Perioperative treatment of nasal polyps in chronic sinusitis
Time concept
Pre-operative period (pre-operative preparation): 7-14 days; mid-operative period (inpatient treatment): 8-10 days; post-operative period (post-operative follow-up): 3-6 months
Definition.
The perioperative period is a period of time centered on surgical treatment that encompasses the preoperative, intraoperative, and postoperative periods, with the three phases of treatment running together as a whole to give the patient the best possible surgical outcome.
Pre-operative period (pre-operative preparation period: 7-10 days)
. Anti-infection – routine doses of antibiotics.
. Anti-inflammatory, anti-edema, anti-metaplasia.
C Topical steroids: endosonar/retrocodone/cozultan, etc. (all patients).
C Systemic steroids: prednisone 30 mg/d orally in the morning (if no contraindications).
C Topical nasal decongestant: Dazurin Significant for reducing intraoperative bleeding, intraoperative determination of lesioned mucosa, and improving the quality of surgery
Mid-surgery (hospitalization period: 8-10 days)
. Examination – sinus coronal CT, skin allergen and specific IgE testing, routine examination.
. Management of related diseases — hypertension, diabetes mellitus, confirmation of any contraindications to surgery.
. Determination of surgical modality – extent of surgery, inferior turbinate, nasal septum (based on patient’s complaints, nasal examination and CT).
. Choice of anesthesia – staging, patient’s general condition and psychological quality.
. Other preparations – the significance of comprehensive treatment: surgery does not completely cure chronic sinusitis.
. Surgical risks: nasal, intracranial, intraorbital complications, anesthesia risks, etc.
Post-operative phase: post-operative management of FESS 3-6 months post-operative phase 1: cleanliness of the operative cavity post-operative – 3 weeks
. Phase II: Mucosal transition to competition phase 2-8 weeks postoperatively Phase III: Epithelialization phase 6 weeks – 6 months postoperatively
Operative cavity cleaning phase – (post-operative ~ 3 weeks)
. Characteristics of this phase: – stale bruising of the operative cavity – massive fibrinous exudation – traumatic edema of the mucosa
C gland hypersecretion — massive dry crust formation
Treatment principles: – Cleanliness of the operative cavity and anti-infection
Basic requirements of nasal filling materials
1, The surface structure of microporous is easy to extract and reduce secondary bleeding during extraction. 2, The surface contains oxidized cellulose coating: it has hemostatic effect. 3, It has anti-inflammatory properties. 4, It rapidly absorbs water around the wound and promotes clotting. 5, The synthetic material avoids iodine allergic reaction.
How to use the medication after surgery?1, How to use antibiotics after surgery ? — Intravenous antibiotics for 1 week — Oral antibiotics for 1 to 2 weeks
2.When to use topical steroids after surgery ? a, Start 5 days to 1 week after surgery b, Pros ? Disadvantages ?
Highly recommended “Use of topical steroid hormones in the nasal cavity”
Competitive phase of mucosal regression 2-6 weeks postoperatively
n Characteristics of this phase: – Sinus cavity mucosal edema, vesicle generation – Adhesions and atresia of the operative cavity – Sinus stenosis or atresia – Overgrowth of granulation tissue
Principles of treatment: Clear the cavity, keep the sinus opening open, eliminate mucosal edema – Clear the cavity of the cysts and granulation, taking care not to destroy the loose mucosa
. Maintain patency and drainage of the surgical cavity and sinus orifice
. Reasonable medication: – Topical steroid hormone – Mucus promoter – Surgical cavity rinsing 1 to 2 times a day to keep the nasal cavity moist, clean the nasal cavity, reduce the inflammatory material to stimulate the mucosa, promote the recovery of cilia function, reduce the formation of dry crust in the surgical cavity
Hypertonic saline helps to eliminate mucosal edema and accelerate ciliary oscillation ? –Antibiotics? –Basically not necessary
Possible reasons for the above: – damage to the lymphatic drainage system
local and systemic metaplasia – local inflammation
–local infection of the surgical cavity (infection)
Management of cystic vesicles in the operative cavity Excision with a cutter or polyp forceps Management of sinusoidal obstruction
The frontal saphenous fossa is the most vulnerable location for vesicles Clear the frontal saphenous fossa for vesicles
management of cavity adhesions – separation of striker – placement of Rhino rhinoplasty
8 weeks postoperative, adhesions between septum and inferior turbinate —- must be reoperated!!!
10 weeks postoperatively, adhesions between middle turbinate and lateral wall of nasal cavity — not all adhesions need to be treated!!!
Management of mucosal edema in the operative cavity – use of cutting system – local minimally invasive removal of vesicles
Management of mucosal edema in the operative cavity
Topical steroids in the nasal cavity! –Elimination of the least inflammatory persistent state of the mucosa of the operative cavity
Mucosal epithelialization stage – 8 weeks – 6 months after surgery Characteristics of this stage: – basic epithelialization of the mucosa – good ventilation of the nasal cavity – no or only a little oral aspiration
Treatment measures: – Regular follow-up: about 1 to 2 months – Use of topical steroids according to the condition of the operative cavity and the patient’s main report
CT scan is not a necessary indicator for the assessment of efficacy
Comprehensive postoperative treatment of chronic sinusitis
. Post-operative antibiotics: generally less than two weeks (longer if needed, depending on the nature of the secretions)
. Topical glucocorticoids.
C is usually used after surgery and is usually continued for more than 3 – 6 months
C is often required for life in some patients (especially those with definite allergic inflammation, eosinophilic inflammation)
. Systemic steroids: Evidence of metabolic reactions
. Ciliogenic drugs: no less than three months
. Nasal rinses: no less than one month
. Management of de novo lesions in the operative cavity: no less than six months of follow-up, emphasizing the minimally invasive concept of perioperative treatment.