淺談慢性鼻竇炎的手術治療 文/趙勻廷 醫師
Surgical treatment of chronic rhinosinusitis Yun-Ting Chao, MD
Chronic rhinosinusitis with/without nasal polyposis (CRSwNP/ CRSsNP) is a chronic inflammatory disease of the mucosa in nasal cavity and paranasal sinuses. The clinical presentation includes purulent rhinorrhea, nasal obstruction, post-nasal dripping and even loss of smell. The symptoms should persist more than 3 months. The diagnosis is based on symptoms, endoscopic findings, and clinical images. Nasal polyposis may appear in sinonasal area in varying degree, aggravating the symptoms. Antibiotics, mucolytic agents, steroid, and saline irrigation are among the first-line medical treatments of CRS. The patient should undergo surgery if their CRS symptoms are poorly controlled by medical treatment. FESS is the mainstay of surgical treatment for CRS. It is a minimally invasive procedure to remove polyps and diseased mucosa. Normal sinonasal mucosa is left intact as much as possible to preserve its function. The procedure is performed under general anesthesia. The endoscope and each instrument are introduced through one of the nostrils. We use navigation technology to real-time monitor the position of the instrument in paranasal sinuses and to avoid injury of adjacent structures, such as great vessels, skull base or orbit. The openings of the sinuses are widened to establish adequate drainage pathway. The polyps and diseased mucosa are removed cautiously by microdebriders. The nasal cavity is packed by absorbable materials to stop the bleeding at the end of surgery. The FESS is to remove nasal polyps and diseased mucosa, to establish an adequate sinus drainage pathway, and to facilitate postoperative nasal irrigation and steroid spray administration. Risks & complications include: mucosal synechia, bleeding, septal perforation, epiphora, periorbital subcutaneous emphysema, orbital hematoma, diplopia, optic nerve injury, cerebrospinal fluid leakage, intracranial injury or postoperative mucocele. If you have any questions, please consult the otorhinolaryngology specialist for further information regarding CRS and FESS.