Endoscopic removal of nose polyps by shaverand other methods

Update: December 2018

After the patient is diagnosed with nasal polyposis,
the main method of relieving nasal breathing and reducing symptoms,
today there are only surgical methods in
combined with further drug treatment.

The basis of the formation of polyps is the release of histamine and other
inflammatory mediators that, destroying and causing swelling
epithelium, begin to form a polyp, after these changes
glandular tissue mucosa.

When a person with a polyposis has a sense of smell,
lack of nasal breathing, greatly reducing the quality of life,
frequent exacerbations of obstructive bronchitis and seizures
asthma, snoring and headaches appear – this is an indication
for surgical removal of nasal polyps. Operations today
performed in various ways, and still apply such
methods that are quite painful and traumatic are
polypotomy and removal of the polypous loop. Эти  способы
accompanied by bleeding and long postoperative
recovery period, to the disadvantage of their use
is that in this way only polyps can be removed,
located in the nasal cavity, and as a rule, almost all polyps
originate in the paranasal sinuses.

With the inaccessibility of polypous tissue in the sinuses after such methods
the removal very quickly again formed neoplasms in the next
1-2 years. Therefore, the most modern, progressive technology
is endoscopic surgery using a shaver.

Endoscopic polyp removal

Functional Endoscopic Sinus Surgery or Functional
Endoscopic Sinus Surgery is an innovative technique based
on the use of modern endoscopic equipment. This allows
otolaryngologists to perform surgical procedures with minimal
the risk of complications and a lesser degree of injury. When conducting
such removal benign neoplasms are removed
completely, which reduces the risk of recurrence by 50%, and healthy tissues do not
subject to unnecessary trauma.

When choosing a method and a surgeon what to pay attention to? Choose
Endoscopic FESS operation, that is, to use the shaver
or microdebrider occurred under the control of navigation – this is the most
modern and efficient method, because without a navigator,
It is quite difficult to clean out all the chambers of the lattice labyrinth. If a
this does not produce, after 3-6 months, the “mycelium” polypous
Tissues can grow new polyps again because the remaining
polypous tissue, like a mycelium creates the conditions for the formation
new polyps. And the patient gets on the conveyor of new operations and
financial expenses. It is also very important that the doctor performing
endoscopic surgery, performed similar operations regularly, had
extensive experience on this equipment.

There are 3 ways to remove polyps:

  • endoscopy, tools – it is difficult to clean deep and
    small cells
  • endoscopy, shaver
  • endoscopy, navigation, shaver – the safest method

If a пациенту показано хирургическое лечение, но у него на
the period of a planned operation is exacerbated by bronchial asthma or
obstructive bronchitis, allergic rhinitis, as well as during
allergic hay fever – the operation should be postponed and
perform it only during remission. Also contraindicated
surgery for:

  • Heart failure, ischemic heart disease
  • Serious diseases of internal organs
  • Acute infectious diseases
  • Even a slight indisposition, cold, increase in blood pressure, should
    reason for delaying the operation
  • Exacerbation of allergic reactions and bronchial asthma

Advantages and disadvantages of the method

  • The advantages of endoscopic surgery are that it does not require
    making no cuts, the whole process is carried out through the nose
    – endonasal.
  • Using endoscopic equipment, the operating surgeon sees
    what he does on the monitor and has access to all inaccessible
    sections of the sinuses and the nasal cavity, which in conventional surgery is not
    possibly.
  • Precision instruments such as the debugger or shaver work with
    minimal trauma to healthy tissue and mucous membranes, with
    millimeter precision.
  • Minimal bleeding is also an advantage.
  • This operation is performed in a hospital and takes
    patient 3-7 days.
  • Almost 80% of patients are satisfied with the results, because
    experiencing tremendous relief, they leave those symptoms that
    were before the removal of polyps with an endoscope.

Удаление полипов в носу

Disadvantages: Any operation to remove nasal polyps does not eliminate
the true cause of their occurrence, so repeated pathological
proliferation of polypous tissue occurs quite often, in 50%
patients. But it usually happens a few years after
successful operation.

How does endoscopic surgery occur?

Endoscopic removal is performed by
endovideosurgical imaging with screen version
fields on the monitor. It uses special modern
instruments:

  • Debreader (shaver, microdebrider) – a device that pulls in
    its tip polyp tissue and shaving it off at the base
  • Head Light
  • Endoscope with optics with different angles
  • Special nasal mirrors

The operation takes place under general anesthesia, its duration and
complexity depends on the clinical picture of polyposis and the number
sinuses in which drainage should be improved and fistula open.
Available visualization and high precision shaver allow
most carefully remove polypous tissue and polyps in all
parts of the nasal cavity and paranasal sinuses. Therefore, after such
procedures increases the time of remission, relapses are recorded
less often and after a longer time than after others
operational methods.

Clearing the paranasal sinuses in this way is simplified and becomes
the most effective further postoperative treatment and
conducting repeated interventions to remove new formations.
How is endoscopic removal of nose polyps by shaver?

After the introduction of anesthesia, the patient falls asleep after a few
minutes The anesthesiologist places a plastic tube in his mouth.
trachea, to be able to breathe during surgery. And heartbeat, and
respiration is recorded during surgery. Since modern
the technique allows removal through the nostrils, no
no cuts are made; endoscopes and illuminators are used to
better examination of the nasal cavity.

With the help of special bone tools, as well as suction –
shaver or debridera, open the paranasal sinuses, of which
all altered tissues and polyps blocking fistula are removed.
If a производится эндоскопическая FESS, то хирург и удаляет полипы
nose, and can correct a curved nasal septum, and take
tissue for biopsy, and open sinus fistula. After surgery in
special tampons leave the nasal cavity, they are removed on
the next day in the morning.

Preoperative preparation

  • Before any surgical intervention is very important to carry out
    thorough preoperative preparation:

The consultation discusses the necessary list of analyzes,
that need to pass the patient. Be sure to do a CT
paranasal sinuses, coagulogram, general and biochemical analysis
blood. You should also determine whether the patient needs
preliminary endoscopic examination to
determine the scope of work and technically difficult areas, it will help
surgeon and reduce the time and improve the quality of the operation.

  • 7 days before surgery

If a у пациента сильный полипоз носа, за неделю до плановой
operations prednisone is prescribed every day 40 mg. When active
nasal infection, anti-inflammatory prescribed
antimicrobial therapy. Also for a week, taking NSAIDs is excluded,
аспирина, витамина Е, которые влияют на свертываемость blood.

  • One day before surgery

On the eve of the operation, a light dinner is allowed in the evening, and in 6 hours
you can not drink or eat, with dry mouth, you can only
rinse mouth with water.

Postoperative period

After any surgery, it takes time to
that the nasal mucosa recovers. Since in the period
after surgery, ciliary epithelium decreases
activity, the circulation of mucus in the nasal cavity is disturbed, which
increases the risk of penetration and reproduction of various infections,
therefore, nasal hygiene is very important. The next morning
the patient is removed tampons, while in the nasal cavity occurs
accumulation of crusts, blood, fibrin plaque.

At this time, in no case be blown away, take
hot food. It should only gently remove mucus and crusts from
nasal vestibule. Usually nasal breathing returns quickly, and
Smell is restored sometimes in a month. Doctors believe
that the operation was successful, if symptoms such as
blockage of outflow in the nasal cavity is a headache, and pain in
some departments of the face.

Possible complications after surgery:

  • Infectious complications
  • Bleeding
  • Fusion and formation of adhesions in the nasal passages
  • Re-growth of new nasal polyps.

Anti-relapse postoperative treatment:

Because any removal method does not eliminate the causes of sprawl.
tissue, therefore, proposed postoperative anti-relapse
treatment. (see Polypas in the nose treatment). After surgery, already in
at home, the patient can nasal wash
ready-made pharmacies such as Physiometer, Aquamaris,
Aqualore, Allergol of Dr. Theis, Marimer, Physiomer, Quicks,
Atrivin-Sea, Gudvada.

And also should take antihistamines – Cetrin,
Zodak, Erius, Loratadin, Claritin (a list of the best modern
allergy pills).

After surgery inсегда назначаются дозированные гормональные
aerosols, such as Fliksonaze, Nazarel, Asmanex, Aldetsin, 
Avamis, Benorin, Nazoneks, Bekonaze, Rinoklenil, Nasobek,
Beclomethasone.

Allergy sufferers with pollinosis should follow a diet, especially
during the flowering of allergenic plants, according to the list of products,
which cause cross allergies (see table in article
allergy poplar fluff and allergic cough).

During the following year, the patient should be observed in
otolaryngologist every 3 months, and allergies should also
observed by an immunologist-allergist. If a полипы носа вызваны не
pollinosis, then after surgery and after medication
anti-relapse treatment supplement homeopathic or treatment
polyps of the nose folk remedies.

Polypolype removal

Special tongs or polyp loop – this is also
method that is used in some clinics. Disadvantage
such a method is the pain of the operation, since the local
anesthesia cannot penetrate deep into the sinuses and can only be removed
those polyps that fell out of the sinuses into the nasal cavity. And the majority
polyps grow from the paranasal sinuses, so this method is not
is effective and relapses occur quickly enough. Also
This is a very atraumatic method with significant bleeding.

Laser removal

It is a more progressive method, less traumatic than removal.
loop, almost bloodless. (see Removing polyps in the nose
laser). It can be performed under local anesthesia.
амбулаторных условиях, процедура занимает всего 20 minutes But
significant disadvantage is that in this way removed
only single polyps, with multiple polyposis, this method is not
is used.

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