What is the inflammation of sieve beans?

Among the paranasal sinuses, the ethmoidal sinus anatomy is the most complicated, especially the semilunar fissure at the opening of the anterior ethmoidal sinus and the uncinate process and ethmoidal funnel near the schematic diagram of the ethmoidal sinus, which are the small protrusions and groove spaces of the middle nasal meatus, and are called sinus-oronasal meatus complex. This place is the impact of inhaled airflow in the nasal cavity, and it is also the place where bacteria, viruses and inhaled antigens (allergens) are most likely to invade. Whether it is infection or allergic reaction, the mucous membrane swells at the beginning, the ciliary movement stops, the ventilation and drainage of ethmoidal sinus are blocked, and then it spreads to other sinuses. Due to poor drainage of ethmoid sinus, if inflammation is not easy to dissipate, it will easily delay to chronic.

1. General symptoms: listlessness, fatigue, dizziness, memory loss, inattention, etc. Acute attack, chills, fever, loss of appetite, constipation and general malaise.

2. Local symptoms: (1) Purulent nasal discharge is the main symptom, which is sticky or purulent. The former group of sinusitis is easy to be ejected from the front nostril, while the latter group of sinusitis flows into the pharynx through the back nostril, and the nose of odontogenic maxillary sinusitis often smells rotten; (2) nasal congestion; (3) headache: (4) decreased vision.

3, olfactory disorder: the sense of smell declines or disappears, often due to unexplained sense of smell loss.

4. Reflex neuralgia can include facial pain, toothache, mastoid, neck, shoulder and back neuralgia.

5. When there is purulent secretion flowing from the back nostril to the pharynx when the head is lowered or the head position changes, nasal drip can be temporarily relieved.

Stenosis of ethmoidal sinus structure. The normal ethmoid sinus is 4 ~ 5 cm long. The anterior ethmoid bone is 2.5 cm high and 0.5 cm wide. The width of posterior ethmoid bone is 65438±0.5cm, and the width of ethmoid top is 0.3cm. If the operation is performed in such a narrow range, if there is bleeding or poor light, it is easy to damage the outer wallpaper template and the sieve plate at the top of the ethmoid sinus. Traditional ethmoid sinusitis surgery can't find the focus completely, and of course it can't cover everything. It is easy to leave the root of the disease and cause recurrent attacks, and it is easy to cause complications: skull base bone injury, intracranial hemorrhage, intracranial infection, optic nerve injury, decreased or lost sense of smell, etc. At present, Jiang's rhinitis ointment, the most commonly used external Chinese medicine, is treated thoroughly twice a day. Patients should avoid traditional ethmoid sinusitis surgery when receiving treatment.

3 Clinical manifestations

Chronic ethmoiditis rarely occurs alone, and its symptoms are atypical. Neuralgia, depression, inattention and other symptoms are more common. When the sinus ostium is blocked, there may be swelling of the nasal root or orbit, nasal congestion, olfactory disturbance and runny nose at the back of the nose. The headache of ethmoid sinusitis is generally mild, and the pain is in the corner of the eye or the root of the nose, with obvious local tenderness. Sometimes turning the eyeball will aggravate the pain behind the eyeball. It can also radiate to the top of the head or occipital region.

Clinical examination found that due to polyp obstruction, the middle turbinate and nasal septum nodules were hypertrophy, olfactory cleft and purulent secretion in the middle nasal passage.

Four diagnostic methods

Schematic diagram of sinus

Clinical examination showed that polyps blocked the middle nasal meatus, the middle turbinate and nasal septum nodules were thickened and olfactory cleft, and purulent secretions were found in the middle nasal meatus.

X line

The shadow of ethmoid sinus and the lesion range can be seen in the frontal position of nose.

Computerized x-ray tomography

Coronal scan showed thickening of ethmoid sinus mucosa, presence or absence of bone destruction at ethmoid apex, axial scan showed the range before and after lesion, and presence or absence of defect or bone destruction on paper template.

Test puncture

First, use 1% caine cotton piece containing 1‰ adrenal gland to contract the middle nasal meatus and anesthetize the mucosal surface, then puncture the ethmoid vesicle with No.5 long needle, inject a small amount of sterile saline, take it out, check whether it is turbid, and do bacterial culture and antibiotic sensitivity test. This method is difficult and dangerous, and must be operated by experienced doctors.

5 treatment measures

Non-surgical treatment

Including nasal drops mucosal vasoconstrictor and antibiotics, negative pressure replacement, physical therapy and so on. Suitable for children and patients with physical weakness and systemic diseases. Chinese herbal medicine for ginger therapy: Chinese herbal medicine for rhinitis: Xanthium sibiricum 30g, Flos Magnoliae 20g, Scutellariae Radix 35g, Asari 4g, Radix Angelicae Dahuricae 20g, Radix Gentianae 10g, etc. , carefully selected, air-dried, ground and externally applied twice a day, not only has a definite curative effect on ethmoiditis, but also has a good curative effect on other rhinitis.

Intranasal ethmoidectomy

1. instruction

(1) Chronic ethmoiditis, conservative treatment is ineffective.

(2) Multiple polyps in ethmoidal sinus area still recur after repeated intranasal operations.

(3) Patients with ethmoiditis have or are suspected to have orbital or intracranial complications.

(4) Used as the first step of frontal sinus surgery or sphenoid sinus surgery.

(5) Tumors and cysts originating from ethmoid sinus.

(6) Fungal ethmoiditis.

2. Contraindications

Patients with acute upper respiratory tract infection and hematological diseases.

Step 3: Surgery

(1) The top wall of the nasal cavity is a sieve plate, slightly lower than the ethmoid sinus. The corner between the outer edge of sieve plate and the inner wall of ethmoid sinus is easy to be damaged by operation, so the instrument should not exceed the plane where the middle turbinate is attached during operation, so as to avoid cerebrospinal fluid rhinorrhea and meningitis caused by mistaken entry into the skull.

(2) There are optic nerve and internal carotid artery in the thin bone wall of ethmoid sinus and sphenoid sinus. If the injury can cause serious complications, we should pay attention to it.

(3) The lateral wall of ethmoid sinus is extremely thin, which is called paper template. Sometimes it is naturally defective, and sometimes it has been destroyed by the last operator. During the operation, we should pay attention not to get into the orbit by mistake, so as not to cause orbital complications.

(4) The ethmoid sinus and the lacrimal sinus were separated in the anterior group. During the operation, a small sickle knife can be used to make an arc incision at the nasal mound, make a mucosal flap and turn it down. Then you can use a sharp spoon to press outward into the nasal cavity, and then use a spoon knife to gently press backward, and gradually scrape off all the diseased air cavities, broken bones, polyps and residual mucosa from top to bottom, from front to back and from inside to outside. You can use suction spoon pliers. At this time, the sphenoid sinus ostium can be seen, and the probe can also enter the frontal sinus.

(5) The middle turbinate lesion is expected to recover after operation, which should be preserved and can be used as a sign of entering the back. If the middle turbinate is too thick or contains air sac (bubble middle turbinate), it can be bitten off together with the inner wall.

(6) Intraoperative lighting must be sufficient, and the blood in the cavity should be sucked clean at any time. Also, try washing or pressing with a cotton pad or gauze soaked with adrenaline to stop bleeding. It is absolutely forbidden to blindly operate or forcibly tear tissue. The removed tissue needs to be checked by the operator. If there is yellow soft tissue, the operation should be stopped immediately to avoid further damage to the orbit. The nasal cavity may not be full after operation. If there is oozing blood, gelatin sponge can be used to stop bleeding. If you need to fill it, you should not fill it too tightly.

Extranasal ethmoidectomy

1. instruction

①X-ray sinus is well developed, including superior ethmoidal chamber of sphenoid bone and maxillary ethmoidal chamber; ② Patients with chronic ethmoiditis complicated with frontal sinusitis; ③ mycosis of ethmoid sinus; ④ Foreign body in ethmoid sinus; ⑤ ethmoidal sinus tumor; ⑥ ethmoiditis with orbital or intracranial complications; ⑦ Repair of traumatic cerebrospinal fluid rhinorrhea.

2. Surgery

(1) posture and anesthesia: Take supine position, use nasal mucosa surface anesthesia, and use 1% ~ 2% procaine (with a little adrenaline) to infiltrate into the periosteum of orbital wall for 2cm, and then block ethmoidal nerve.

(2) The incision was made from the lower eyebrow edge between the inner canthus and the midline of the nasal root to the lower orbital edge, and an arc incision with a length of about 2.5cm was made.

(3) Stripping the subcutaneous tissue along the curvature of the bone wall to expose the frontal process and part of the nasal bone of the maxilla, then exposing the lacrimal bone and the ethmoid paper template, and then cutting the periosteum to strip the exposed bone surface, paying attention to protecting the medial canthus ligament and lacrimal sac.

(4) Cut through the lacrimal bone, cut into the ethmoidal chamber, bite off the lacrimal bone, part of the maxillary frontal process and cardboard, enlarge the incision of the anterior ethmoidal sinus, bite off the air septum under direct vision, and remove all pathological tissues in the ethmoidal sinus. Because the ethmoid sinus top wall and cardboard are in bright field of vision, they are not easy to be damaged. The middle turbinate should be preserved. This operation extends backward to see the anterior wall of sphenoid sinus and its opening, and can be explored if necessary.

(5) After filling and suturing to clean the surgical field and stop bleeding, fill the surgical cavity and nasal cavity with spun yarn containing antibiotics, sew two layers of incision, and then pressure bandage.

(6) Take out the tampon on the second day after operation, and take out the stitches on the sixth day.

3. Precautions for operation

Radical ethmoid sinus surgery requires all air chambers to be completely open, which can not damage adjacent organs and tissues and avoid complications, which constitutes a certain difficulty. Therefore, it is necessary to pay attention to the following important anatomical landmarks.

(1) Liu Qingming and Zhu Shijie think that the middle turbinate can be used as an important sign of ethmoidectomy. Attached to the superior medial surface of ethmoidal labyrinth, suspended between nasal septum and ethmoidal sinus air chamber, and the operation was performed between middle turbinate and paper template. The average distance from the anterior end of the middle turbinate to the ostium of sphenoid sinus is 34mm, which can be used as the front and rear boundary of ethmoidectomy. The average distance from the middle point of the lower edge of the middle turbinate to the sieve plate is 22mm, which can be used as reference data to prevent the sieve plate from being damaged.

(2) Pattern positioning The distance between the patterns on both sides is narrow at the top and wide at the bottom (the average upper edge is 24mm in front, 26mm in the middle and 28mm in the back; The average lower edge is 32mm in the front, 35mm in the middle and 37mm in the back). The paper template is trapezoidal on the coronal plane of ethmoid bone, which is located on the vertical plane of the lateral wall of nasal cavity (the medial wall of maxillary sinus), or on the inner side of the vertical plane, not on the outer side. Therefore, marking the external wall of nasal cavity during operation can avoid damaging the paper template or accidentally injuring the orbit and important nerves and blood vessels.

(3) The anterior nasal spine can be used as an external anatomical marker. The average distance from the spine to the optic foramen is 70mm, and the average angle between the two points and the midline is 1 1.7, which indicates the optimal range of ethmoid sinus resection.

There are many anatomical variations of ethmoid sinus, and the above data are for reference only.

Axillary ethmoidectomy

This operation is a multi-sinus operation with maxillary sinus and ethmoid sinus as the main parts. Its advantages are that it can treat multiple sinusitis in one operation, leaving no scar on the face and less surgical complications, which is safer than intranasal ethmoidectomy. The disadvantage is that the anterior ethmoid sinus air cavity is not easy to be completely removed.

1. instruction

Chronic ethmoiditis or polyp with chronic suppurative maxillary sinusitis was confirmed by X-ray film of paranasal sinus or maxillary sinus puncture.

2. Surgery

First, complete the radical maxillary sinus surgery routinely. After complete hemostasis, the inner wall of ethmoid sinus was slightly cut outward at the upper part of the inner corner of ethmoid sinus, and the pathological changes in ethmoid sinus were gradually removed with curette or round-headed occlusal forceps, and the paper template was enlarged outward with curette as a surgical sign. Continue to scrape back to the anterior wall of sphenoid sinus and explore if necessary. Lesions near the anterior ethmoidal sinus air chamber and the opening of the nasofrontal canal can be removed through the nose.

Radical operation of bilateral maxillary sinus by eversion nose method

This legal system 1959 was first put forward by Maniguwa. Bilateral ethmoidal sinus and maxillary sinus can be opened at the same time in one operation, which has the advantages of expanding the surgical field of vision, clearing the focus thoroughly, reducing the number of operations and leaving no scars on the face.

1. operation

(1) Anesthesia is the same as surgical anesthesia in Kelu.

(2) The incision was cut from the midline along the gingival sulcus of the upper lip to the third molar, with a length of about 6cm.

(3) Expose the piriform foramen and cut its mucosa, separate the periosteum upward, reach the transition part of the anterior and posterior wall of maxilla on the lateral side, approach the suborbital foramen upward, expose the edge of the piriform foramen on the medial side, and peel off the medial foot of pterygoid cartilage on the midline. At the edge of the pear-shaped hole

Otolaryngology examination

Cut the nasal mucosa from the bottom of the nose and cut it up along the edge of the pear-shaped hole to the lower edge of the nasal bone.

(4) Cut the whole nasal septum, insert the inferior turbinate scissors from the place where alar cartilage and nasal spine are separated, and cut the whole nasal septum upward to the vertical plate of ethmoid bone, which requires one-time incision.

(5) Expose the top of the nasal cavity and clean the nasal cavity. The whole pear-shaped hole can be completely exposed by pulling up the soft tissue of nose, lips and cheeks and the upper part of nasal septum with a retractor. Bite off a part of the frontal process of maxilla with rongeur, and the top and front of nasal cavity, middle turbinate and inferior turbinate will be clearly visible. If there are nasal polyps or middle turbinate polyps in the nasal cavity, they should be removed.

(6) Open ethmoid sinus. Use ethmoidal sinus curette to press ethmoidal chamber at nasal mound or ethmoidal vesicle, scrape all ethmoidal chambers from front to back and from top to bottom, draw blood with aspirator, and take out broken bones. The middle turbinate without polypoid transformation can be preserved, or it can be used as an anatomical sign to press inward. The ethmoid sinus is opened after the completion according to the main points of opening the ethmoid sinus in the nose.

(7) Dig the maxillary sinus to clean up the exposed canine fossa, dig the front wall of the maxillary sinus as usual, peel off part or all of it according to the pathological degree of the sinus mucosa, and dig holes parallel to the inner wall. The air chamber of the posterior ethmoidal sinus can be removed by digging through the back of the upper corner of the maxillary sinus, which is consistent with the opening of the nasal ethmoidal sinus, so as to achieve the purpose of leaving no residual infection focus.

(8) After the operation, the nasal and buccal soft tissues were restored. The mucosa at the pear-shaped hole does not need to be sutured. The incision of nasal septum needs to be reset and aligned, and both sides should be fixed with nasal gauze. No need to sew, just sew a few stitches at the incision of labial gingival sulcus. Compression bandaging and postoperative management are the same as those of the continental surgery. Take out stitches on the sixth day.

Functional endoscopic ethmoidectomy

This operation is a new nasal technique created by Messerklinger in 1978, summarizing the previous experience and theorizing it. Later it was improved and popularized by Kennedy Steinberg. The purpose of this operation is to improve the traditional radical surgery (destructive surgery) into functional surgery (reconstructive surgery), so as to completely cure sinusitis and restore its original function. According to the characteristics of respiratory airflow in the nasal cavity, the airflow first impacts the middle turbinate, middle nasal meatus and anterior ethmoid sinus after entering the nasal cavity, so this area is the area where infections and allergens attack the most. Modern theory holds that ethmoidal sinus has the highest incidence and is also the source of other sinuses. The focus of functional endoscopic sinus surgery is ethmoid sinus surgery. Sinusitis of maxillary sinus, frontal sinus and sphenoid sinus, which used to be considered irreversible, can gradually disappear without additional surgery if the lesion of anterior ethmoid sinus is removed by surgery and the normal ventilation and drainage function of sinus is restored.

1. Preoperative preparation

(1) The nasal endoscope with 0, 30, 70, 90 and 120 degrees will be selected as the instrument, which not only has strong illumination, but also has no blind area in the field of vision. There are several ethmoid sinus forceps with various curvatures, including straight and deformed aspirators 1 set, nasal septum surgical instruments 1 set, and 65433 nasal snares. 1 nasal forceps, 1 scissors, 1 nasal endoscope, 1 electrocoagulation hemostatic forceps, 1 TV and video recording system.

(2) Patient preparation

① Ask if there is any history of intranasal surgery. Those who have a history of nasal polyp surgery should pay attention to that those who have taken salicylic acid should postpone the operation.

② General examination includes routine hematuria examination and electrocardiogram examination.

③ Eye examination should pay attention to vision, visual field, intraocular pressure, eye muscle strength and exophthalmos.

④ Nasal treatment, hair cutting, negative pressure replacement and antibiotic dripping nose.

⑤ 500ml of blood should be prepared, and more blood should be prepared for the second operation.

⑥ X-ray film and CT film of sinus, and pay attention to the situation of ethmoid sinus roof and paper template.

⑦ Bacterial culture and drug sensitivity test of nasal secretions were started several days before operation. There are often anaerobic bacteria in the pathogenic bacteria of sinusitis, so it is necessary to cultivate anaerobic bacteria. If it is positive, take metronidazole 200mg orally two days before operation, three times a day.

⑧ Do a good job in explaining patients and their families, objectively analyze and estimate the operation effect and possible complications, especially when the operation involves the anterior skull base, sphenoid sinus and orbital cycle, explain that there are certain risks, and it is not appropriate to ignore the signing of the consent form for the operation.

Pet-name ruby lumina 0. 1g was injected intramuscularly half an hour before operation.

2. Surgical position and anesthesia

(1) Posture supine or 30 supine.

(2) If local anesthesia is used for anesthesia and bilateral sinus surgery, 25ml of 2% dicaine can be used, 2 ~ 3 ml of 0. 1% adrenaline can be added, mixed evenly, soaked with cotton sheets, and squeezed slightly after taking out until the liquid medicine does not drip. The nasal mucosa can be anesthetized twice, with an interval of 5 minutes each time. The middle turbinate and nasal mound need submucosal infiltration anesthesia with a 5 # long needle. The medicine can be 5ml of 1% lidocaine and 2 ~ 3 drops of 0. 1% epinephrine. If tracheal intubation is used for general anesthesia, local mucosa should also be treated with epinephrine cotton tablets to reduce the amount of bleeding during operation.

3. The position and responsibilities of the operator

The operator is located on the right side of the patient; The first assistant is located beside the operator and is responsible for the work directly related to the operation, such as instruments, dressings, anesthetics, etc. The second assistant is located on the left side of the patient, responsible for managing the video monitoring system and taking pictures and videos according to the instructions of the operator; The visiting nurse is responsible for infusion, blood transfusion and injection, and provides all kinds of surgical supplies needed by the operator.

4. Surgery

(1) facial disinfection: 75% alcohol is used for facial disinfection, and mercuric chloride can be used for nasal disinfection. Thiomersal can damage mucosa and should not be used. Do not cover the patient's eyes when laying the surgical towel, so as to check the patient's vision and extraocular muscles at any time during the operation.

(2) If there is no polyp in the middle nasal meatus, a longitudinal incision can be made at the front of the middle nasal meatus, which is equivalent to the front edge of the middle turbinate, or a half-moon incision can be made at its front lower edge. If there are polyps in the middle nasal meatus or the middle turbinate, it should be cut between the inner surface of the middle turbinate and the polyps. Using laser knife can avoid bleeding, and using 0-degree speculum to guide the operation.

(3) Use a nasal septum stripper to separate the mucosa of the middle nasal meatus, expose the ethmoid vesicle, lightly press the ethmoid vesicle with the stripper or open it with straight pliers. For the thick bone wall, it can be chiseled. In order to fully expand the approach, the middle turbinate can be pushed to the nasal septum. Preoperative imaging examination can provide the size of ethmoid vesicle.

(4) Under the endoscope, the ethmoid sinus roof in the ethmoid sinus cavity in the cleaning group was pale yellow. Special care should be taken during this operation. Usually, a 30-degree or 70-degree mirror is used with a curette, and polyp forceps are not used.

(5) Clean the anterior ethmoidal chamber and supraorbital ethmoidal chamber with 70-degree lens and polypus forceps with large opening. Clean the anterior ethmoidal chamber and supraorbital ethmoidal chamber, reach the bottom of frontal sinus, reach the outside of paper template, continue the paper template in the middle ethmoidal region, and reach the frontal process of maxilla. Sometimes the anterior ethmoidal artery running along the skull base can be seen, so care should be taken not to damage it. When cleaning the anterior ethmoidal chamber, be careful not to damage the lacrimal sac and nasolacrimal duct.

(6) After cleaning, use a 4mm 0-degree wide-angle lens and large-opening straight pliers, and switch to open straight pliers when entering the last group of sieve chambers, so that all sieve chambers are removed, reaching the sieve top, reaching the outer side of the pattern, reaching the front wall of the sphenoid sinus and reaching the medial middle turbinate, so that the whole ethmoid sinus becomes a cavity.

(7) Open and explore the frontal sinus. Use a 70-degree mirror with a curette or aspirator to explore the bottom of the frontal sinus. After finding the frontal sinus opening, use a curette to enlarge it around the sinus opening. There is a bony process between the frontal recess and the anterior ethmoid bone tip, which is an important sign. The frontal sinus floor and its opening are in front of it, and the ethmoid roof, that is, the anterior skull base, is behind it. Surgery is not allowed after this bone protrudes. Enlarging the opening of frontal sinus should not be less than 0.5cm, so as to fully drain after operation and prevent sinus orifice obstruction. Unless there are polyps or new organisms in the sinus, the mucosa in the frontal sinus is generally not treated.

(8) Open and explore the maxillary sinus. Under the guidance of a 70-degree or 90-degree microscope, the maxillary sinus ostium was enlarged by 65438±0.0cm with reverse rongeur, and the situation in the sinus was observed by endoscope at different angles. If polyps or cysts are found, they should be removed; If there is still mucosal hypertrophy, it is not necessary to deal with it; If there are many purulent secretions in the sinus, in order to promote ventilation and drainage, a hole can be opened in the inferior nasal passage to make the sinus have two openings. This method is also called combined hole-making method.

(9) After opening the sphenoid sinus and cleaning the posterior ethmoidal chamber, if the opening of the sphenoid sinus is low, it can be enlarged along its periphery with a curette; If the position is higher, the anterior wall of sphenoid sinus can be opened with sharp ethmoid forceps, and its position can be determined with a probe, and then enlarged with a rongeur. The distance from the anterior wall of sphenoid sinus to the anterior nostril is 7.5 ~ 7.8 cm, rarely less than 7.2cm, which can be used as a reference for finding the anterior wall of sphenoid sinus. According to Geng Xu's observation of 100 adult skulls, about 20% of them have superior ethmoidal chamber of sphenoid bone, which should not be mistaken for sphenoid sinus to avoid complications. The coronal CT scan of paranasal sinuses before operation can be used as an intraoperative reference. If in doubt during the operation, you can also observe it with a 0-degree microscope or take out the speculum for general observation.

After all the operations are completed, the ethmoid sinus is washed with saline, the residual pathological mucosa and bone chips are checked and removed, the bones in the ethmoid chamber are scraped off, and all the open sinus openings are filed flat. If there is active bleeding, bipolar electrocoagulation is needed to stop bleeding. Finally, gently fill the surgical cavity with gelatin sponge or vaseline gauze.

5. Postoperative treatment

(1) Patients under local anesthesia after operation should take a semi-sitting position, pay attention to whether there is blood flowing out of the posterior nostril, and ask the patients to spit blood into the curved disc, and a small amount of oozing blood can be left untreated. If the amount of bleeding is large, it should be refilled.

Patients under general anesthesia should pay attention to the unobstructed respiratory tract before waking up, often suck out pharyngeal secretions and blood, and get out of bed the next day after waking up. The specific treatment method is the same as that of patients under local anesthesia.

(2) intravenous infusion of 5% or 10% glucose, adding 4 ~ 6g cephalosporin every 500ml, and feeding semi-liquid food.

(3) Routine eye examination, including eyelid, bulbar conjunctiva, eye muscle, intraocular pressure, vision, visual field, exophthalmos, etc. , and compared with preoperative. Generally, there will be mild congestion and edema of eyelid after operation, which is because the reflux of periorbital vein is blocked and will gradually subside after pulling out gauze. If there is conjunctival congestion, eye movement disorder, decreased vision and exophthalmos, it means that the orbit is involved, and the gauze should be pulled out immediately and handled in time.

(4) The time for taking out gauze routinely is 65438+ 0 ~ 2 days after operation, and pay attention to whether there is cerebrospinal fluid rhinorrhea. If there is cerebrospinal fluid leakage, it is forbidden to blow your nose and use enough antibiotics to prevent intracranial infection. Wash the operating cavity with normal saline containing antibiotic strains every day for 5 ~ 7 days.

(5) Cleaning the surgical cavity is a long-term treatment related to the success or failure of the operation, which needs to be carried out under the endoscope and is divided into three stages.

① The blood clots in the operation cavity were sucked out every day in the near future (7 ~ 10 days) after operation, the residual diseased tissues were cleaned with polyp forceps, and the nasal mucosa was contracted with 1% ephedrine cotton piece, paying attention to the ostium of the anterior ethmoid sinus and the front end of the middle nasal meatus. If the surgical cavity is blocked and cannot be drained, the operation will fail. New granulation or scab may appear after operation, which should also be removed and washed with salt water. The scab can disappear within 2 ~ 3 weeks.

② Within 3 months after operation, the patient should be reexamined in the hospital every 1 ~ 2 weeks. We can shrink, clean and flush the surgical cavity according to the above methods, and pay attention to whether there are secondary infections, polyp regeneration, sinus stenosis, middle nasal meatus adhesion and so on. And should be treated in time to restore the ciliary function of the operating cavity.

③ Within half a year after operation, come to the hospital for reexamination every 1 ~ 2 months, and the treatment method is the same as before, so as to consolidate the operation effect. Generally, the middle turbinate returns to normal shape, and the middle nasal meatus is unobstructed. If the sinus ostium is blocked or adhered by endoscopy, a second operation should be performed. However, because the anatomical landmarks of the nasal cavity have been destroyed, the second operation is difficult, and it is best to perform the operation by the original operator.

6 pathological changes

Mucosal lesions include polyps, hypertrophy and atrophy, and bone wall lesions include the following three types:

1. Hypertrophic osteopathy is stimulated by submucosal hyperemia, and there is proliferative osteitis on the bone wall, which makes the ethmoid bone wall hard.

2. Atrophic bone disease is due to the long-term compression of ethmoid bone wall by polyps and hypertrophic mucosa, which leads to the thinning or disappearance of bone wall due to insufficient blood supply.

3. Ulcerative bone lesions spread to the bone wall due to mucosal thrombophlebitis, resulting in necrosis of the ethmoidal wall, and each ethmoidal chamber can be fused into a large cavity with pus in it. If the infection is serious, orbital or intracranial complications may occur.

7 concurrent symptoms

Common complications of ethmoidal sinus surgery Among sinus surgery, ethmoidal sinus surgery is the most prone to surgical complications, because ethmoidal sinus is the smallest of all sinuses. According to Rice( 1989), the normal ethmoid sinus is 4 ~ 5 cm long from front to back, 2.5cm high in front, 0.5cm wide in back, 1.5cm wide at the top and 0.3cm wide at the top. If the operation is performed in such a narrow range, if there is bleeding or poor light, it is easy to damage the outer wallpaper template and the sieve plate at the top of the ethmoid sinus. Among the above ethmoidectomy, intranasal ethmoidectomy is the most prone to orbital and intracranial complications, followed by Lima operation and extranasal ethmoidectomy. In recent years, functional endoscopic sinus surgery has been carried out. Although there are advanced surgical equipment, complications have been reported at home and abroad due to the inexperience of the operators.

Skull base bone injury

Cerebrospinal fluid rhinorrhea and intracranial pneumatosis (pneumatosis) are often caused by the operation of surgical instruments too upward, beyond the attachment of the middle turbinate, and the appearance is higher than the inner canthus plane.

intracranial hemorrhage

Subdural hematoma, frontal lobe hematoma and cavernous sinus-internal carotid artery fistula are caused by sharp forceps clamping the tissue at the top of ethmoid sinus too upward or clamping the tissue at the side wall of sphenoid sinus to damage blood vessels. If the internal carotid artery ruptures, the patient will soon die of nosebleeds.

Intracranial infection

Common cases are meningitis, subdural abscess and brain abscess.

Paper pattern damage

Mild cases only have emphysema in orbit and subcutaneous blood stasis in eyelid. In severe cases, the anterior ethmoidal artery ruptures, leading to orbital hematoma, which will soon lead to blindness. If the medial rectus muscle is injured, strabismus and diplopia may occur.

Optic nerve injury

Including optic ganglion and posterior segment injuries. If the tissue taken out during the operation contains yellow orbital soft fat, it may damage the optic nerve, orbital blood vessels and medial rectus muscle, cause reflex omental spasm or embolism, and lead to blindness.

Lacrimal duct injury

Including lacrimal sac and nasolacrimal duct, the main sign is tears.

Intraorbital infection

There are orbital periostitis, orbital cellulitis and orbital abscess. This may happen a few days after the operation. The main symptoms are fever and eye pain.

Intranasal complications

(1) The decline or loss of sense of smell is often caused by excessive loss of mucosa in the olfactory region.

(2) Adhesion of nasal meatus complex in paranasal sinuses may lead to failure of functional endoscopic sinus surgery.