FESS surgical technique tips. and hints. Lujber László és a. szerző engedélyé. Prof. Dr. Imre Gerlinger
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1 FESS surgical technique tips and hints Prof. Dr. Imre Gerlinger
2 013 szakvizsga kötelező tanfolyam
3 013 szakvizsga kötelező tanfolyam
4 Importance of cadaver dissection Position of the head Anaesthesia of the mucous membrane Positioning of the endoscope and the sucker Mucous membrane on the endoscope bleeding Practising nasal endoscopy Practising sinoscopy 1 2 3
5 Preoperative tricks and hints 013 szakvizsga kötelező tanfolyam Never operate without CT scan The notes should be in the operating theatre Do not rush, CT checklist! Role of vasoconstrictors! Appreciate the efforts of both the anaesthetist and the theatre staff! Bradycardia decreases the cardiac output, much less bleeding. 1 tablet beta blocker one day prior to surgery and just before surgery (periférial vasodilatation) Do not cover the patient s eye, collect all the tissues which are removed
6 Surgical hints Anatomical knowledge, CT! Forget about pull and tear technique. Check/ballotate the eyeball regularly! Keep distance with the endoscope! Keep the instruments in front of the tip of the endoscope Anatomical landmarks! In case of serious bleeding: STOP! Do not remove anything! O o endoscope mostly (occasionally 45 o ) Medial-inferior direction Respect the ethmoidal anterior artery Respect the mucosa of the frontal recess Gentle palpation with the curved probe/j curette! Do not stick! Keep the integrity of the olfactory mucosa! (gently lateralisation of the MT at the of the procedure)
7 Infundibulotomy (resection of the uncinate process) infundibulotomy ostium of the maxillary sinus
8 Infundibulotomy
9 Infundibulotomy, opening of the agger nasi cell
10 Infraorbital (Haller) cell
11 Partial anterior ethmoidectomy 013 szakvizsga kötelező tanfolyam
12 Perforation of the ground lamella (posterior ethmoidectomy) Posterior ethm. cells ground lamella
13 Frontoethmoidal cells (Kuhn 1-4.) Kuhn 1. Kuhn 2. Kuhn 3. Kuhn 4.
14 Further frontoethmoidal cells supraorbitalis suprabullaris bulla frontalis sinus interfrontalis
15 Exploration of the frontal recess
16 Exploration of the natural ostium of the frontal recess, removal of terminal recess 013 szakvizsga kötelező tanfolyam
17 Fronto-ethmoidectomy (revision) Agger nasi és Kuhn 1. cells
18 Opening of the frontal sinus, removal of a large frontoethmoidal cell (Kuhn 3. cell)
19 Frontal sinus empyema
20 Ethmoidectomy with shaver (diffuse polyposis)
21 Exploration of the sphenoid sinus (sphenoidotomy) sphenoidotomy 1: optic nerve 2: internal carotid artery 3: anterior wall of the sphenoid sinus
22 Transethmoidal sphenoidotomy 013 szakvizsga kötelező tanfolyam
23 Large Onodi cell, exploration of the sphenoid sinus
24 Sphenoidotomy, sphenoid sinusitis (Onodi cell)
25 Exploration of the natural ostium of the maxillary sinus (revision)
26 Mucocele (maxillary sinus)
27 Postoperatív hints Saline irrigation (blood clot, mucus), until the function of the cilia regenerates Endoscopic nasal toilette after 1 week, try to prevent adhesions. Do not check the patient too frequently. Per oral prednisolon in the post. op. period, try to create a good complience. Prepare the patient for tampone removal. Postoperatíve anelgesia.
28 Puy St. Vincent (France, 2011) Thank you for your attention!
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