Sinus Surgical Techniques from Caldwell-Luc to MIST View Full Text


Ontology type: schema:Chapter     


Chapter Info

DATE

2014

AUTHORS

Peter J. Catalano , Rahul C. Gupta , Meir Warman , Rohan C. Wijewickrama

ABSTRACT

Surgical treatment for chronic and acute sinus infections, including polyposis, began with external trans-facial approaches requiring skin incisions and their associated issues. The first attempt at concealing external incisions for access to a sinus was the Caldwell-Luc procedure using a sublabial approach. While the incision was not visible, the morbidity of the procedure was as patients always had a swollen cheek and upper lip, ipsilateral anesthesia of V2, and nasal packing. With the introduction and subsequent adoption of the nasal endoscope, facial incisions became rare; however, nasal packing remained a routine postoperative requirement, and post-op pain and facial bruising were still likely. Surgical morbidity was initially quite high due to a steep learning curve and the frequent anatomic disorientation of the surgeon. Visual change, orbital ecchymoses, blindness, and CSF leak occurred at unacceptably high rates. With proper training that soon began in residency instead of in the postgraduate phase and the introduction of the camera-endoscope combination, it became easier and safer to train the next generation of sinus surgeons and allowed postgraduate surgeons to learn quicker and with better instruction as techniques could be demonstrated and visualized “live” on a flat screen monitor. Along with the endoscopes, softer, more comfortable nasal dressings were available to replace the yards of cotton gauze previously used for nasal packing. Within another decade, resorbable nasal dressings have become very popular and effective, not only for hemostasis, but for topical drug delivery to target tissues within the surgical site. More recently, balloon dilation technology (BSP) has become popular as either a stand-alone intervention for less extensive sinus disease and for those with recurrent acute sinusitis, whereas hybrid procedures using balloons and conventional techniques are commonly applied to all other scenarios. The latter two options have dramatically reduced nasal trauma and post-op morbidity, often allowing patients to return to work or school within 24 h of surgery, and “office BSP surgery” under local anesthesia is becoming a popular option for select patients. More... »

PAGES

389-410

References to SciGraph publications

  • 2003-10. Anaesthesia in endoscopic sinus surgery in EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY
  • 2001-04. Topical Corticosteroids in Nasal Polyposis in DRUGS
  • Book

    TITLE

    Diseases of the Sinuses

    ISBN

    978-1-4939-0264-4
    978-1-4939-0265-1

    Author Affiliations

    Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/978-1-4939-0265-1_21

    DOI

    http://dx.doi.org/10.1007/978-1-4939-0265-1_21

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1038379207


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