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Clinical Application

Endoscopic laser treatment under the care sinus cyst

Keywords: ENT, Endoscopic laser treatment under the care sinus cyst

From 2004 to 2009, the Division in the semiconductor laser under nasal endoscope combined with surgical treatment of 26 cases of paranasal sinus mucoceles, now nursing summary report are as follows.
1.
clinical materials
The group of 26 patients, including 15 males and 11 females, aged 33 to 71 years. Were confirmed by CT or MRI, pathology for the mucocele. Ethmoid cyst in 11 cases, frontal sinus cyst in 8 cases, 5 cases of sphenoid sinus cyst, 2 cases of cysts butterfly screen; paper sample of 24 cases of bone destruction, destruction of sella broke into the middle cranial fossa in 1 case. 26 patients were dizziness, headache, blurred vision, decreased visual acuity, eye shift. Surgery under local or general anesthesia. Ethmoid cyst: 0 ° endoscopic resection of the uncinate process, ethmoid bulla open, open, while fully exposed before and after the ethmoid anterior cyst wall, the semiconductor laser resection and bone wall to flush stoma. Sphenoid sinus cyst: 0 ° endoscopic laser ablation of the posterior part of the middle turbinate anterior sphenoid sinus exposure, locate the sphenoid sinus opening as a center around the laser ablation of sinus mucosa, point by point to bite than an open sinus bone, laser resection wall. Frontal sinus cyst: a thorough screening before opening fully open frontal sinus openings, in the 30 ° endoscope to the bottom wall of the frontal sinus expanding bite addition to bone, laser ablation of the wall. After all expansion foam packing, 48h after the extraction. Under the periodic dressing of conventional endoscopy, blood around the stoma clean scab, secretions, mucous membrane vesicles, and edema. Postoperative results were satisfactory, dizziness, headache, ocular symptoms improved significantly improve visual acuity in 20 cases, five cases of recurrence after reoperation, three cases of orbital hemorrhage after 1 week after treatment were cured. Follow up of 1 to 5 in both sinus drainage was adequate and no cyst recurrence.
2.
Nursing
2.1
Preoperative Care:
(1) Psychological Care: sinus cysts without any symptoms early may, with the cysts gradually increased, there may be dizziness, headache, decreased vision, blurred vision, proptosis, strabismus and urgent requirements such as surgery, but the effect of surgery is often a fear of tension, fear. At this point should be passionate about your surgery, treatment effect, eliminate the tension, fear.
(2) preoperative preparation: doing the routine check; to 1% of the intranasal furosemide Well, Berkner nasal spray, 3 times / d; prevention of respiratory tract infections; quit alcohol; church approach blowing your nose, cut nose preoperative 1d , cleaning the nasal cavity.
2.2
Postoperative care:
 (1) nasal packing care: routine use of postoperative nasal packing foam expansion, hemostasis and promote wound healing, and you should ground patrol unit, observe the situation of nasal bleeding. General Packing 24 ~ 48h, prolapse should be compensated in the plug. When the pressure within the nasal cavity nasal packing abundant nerve endings can cause headache, nasion Ministry pain, dental pain, 24h in to nose, forehead cold compress to reduce congestion, swelling, pain relief, if necessary, application of analgesics. Instruct patient to semi-supine or supine
high pillow, and promote blood circulation, relieve congestion and edema.
(2) surgical cavity care: 48h after removal of nasal packing material used for nasal irrigation nasal irrigator, 2 / d, in order to promote secretion and excretion of blood scab, which will help the inflammation and edema subsided, and promote mucosal epithelialization. When washing the body forward 30 °, bow mouth fat "ah" sound, so that fluid from the mouth or nose the other side of the natural flow. Note Do not flush when blowing your nose or swallow hard to prevent the cleaning fluid along the eustachian tube into the middle ear cause otitis media. Fluid temperature suitability. Endoscopic examination after a day, timely cleaning and suction crust, discharge.
2.3
Complications of care
(1) Bleeding: bleeding and more severe coughing, or forced by the trigger sneezing, nasal bleeding or appears out of his mouth fresh blood. The group 1 patients due to hard stools 3h moderate nasal bleeding occurred while the patient comfort, while a 1% furosemide Ma intranasally, 1 ~ 2min blood only. Should remind patients to avoid the force after sneezing, coughing, hard stool, the church proper method of blowing your nose.
(2) sinus occlusion: sinus occlusion as nasal secretions, and blood crust failure to inflammation caused by mucosal adhesions. 5 cases of recurrence due to sinus occlusion, mainly after the dressing change specifications without timely, clean operative cavity.
 (3) cerebrospinal fluid leakage: usually occurs in the sphenoid sinus surgery opening at the top, concave sieve and ethmoid injury can cause leakage of cerebrospinal fluid. See, for example surgery watery fluid outflow, immediately after the endoscopic temporal fascia with the ear or iodoform gauze packing; take a half after the patient supine, and has asked not to hard to play sneeze, cough, do not at stool; and close observation of patients consciousness, pupil, vital signs; watery nasal cavity with or without effusion, effusion, when necessary, to send laboratory. Directed by your doctor of preventive use of dehydration, antibiotics to prevent retrograde infection. No one cases occurred in this group.
(4) blind: a model due to perforation of paper and orbital periosteum direct injury or increased intraocular pressure caused by optic nerve damage, such as the eye does not see the normal activity or prominent, or eyelid edema, ecchymosis, see pupil visual changes and nasal adipose tissue should be immediately discontinued operations, close observation and attention to signs of increased intraocular pressure, visual acuity, with mannitol 1 ~ 2g/kg rapid intravenous injection, and requested emergency ophthalmology consultation.
(5) diplopia: mainly due to surgery breakthrough model and the orbital periosteum of paper within the rectus muscle or nerve damage or blood supply, electrocautery or laser surgery of orbital subperiosteal wave when worn easily cause diplopia. Postoperative visual acuity examination, listened patient complained of, if found to hormone treatment, eye treatment should be persistent diplopia. No one cases occurred in this group.
(6) orbital hemorrhage: 3 cases in this group. CT suggest a model paper damage, intraoperative blood sample by the paper into the intraorbital defects in periorbital ecchymosis caused by antibiotics, hemostatic agent, 72h within the local cooling, ecchymosis disappeared after 1 week.
2.4
The discharge guide: to keep warm to prevent cold; Do not dig hard nose, nasal irrigator churches patients, the right nasal wash, 2 times / d, every two weeks to replace a washer, directed by your doctor to continue taking anti-inflammatory drugs and sticky sputum chelating agents, topical nasal drops and nasal spray, this drug effect and adverse reactions; was regularly standardized dressing (after 1 month, 1 week, 2 to 3 weeks after an appropriate time until complete epithelialization mucosa). At least 2 years follow-up.

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