The article presents a clinical case of surgical of a recurrent chronic purulent dacryocystitisof traumatic etiology. Under endoscopic control, the patient underwent a revisional endonasal laser dacryocystorhinostomy with bicanalicular silicone stent. All surgical steps were controlled on the navigation system display. Navigation equipment was used to accurately visualize the structures of the nasal cavity and lacrimal pathways, because the anatomy of this area was changed as a result of the midface trauma and preliminary unsuccessful surgical procedures. During surgery, the functional and anatomical patency of the lacrimal pathways was achieved. Thus, the navigation system is a useful supplementary equipment that allows identifying the lacrimal sac in complex surgical situations, to monitor the state of lacrimal passages and surrounding nasal structures, which ultimately increases the effectiveness and safety of the procedure.
The nasal swell body (NSB) is a structure in the form of mucosa thickening from the nasal cavity bottom up to the middle nasal concha. The septal swell body was first described by Wustrow in the 17th century, he indicated it as an “intumescentia septi nasi anterior”; later, in 1900, P. Schiefferdecker studied the vasculature of the first third of the nasal septum and called it “septal turbinate”. The objective of our study is to assess the nasal breathing condition before and after nasal septal swell body laser reduction in the patients with vasomotor rhinitis. The study was performed in the Clinic of Otorhinolaryngology of Pavlov First Saint Petersburg State Medical University. We examined 32 patients aged 21–44 years (13 males and 19 females). All the patients were performed a set of examinations: endoscopic examination of the nasal cavity and nasopharynx, anterior active rhinomanometry, computer-aided tomography of paranasal sinuses. The subjective evaluation of the nasal obstruction was based on Nasal Obstruction Symptom Evaluation (NOSE) scale. The patients were divided into 2 groups. The 1st group patients (n-17) underwent surface contact laser vasotomy of inferior nasal concha and reduction of NSB area by means of 970nm injection laser. The second group (n-17) consisted of patients with the same pathology after laser vasotomy without the nasal swell body area, they formed a control group. The comparative analysis between the 1st and the 2nd group of patients didn’t reveal any significant difference in the measurement of VFR and NR in the postoperative period. Besides, the 2nd group patients in 47% (8) of cases mentioned the nasal airflow deficiency according to NOSE scale. The necessity of NSB area reduction is extremely important for achievement of favorable results of the nasal obstruction surgical treatment.
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