Monday, January 21, 2013

Postoperative care in endoscopic sinonasal surgery

Postoperative care in endoscopic sinonasal surgery

In endoscopic sinonasal surgery, surgical treatment of the nasal passages and sinuses is performed under internal visual control by means of a flexible optical system that is inserted in the nostrils. This type of surgery has become increasingly popular in recent years, thanks to the improvements made in the technique and its acceptance by physicians and patients alike. It is often carried out in chronic conditions, which are usually associated with mucus production, such as nasal polyps, chronic sinusitis and surgery for tumours or sinonasal disorders.

The priority goal of postoperative care after this type of surgery is usually to restore the patency and ventilation of the nasal passages and paranasal sinuses and the mucociliary clearing mechanism, as well as speeding up the healing process. To achieve this goal and in order to prevent complications and risks (such as bleeding, scab formation, synechias and granulomas, closure of the ostium and accumulation of secretions in the immediate postoperative period), it is considered vital to establish an effective guideline for postoperative care. “these protocols vary from one centre to another and the efficacy associated with them also varies”. Given the success rate at Graz Hospital, it was particularly interesting to learn at this forum the premises used as the basis for their action protocol in such cases.
physiological healing process and rapid recovery of the ciliated mucosa and ciliary transport, obtain adequate ventilation and drainage of the nasal sinuses, reduce the risk of postoperative infection, oedema and stenosis and, above all, improve the patient’s comfort.
The treatment given in the preoperative period has an influence on the postoperative care that should be offered to the patient who has undergone endoscopic sinonasal surgery. The choice of medical treatment in the postoperative period will depend, to a great extent, on the previous treatment. It is currently accepted that topical steroids are the drugs of choice for polyposis and allergic rhinitis; the oral antihistamines are also drugs of choice in allergic rhinitis. As regards the systemic steroids, they may be indicated in patients with asthma or polyposis. Finally, the antibiotics would be indicated when there is infection.
During the perioperative period, success will depend on using the appropriate instruments. It is also vital to avoid causing unnecessary injury to the mucosa.
Doctors recommended preserving the mucosa as much as possible and avoiding any type of injury at this level (he recommended the use of microdebriders), not leaving the bone exposed without mucosa during surgery (this enables complications to be avoided in the postoperative period), avoiding combining septoplasty and other operations, and avoiding the so-called packing (using hyaluronic acid).

G. Wolf
ORL University. Graz Hospital. Austria

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