What is the most common complication of transsphenoidal surgery? Sinusitis! Some statistics show its incidence to be as high as 50%. But for years, clinicians have often ignored this problem.
I. What are the types of sinusitis?
1. Classification according to the cause.
Primary: i.e., sinusitis of varying degrees before surgery and its inflammation flares up or worsens after surgery. It is usually possible to determine whether there is primary sinusitis by viewing the pre-surgical MRI or CT film.
Secondary: This refers to sinusitis that occurs after surgery. It usually occurs a few days or even months later. The triggering causes are mostly blockage or poor opening of the sinus, adhesions of the nasal mucosa, and excessive filling of the pterygoid sinus with filling material.
2. Classification according to pathological characteristics.
Bacterial infectious: Inflammation is caused by different bacteria, thus causing the accumulation of pus or excretion of pus in the sinuses. Usually the clinical manifestations of this type of inflammation are more severe. Symptoms such as fever, headache, and purulent discharge from the nasal cavity may occur. Antibiotic treatment is usually required, and in severe cases, surgery is needed to clear the pus accumulation and lesions in the sinuses.
Non-bacterial: The mucous membrane of the sinuses in the surgical channel is only thickened, or is granulation tissue. This type of so-called “sinusitis” is often only described by the imaging physician on the MRI report, but clinicians often do not call it “sinusitis”. It is usually not treated.
Second, what are the symptoms of sinusitis?
1. Headache: Nearly half of the patients have headache. Mainly located in the forehead, between the eyebrows, temples, or zygomatic arch and other parts; pain is mostly persistent. Often aggravated by cool air. Bacterial infection sinusitis headache is more serious.
2, nasal secretions: bacterial infectious sinusitis secretions are large, pus-like and sticky, and accompanied by odor; non-bacterial secretions are small, mostly just a small amount of yellowish mucus dripping out.
3, other discomfort: tinnitus, nasal congestion, speech nasal sound heavy. Severe purulent sinusitis is accompanied by fever.
What are the other conditions that need to be distinguished?
1.Cerebrospinal fluid nasal leakage: cool fluid and constant flow of fluid.
2.Wound healing recovery period: Within 1 week (several weeks individually) after transsphenoidal surgery, there is constant exudate from the mucosal trauma in the nasal cavity.
3.Secretion from residual tumor: close to mucosal trauma exudate, but for a longer period of time.
4, excretion in the butterfly sinus: bleeding radicals, filler irritation reaction, etc.
Four, sinusitis how to prevent and control it?
1.Prevention before surgery: If you have ever had a more serious rhinitis before surgery, you should report your condition to the doctor so that he or she can do some corresponding examination and treatment. Sinusitis or rhinitis in the attack period, the symptoms are obvious need to delay the surgery. There are still some doctors who list sinusitis as a contraindication to transsphenoidal surgery. I believe it needs to be determined on a case-by-case basis. If there are no episodes of previous sinusitis or no obvious symptoms before surgery, furacilin nasal drops can be administered in the nose a few days before surgery. It does not affect the prognosis of the surgery.
2.Post-surgical prevention.
(1) After the intra-nasal stuffing is removed, intra-nasal drops of furacilin drops and peppermint oil nasal drops are administered three or four times a day, alternating between the two. Generally, the drops are administered for 7-10 days.
(2) Within 2 weeks after surgery, clean the nasal cavity and nasal tract 1-2 times in the ENT department. Reduce the chance of mucosal adhesions in the nasal tract and keep the nasal tract open, which can greatly reduce the incidence of sinusitis. If there is a lot of secretion, it is necessary to increase the number of times.
(3) Those who have a more serious history of sinusitis before surgery need to use antibiotics for a few more days after surgery. Once sinusitis has flared up, strict treatment is needed to prevent the spread of the inflammation. Ask the ENT department to assist with treatment.
(4) You can purchase your own nasal rinse at a street pharmacy (price around 100 yuan), read the instructions carefully on how to use it, and rinse 2-3 times a day, or even 3-5 times a day, which can also prevent and reduce the chance of sinusitis.