral edge. This is for counter insurance, as lentigo-melanoma is a favorable type, and previous surgery is likely to put an end to
this story and the forecast is favorable. All the necessary manipulations for the study are possible in our Clinic; we have our own well-equipped laboratory with the possibility to ask the advice concerning the sample in Germany and Israel. You should make an appointment with the surgeon-oncologist (Marina Bissessar) in the nearest time to conduct the diagnostic re-excision. Hope to help!
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A spot on the back and chest
I have a spot on the back and chest, what could it be?
A spot on the skin is one of the most common symptoms of various skin diseases. Infectious (viral, bacterial or fungal) as well as noninfectious skin including serious diseases and nevi (moles or birthmarks) can manifest as spots on the skin. You should go to the dermatologist for accurate diagnosis. The doctor will
examine you and, if necessary, a special instrument (Dermatoscope, wood lamp) will be used. A skin scraping can also be done in the lesion for microscopy, cytology or culture. A treatment will be prescribed after diagnosis.
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Batkaeva Nadezhda
07 September 2016
Uterine cancer
My mom was diagnosed with the uterine cancer. She is 68 years of age and has an obesity of 4th grade (the growth of 166 cm, weight 135 kg) and hypertension. Admission to the radiology department was recommended. What should we do? As far as I know the surgery is the only method for cancer of the uterus to be removed.
Is it really so that this surgery is only possible for young and relatively healthy persons?
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It is not quite so. We can operate on any patient, but the issue is which complications can lead to patient’s death and which of them can just delay the recovery. From the anesthesiologist’s point of view, it is a major challenge to intubate patients with 4th degree obesity; the abdominal section is also possible,
but there is a 100% risk of suture line disruption and inflammation, let alone the postoperative pneumonia, venous thrombosis, etc. There is another option such as vaginal hysterectomy which is more acceptable and relatively safe in obese patients. It is not a «treatment standard», however, as it allows not obtaining pelvic washings, but still there is a possibility of complete cure. Anesthesia remains a problem - both general and spinal. Radiation therapy without surgery is another acceptable treatment option besides vaginal hysterectomy. A chance of complete cure is still exists, but the survival rate is on average lower than in surgical treatment
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Vladimir Nosov
07 September 2016

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