FIELD:
otorhinolaryngology.SUBSTANCE: under endotracheal
anesthesia, an
endoscope equipped with
optics and an instrument for removing
pathological contents of the
maxillary sinus are inserted into the
nasal passage. The inferior nasal concha is displaced medially using a raspatory. Then, stepping back from the edge of the piriform opening by 1.5–2.0 cm in the caudal direction, a mucoperiosteal flap of the lateral wall is separated in the lower
nasal passage. The mucoperiosteal flap is displaced posteriorly, exposing the bone skeleton in the projection of the inferomedial angle of the
maxillary sinus. Next, using a cold
plasma coblator, in
ablation mode, the mucous surface of the bone skeleton is evaporated for 2–3 seconds, followed by coagulation of small vessels. Then, a bone valve measuring 10–15 mm is formed from the exposed bone skeleton. The bony valve is retracted in the caudal direction, forming an antrostomy. A 70-degree
endoscope is inserted through the formed antrostomy and the
pathological contents of the sinus are visualized. In this case, if the
cyst is visualized with a coblator in
ablation mode, the
cyst is evaporated along with its contents, and the remaining
cyst is captured and removed. If a polyp is visualized, the polyp stalk is first evaporated, and then the remaining part of the polyp is removed. If a
foreign body is visualized, it is removed with
forceps. In this case, if the
foreign body is encapsulated or located in the thickness of the mucosa, a coblator in
ablation mode evaporates part of the mucosa until the
foreign body is exposed, and then removed. Next, the
sinus cavity is washed with
saline solution. The antrostomy is closed with a bone flap. The formed mucoperiosteal flap is placed back in its original place.EFFECT: method allows for endoscopic endonasal removal of
pathological contents from the maxillary sinuses with a
minimal risk of cyst / polyp recurrence and postoperative complications, reduced
blood loss during
surgery, shortened surgical time,
postoperative rehabilitation periods, and temporary disability.3 cl, 3 ex