Currently, fungal sinusitis is found more and more clinically. The clinical manifestations of fungal sinusitis are mainly nasal odor, bloody smell, unilateral nasal bleeding, facial swelling and pain, nasal congestion, etc. CT examination of sinuses can be performed to find low-density shadows in the sinuses with clump-like high-density foci in between. In the case of fungal sinusitis, the traditional Kirkland-type surgery is to remove the lesion under direct vision through an incision in the oral labiogingival groove and an opening in the anterior wall of the maxillary sinus, which will bring about facial swelling and numbness, as well as local defective depression of the jawbone, and the maintenance of facial numbness is also longer, affecting the local sensation after surgery.
Recently, due to the application of nasal endoscopic surgical techniques, there is an increasing tendency to use a transnasal endoscopic lateral nasal wall approach, but this requires the operator to have considerable experience in endoscopic surgery and to master the surgical skills of a 70-degree endoscope in addition to being able to operate with a 0-degree nasal endoscope, because only a 70-degree endoscope can remove lesions from all walls of the maxillary sinus without missing anything. Some of our clinical rhinologists think that by repeatedly flushing the maxillary sinus cavity under a 0-degree mirror, the lesions in the maxillary sinus can be flushed out, and when there are no obvious bean-like lesions flushed out, the surgery is considered complete. This is not always correct.
Over the years, we have done a controlled study in this regard during surgery, firstly, repeatedly flushing the sinus cavity under a 0 degree mirror until no lesion is indeed flushed out, then switching to a 70 degree nasal endoscope to check again, and found that there are often fungal masses attached to some of the walls of the sinus cavity. We used special endoscopic instruments suitable for 70 degree endoscopy to completely remove all lesions. Such an operation created a good basis for the patient’s rapid postoperative recovery. We observed through close follow-up that the recovery process of these patients was indeed greatly shortened, and often the maxillary sinus orifice and the mucosa in the maxillary sinus returned to a basically normal state in the first month after surgery, with no recurrence seen. Also, this further confirms the reason why some previous patients had recurrence within a short period of time even after 0 degree endoscopic surgery.
By adopting such a surgical approach, we avoid the occurrence of postoperative facial numbness, swelling, pain, and local depression in patients, and we also have little or no postoperative nasal filling, rapid recovery, less bleeding, much improved comfort, and most critically, greatly reduced the possibility of postoperative recurrence and avoided the pain of reoperation.