Many patients wonder what types of interventions are available and what their advantages and disadvantages are. Let's try to answer these questions.

Indications and contraindications for surgery

Like any medical procedure, surgery to treat sinusitis has its own indications and contraindications.

Indications include:

• lack of effect from the use of sprays, anti-inflammatory drugs, physiotherapy techniques;
• the appearance of complications of a secondary type, which are caused by a chronic infectious process in the paranasal sinuses;
• formation of cysts containing infected exudate;
• the appearance of intracranial complications;
• closed sinusitis in;
• active spread of infection throughout the body;
• the presence of foreign objects in the nasal passages that interfere with normal breathing.

The manipulation also has a number of contraindications. They are determined on an individual basis, and the patient’s general condition is assessed, the presence of diseases of the circulatory, endocrine, and hematopoietic systems, a history of recent surgical interventions, and the presence of active infectious processes in the body. Contraindications can be either temporary or permanent. Many patients cannot decide whether it is worth having surgery for sinusitis at all? The decision regarding the advisability of surgical intervention in a particular case must be made by the attending physician.

Puncture

Puncture or, as it is also called, puncture is one of the classic operations performed for sinusitis. It is often regarded by doctors as a therapeutic and diagnostic procedure, since during its implementation it is possible to obtain material for bacteriological research and the choice of further treatment tactics.

The intervention is performed under local anesthesia or general anesthesia, depending on the general condition of the patient and the presence of additional diseases. In most cases, local anesthesia is preferred. During the procedure, the doctor makes a puncture in the maxillary sinus and removes purulent contents.

Basically, the operation bears fruit after the first time, but sometimes it needs to be repeated. If after 5-6 manipulations relapses of sinusitis still develop, they resort to more serious methods of solving the problem.

After the suction instrument is removed from the sinus, it must be washed. Basically, a solution is used, with which you can neutralize a significant part of pathogenic microorganisms and significantly reduce the risk of relapse.

Balloon sinuplasty

A technique that has recently become actively used for sinusitis. The principle of the intervention is very simple: it is necessary to expand the sinuses of the nasal cavity, which are in a narrowed state due to illness.

The doctor, using special flexible conductors that prevent trauma to the nasal cavities, inserts special balloons into the sinuses. When the balloon is in the right place, it is inflated with air using a cuff, which allows you to expand the diameter of the anastomosis and eliminate pus and accumulation of microorganisms by rinsing. After dilation of the sinuses, it is also possible to increase aeration, which has a positive effect on the healing process.

The intervention has become especially popular due to the absence of trauma to the natural structures of the nose, as well as the almost complete absence of complications.

Catheter Yamik

Another minimally invasive method that helps with sinusitis. The device consists of three tubes of different lengths, two of which have special cuffs.

The catheter is inserted through the nasal passages, the cuffs are inflated, creating a slight vacuum, thanks to which accumulations of pus can be easily removed from the sinus affected by the disease. To facilitate the insertion of the catheter and reduce swelling, the mucous membranes can also be treated with an antiseptic. After removing the pus, the sinuses must be washed.

The operation itself is so simple that it can be performed even in a clinic. There is no need for anesthesia, since the intervention is completely painless.

Endoscopic surgery

Unlike previous methods, endoscopic intervention for sinusitis is considered a radical way to solve the problem, even despite its low invasiveness. It is mainly resorted to if previous treatment methods have proven ineffective. To carry out the intervention, it is necessary to use an endoscope, so it is impossible to perform it in an outpatient setting.

A device equipped with a camera allows you to monitor the progress of the intervention from the inside. Thanks to this, it is possible to preserve the maximum amount of healthy tissue and cope with pathological changes. In this case, the doctor will clearly understand what he is doing, not acting blindly. During an endoscopic operation, usually not only the pus is sucked out from the sinuses, but also the overgrown epithelium, which is no longer able to fully perform its main functions, is removed.

Laser

Laser therapy for sinusitis is a type of endoscopic intervention. Laser exposure refers to the effect on the mucous membranes of specially focused light rays of a certain frequency and high intensity. During irradiation, a microburn of the nasal mucous membranes appears, which allows the destruction of pathogenic microorganisms that led to the development of sinusitis.

It is important to understand that the intensity of the burn during laser treatment is so low that the patient does not feel anything at all. In most cases, strong anesthetics are only used if the patient is very sensitive to pain.

Such an intervention has several advantages:

• several successive sessions of laser treatment can reduce the thickness of the mucous layer, which improves the aeration of the nasal sinuses and reduces the rate of reproduction of pathogenic microorganisms in them;
• thanks to external influences, it is possible to improve blood circulation processes and, as a result, regeneration;
• due to the presence of a foreign object, local immunity is activated, which also contributes to the destruction of pathogenic microorganisms.

Caldwell-Luke operation

The Caldwell-Luc operation, used for severe sinusitis, is the most radical of all types of interventions. It is carried out only if the disease has affected the mucous membranes of the sinuses so severely that other treatment methods have been ineffective. Such changes occur most often with odontogenic, cystic or fungal sinusitis.

The manipulation is performed under general anesthesia. The patient is in a supine position. The doctor, moving the upper lip, makes an incision under it on the side on which the diseased sinus is located. Then, using a chisel or drill, the doctor is able to examine the maxillary sinus through the bone tissue and removes pus and pathologically altered mucous membrane from it. The intervention is considered the most traumatic and complications are usually associated with it, ranging from intolerance to anesthesia and ending with purulent inflammation of the postoperative wound.

Postoperative care

The specificity of most operations performed for sinusitis is such that very little external damage is caused to the body. Thanks to this, postoperative care for the patient is minimized and does not present any difficulties.

A person who has undergone surgery to remove sinusitis is allowed to go home a few hours after the end of the procedure. Rarely, if unforeseen complications develop, you have to stay in the hospital for a longer period.

After discharge, the patient is prescribed the same medications that were used during the main treatment of sinusitis.

These include:

• broad-spectrum antibiotics (penicillins, macrolides, cephalosporins, fluoroquinolones);
• vasoconstrictor medications (,);
• antihistamines (Zodac, Zyrtec);
• local glucocorticosteroids ().

Sinusitis is a disease that often requires surgery if conservative treatment methods are ineffective. The decision about which intervention technique is suitable for a particular patient is best left to the doctor. Only a specialist will be able to determine the presence of indications and contraindications for surgery based on the individual characteristics of the patient and the stage of the disease. It is not recommended to refuse surgical intervention if the doctor raises the question of its necessity.

Useful video about the treatment of sinusitis

Sinusitis is by far the most common type of sinusitis and is an inflammatory process in the maxillary paranasal sinuses. They are paired, so the disease can affect each of them separately, or two at once. At the same time, complications of sinusitis can affect the nasopharynx, orbit, skull bones and even the brain due to the fact that there are a lot of different passages in the skull that connect almost all the structures in it. It should be noted that with a high risk of such complications, as well as with severe disease, surgical treatment of sinusitis is very often used.

Treatment of sinusitis in adults and children involves an integrated approach, that is, the influence on the purulent inflammatory process occurs from different sides. The following types of treatment are usually used:

• etiological, aimed at the causative agent of the process or elimination of factors in the development of the disease;
• symptomatic, allowing to combat the main clinical manifestations;
• preventive, consolidating the effect of the therapy.

Complex treatment can be carried out conservatively - with the help of medications. In severe cases, it can be surgical - a puncture of the maxillary cavity is performed, or a maxillary sinusotomy is an operation to remove the mucous membrane. The name lies in the process of opening the sinus. It can be performed either traditionally or endoscopically. Endoscopic surgery for sinusitis eliminates the need to open the sinus through the mouth. It allows you to normalize aeration (enrichment with air) of the sinuses and other structures of the respiratory system.

Surgery on the maxillary sinus involves the removal of structures such as:

• soft tissues subjected to inflammatory processes, infection and damage;
• foreign bodies that served as a trigger for the disease. These may also include carious teeth, in which case the operation should be performed together with an oral and maxillofacial surgeon;
• destroyed bones or sections of bones to create artificial connecting passages in order to improve the outflow of mucus and aeration;
• cysts and polyps located in cavities.

Sinus puncture

In addition to surgical treatment by maxillary sinusotomy or endoscopic surgery, a technique called puncture is widely used. It can be prescribed for both therapeutic and diagnostic purposes, and is a very effective method of treating pathology. A puncture can effectively treat purulent sinusitis if performed correctly.

The manipulation is done under local anesthesia. In addition to eliminating the contents of the cavity, it is washed and irrigated with antibacterial and antiseptic solutions. After the puncture, a course of antibacterial therapy with drugs that have a wide spectrum of action is prescribed. This is due to the fact that pathology can develop due to the introduction of various microorganisms.

Local anesthesia is done by introducing a turunda with an anesthetic into the nasal passage. It allows you to eliminate pain and discomfort. Sometimes a sensation of a foreign body in the nose may develop during the procedure. It should be noted that the doctor relies solely on his tactile sensations and experience during manipulation, and his incorrect actions can lead to undesirable consequences.

An ordinary syringe can be used as equipment to remove the contents of the sinus. They also inject antibacterial agents and antiseptic solutions into the maxillary sinus.

Endoscopic surgery is a minimally invasive technique and allows intervention with minimal consequences. After performing such treatment, there are no visible consequences of the intervention, since the endoscope (device for performing the operation) is inserted through the nasal opening and does not damage the mucous membrane of the nasal passages. Video images are usually displayed on a monitor connected to the device.

According to medical statistics, sinusitis after such an operation is much less likely to be complicated or worsened. It should also be noted that the price for this method of treatment is much lower than for traditional maxillary sinusotomy. This allows it to be used much more often. However, there is also a negative point - not all hospitals are equipped with devices for endoscopic surgery, which means that sometimes it is necessary to treat sinusitis with a conventional operation, and the patient will have to pay the full cost of such treatment.

The duration of the intervention takes from half an hour to one and a half hours, depending on how severe the inflammatory process has developed. Individual characteristics of a person also play a role. Only an experienced specialist will say how long the operation will take, but not always, and he will be able to predict the exact time the patient will remain on the operating table.

More often, this method of treatment is used in adults, which is due to the anatomical and psychological characteristics of the child’s body.

The procedure involves inserting an endoscope, an optical device, into the nose. Using this device, the doctor can see the condition of the mucous membranes, the presence of pus, foreign objects and other defects. The device can be equipped with cameras that allow you to display video on a special monitor, as well as take photos and record the progress of the operation. This allows you to save information for use for study.

Using an endoscope, you can insert instruments for the treatment of sinusitis - a laser, a scalpel and scissors - into the maxillary sinus. Such an intervention usually occurs without any pain, so it does not require additional anesthesia. Local anesthesia may be used if the patient has a low pain threshold.

Maxillary sinusotomy

In case of low effectiveness of conservative therapy, as well as the lack of effects from puncture of the maxillary sinus and endoscopic treatment of sinusitis, surgical treatment of the disease is usually prescribed - maxillary sinusitis. Very often it can be called the most effective, but also the most dangerous method of treating pathology. The essence of this operation is to open the maxillary sinuses through the oral cavity and eliminate the inflammatory focus and affected soft tissues and foreign bodies. Very often it requires such an operation.

It consists of two stages: opening access and cleaning the sinus. Depending on where the inflammatory focus is localized, two methods are used - through the oral cavity (used much more often) and through access on the face. It should be noted that such an operation is very difficult to perform, since the area of ​​​​the intervention is very limited by external structures, and the walls of the cavity itself are lined with mucous membrane, which can very easily be damaged, causing complications of the disease.

Today, access through the oral cavity is in first place, which is due to its cosmetic viability. The second option can be done if it is necessary to better examine the contents of the sinus. Combined treatment is also possible, when an endoscope is inserted into the maxillary sinus through external access or through the oral cavity.

The operation is performed under anesthesia.

The contents of the affected maxillary sinuses are removed using surgical instruments - a Volkmann spoon, which looks very similar to an ordinary spoon.

Since surgical treatment takes place under anesthesia, it is absolutely painless. The sinus is completely open to the doctor, which allows him to perform all the necessary procedures to treat the disease and prevent the development of relapses. It is also possible to carry out treatment procedures on other parts of the respiratory system, which are located in close proximity to the maxillary sinus.

A cyst in the maxillary sinus is formed from thin tissues of the mucous membrane with fluid and is a benign formation. The most effective results in the treatment of this disease were shown by the endoscopic method of intervention. This approach to treating cysts can reduce the risk of injury to organs and the outer skin.

Clinical picture of the disease

The cyst may not manifest itself for a long time, because... its development is not accompanied by a painful syndrome. It is often diagnosed by examining other organs using x-rays. Most often this happens during the provision of dental services. In most cases, patients turn to an otolaryngologist with the following complaints:

Pain syndrome in the upper jaw, spreading to the organs of vision.
Frequent and severe headaches.
Constant nasal congestion without cold symptoms.
Systematic inflammation in the nasal cavity.

A doctor can diagnose the disease based on X-rays and CT scans to examine the appendages of the nasal cavity.

A cyst of any form of complexity occurs with virtually no symptoms and does not cause discomfort to a person. But in advanced cases, the patient may feel all of the above symptoms and attribute them to colds or other inflammatory processes.

If the cyst does not cause discomfort to the patient, then endoscopic intervention can be postponed under the supervision of a doctor. Once the cyst has reached a large size, surgery is performed using an endoscope. In most cases this is enough, but sometimes it is necessary to make a puncture above the patient's upper lip.

The essence of the endoscopic procedure

The process of the endoscopic method involves inserting an elastic endoscope into the nasal cavity. Thanks to the presence of a video camera in the endoscope, the doctor can monitor the manipulations on the LCD monitor. With the help of an endoscope, the cyst is eliminated using a laser that is equipped with the endoscope. The instrument is inserted through a natural opening. In most cases, complications do not appear, and the recovery period takes 2-3 days. It is worth noting that this procedure is performed without the use of anesthesia, and after a few hours the patient leaves the clinic.

The advantage of the endoscopic method is:

No pain during and after surgery.
No anesthesia or anesthetic is required.
There is no need for inpatient observation.
No need to pierce the skin. The endoscope is inserted through a natural opening.
During the procedure, other organs are not affected.

Additional methods in the treatment of cysts

It is necessary to understand what a formation is, how a cyst requires its removal. Traditional methods of treatment in the form of ointments, pills and procedures do not relieve the patient of the disease, because... a cyst formed in the nasal cavity does not resolve, but only increases in size. Therefore, when a doctor recommends endoscopic surgery, he takes into account not only the size of the cyst, but also its effect on nearby organs.

In addition to endoscopy, there is also a classical method of cyst removal. But it should be noted that this method is traumatic and uncomfortable for the patient. The essence of the classical method is that an incision is made above the patient's upper lip. The anterior wall of the nasal sinus is opened through this hole and the cyst is removed. The recovery period takes a long time. After the operation, the patient feels pain and discomfort, and a scar remains at the incision site. With the advent of endoscopic intervention, the classical method is used less and less.

Endoscopic surgery on the maxillary sinus, the price of which is from 2,000 rubles, is the most optimal way to remove the cyst. The classical method is cheaper, but it has a number of consequences, incl. and plastic surgery.

To treat such ailments, surgery on the maxillary sinus is often prescribed. Despite the fact that this is an extreme measure of therapy, it is still quite common due to the specifics of the disease. Let us consider in more detail the features and consequences of such an operation.

They got their name in honor of the English anatomist surgeon Nathaniel Gaymora, who studied the pathologies of the paranasal sinuses. It was he who first described the disease, which was later called sinusitis.

The sinuses in question, as mentioned earlier, are the largest and occupy almost the entire cavity of the upper jaw. Each person has individual indicators of their shape and volume. They depend on the anatomical features of the structure of the skull.

The structure of the paranasal sinuses

The paranasal sinuses are connected to the nasal cavity using a narrow channel - anastomosis. The sinuses are covered with a mucous membrane, which ensures the removal of pathogenic microorganisms, and in a healthy state filled with air.

Reference. If the anastomosis is blocked for a long time, this contributes to the accumulation of mucus and its thickening, after which it turns into pus. This process is fraught with inflammation of the walls of the sinuses, which leads to the development of various diseases.

It consists of inner, anterior and posterior, upper and lower walls, and any violation in each of them leads to certain health complications.

The maxillary sinuses perform the following functions:

• purifying the air while breathing– the air mass, before entering the lungs, is purified, heated to the required temperature and increases the humidity level;
• odor recognition– a feature of the surface of the sinuses is that they are able to enhance the functioning of olfactory receptors;
• protective function– lies in the fact that all harmful microbes and viruses settle on the mucous membrane, which are subsequently removed from the body.

In addition, the paranasal sinus takes part during the formation of voice and timbre. It is the emptiness of the nasal sinuses that are responsible for performing resonant function.

The mucous membrane of the sinuses facilitates the rapid delivery of medications due to rapid absorption into the branched system of blood vessels located in it.

In what cases is surgery necessary?

Before prescribing an operation, the doctor analyzes all the characteristics of the disease and the need for the procedure in each case.

Without a justified need, endoscopic surgery on the maxillary sinus is not performed.

This is an extreme method of treatment that specialists in such cases have to resort to. reasons:

1. For chronic pathology, that is, long-term treatment of the patient is unsuccessful, while various inflammatory processes in the nose do not stop.
2. The presence in the maxillary sinuses of various neoplasms and growths, the removal of which occurs only mechanically.
3. Inflammatory processes in the maxillary sinuses are provoked by various jaw pathologies or other dental diseases.
4. In case complications with sinusitis, for example, when there is a threat of purulent masses entering the skull, which leads to more severe consequences.

Based on the above, we can conclude that endoscopy is performed only when necessary, mainly in a situation where there is a threat of more serious health consequences.

Carrying out endoscopic surgery

Endoscopic or intranasal surgery– type of surgical intervention belonging to the group minimally invasive, since after its implementation there is no obvious tissue damage or serious disturbances in the anatomical structure of the nose.

Negative consequences with this type of surgical intervention develop much less frequently than with abdominal surgery. Among other things, this type of treatment is suitable for most patients because it is less expensive.

This procedure can be performed both in an inpatient and outpatient setting.

Reference. Endoscopic surgery duration is from 30 min. up to 1 hour 30 minutes. The duration depends on the anatomical features of the patient’s maxillary sinuses and the doctor’s experience.

The procedure for the surgeon to perform the operation is as follows::

• An endoscope is placed in the nose(special optical device). With its help, the doctor visually controls the progress of the operation;
• a surgical instrument is inserted into the nose, with the help of which the procedure itself is performed. The choice of instruments depends on the type of disease. Typically used: laser– burning of tissues, scalpel or hangnails– removal of formations.

This operation is performed without anesthesia, as it is painless. In some cases, when the patient has a low pain threshold, the procedure is performed under local anesthesia.

Scheme of endoscopic surgery on the maxillary sinus

After endoscopic surgery, as well as after abdominal surgery, observation of the patient for several weeks. This is necessary so that the specialist can monitor the patient’s condition and remove blood clots and mucous masses in a timely manner. During this period, the patient must comply special diet necessary to increase the body’s regenerative capabilities.

Endoscopic surgery on the maxillary sinus: consequences

The consequences of refusing surgery may be much more severe than possible complications of the postoperative period

After the operation, you should prepare for the fact that in the first few days breathing through your nose will be impossible, and on the first day after removing the tampons, tears will flow uncontrollably.

But such phenomena pass very quickly.

Attention! The use of nasal drops with a vasoconstrictor effect after surgery is strictly prohibited without the permission of a doctor.

Practice shows that endoscopy rarely causes any complications. However, such a factor cannot be completely excluded, since sometimes there may be the following consequences:

1. Bleeding from the nose. The phenomenon is not terrible and can be easily stopped by a doctor using a regular tampon.
2. Blood in the eyelid area. Sometimes blood gets into the eye sockets, but goes away on its own and does not cause any problems.
3. The occurrence of inflammation in the sinuses. If there is obvious discomfort, you should immediately inform your doctor.
4. Formation of crusts in the nose.
5. Re-formation of a purulent cyst, which leads to another operation.
6. Adhesion formation between the wall and septum of the nose.
7. Headache, in case of damage to nerves during surgery.

The above consequences are observed extremely rarely, but if this happens, then a timely contact with a specialist will help eliminate the problem.

Of course, any operation is stressful for the body, and specialists do not prescribe surgical intervention unless absolutely necessary. However, there are cases when such a procedure cannot be avoided.

In this regard, endoscopy is the most gentle method of treating various diseases of the maxillary sinuses.

It is quite reasonable to start thinking about having an operation. Modern endoscopic microsurgery is advancing by leaps and bounds, so the range of possible operations gives the specialist the opportunity to choose the most effective and efficient one.

In the Open Clinic network, endoscopic sinus surgery is most often performed. Thanks to endoscopy, such an intervention has a number of advantages over radical interventions:

• Endoscopic sinus surgery restores the normal architecture of the sinuses and nasal cavity;
• Nasal breathing is restored.
• The patency of the anastomosis is restored.
• There is no surgical incision - minimally invasive and minimally traumatic.
• The cause of sinusitis is removed.
• Reduced risk of postoperative complications.
• There is virtually no swelling or postoperative pain.
• Possibility of taking a biopsy.
• Modern high-quality image and computer navigation system, which greatly facilitates the work of an ENT surgeon.

Thus, endoscopic microsurgery allows complex operations to be performed under endoscopic control. Endoscopic sinus surgery is the most gentle treatment method for chronic sinusitis today.

Endoscopic surgery on the maxillary sinus

According to the latest data, most Russian hospitals have begun to adhere to the tactics of surgical removal for chronic sinusitis. Unfortunately, insufficient equipment in operating rooms and low qualifications of operating surgeons do not allow modern interventions to be performed. Until now, the most used operation in the Russian Federation is radical treatment of maxillary sinusitis.

The Open Clinic network has modernly equipped operating rooms and hospitals, so the preference of our specialists is endoscopic surgery on the maxillary sinus. Thanks to this intervention, it is possible to expand the anastomosis, restore free breathing, remove cysts, foreign bodies, and neoplasms of the sinus.

All over the world, endoscopic operations are the gold standard of ENT surgery.

Endoscopic surgery on the frontal sinus

Endoscopic surgery on the frontal sinus is considered one of the most difficult interventions due to its structural features. Before the procedure, a CT scan is required to determine the anatomy of the frontal sinus, its shape, topography, location of the anastomosis and ethmoidal artery. There are several options for the location of the ethmoidal artery and anastomosis, and this is where the complexity of the endoscopic operation lies.

Specialists of the Open Clinic network have extensive experience in conducting these interventions. The good equipment of our operating rooms, the availability of advanced technologies, operations under the control of a computed tomograph, experienced surgeons - all this makes it possible to carry out such operations in our clinics at the level of the best European ENT centers.

Endoscopic sinus surgery

The “Open Clinic” operating networks are equipped with modern equipment, thanks to which endoscopic surgery on the sinuses can be performed. Mandatory conditions for the intervention are:

• Availability of modern endoscopic equipment.
• High resolution HD screen.

Thanks to modern technologies in medicine, patients do not have to make a choice between a complete cure for chronic sinusitis and surgery. Endoscopic interventions are an alternative to classical operations. They are effective, safe, painless and suitable for different age groups.

In Europe and America, endoscopic ENT surgery is a common and effective method. Carrying out similar operations has become possible in the Russian Federation in the Open Clinic network. We take the experience of our foreign colleagues as a basis and create our own techniques and methods of endoscopic interventions.

Why should you come to us?

In the Open Clinic network:

• Advanced operating equipment is used.
• Such operations are carried out regularly.
• We achieve high and stable results.
• All our specialists constantly improve their skills in the best European clinics.