Microscopic antrostomies in children: A review of the literature in chronic sinusitis and a plan of medical and surgical treatment

Abstract

Potential complications, morbidity, treatment failures and "nasal cripples" make one cautious about advising radical sinus surgery. Though antibiotics have greatly reduced the need for radical surgery, some patients do not respond to conservative treatment. Reviewed is pertinent literature concerning treatment of chronic, refractory sinusitis in children, particularly intranasal antrostomy. Medical treatment for chronic sinusitis precedes surgical intervention. Allergic history, nasal cytology and radiographic examination are essential. Since principles of adequate surgical drainage and ventilation have long been established, controlled antrostomy procedure is done with the aid of the operating microscope, creating a nasal mucosal flap. A new instrument is presented---a self-retaining stabilized retractor speculum which allows adequate visualization with the microscope while protecting the mucosal flap and freeing both hands for the procedure.

Endoskopische Chirurgie in den oberen Luft- und Speisewegen des Kindes*

“…Einigkeit besteht darin, daf äuferste Zuruckhaltung mit aggressiven diagnostischen und therapeutischen Mafnahmen angebracht ist. Weiterhin soilte gelten, wenn uberhaupt Operation, dann nicht transoral und keinesfalls radikal (Dixon, 1976;Draf, 1982; Panis, Thum fart und Wigand, 1979 (Wigand, 1981 a).…”

Micro-endoscopic Surgery of the Paranasal Sinuses

“…Special instruments were conceived and developed to facilitate the endonasal microsurgery procedures, leading some to utilize transnasal microsurgery techniques to treat paranasal-sinus diseases in children [6,51]. The introduction of angled endoscopes in radical and extensive surgery involving sphenoethmoidectomy and the posterior-to-anterior technique was accomplished by Wigand et al [74], who began the procedure at the ostium of the sphenoid sinus and proceeded anteriorly along the anterior skull base.…”

“…6. A broken line divides the middle turbinate into two aspects: the meatal surface(1) and the septal surface(2) bone (which is medial to the orbital wall), medially by the vertical part of the middle turbinate and attachment to the skull base, posteriorly by the skull base, ethmoid roof, anterior ethmoid artery and ethmoid bulla, and anteriorly by the agger nasi cells and the supraorbital, frontal and suprabulbar cells.…”

Zur Mikrochirurgie der Nasenhaupt- und Nebenhöhlen*

“…Die Prioritat bei der Einfuhrung des Mikroskopes in die Nebenhohlenchirurgie gebuhrt wohi Heermann sen. 1958. Seither werden in ständig wachsender Zahi in der Literatur mikrochirurgische Verfahren mitgeteilt (Dixon, 1976(Dixon, , 1985Heermann et al, 1986;Neto, 1979;Prades, 1977Prades, , 1978von Ilberg, 1987;Rudert, 1988), die sich hinsichtlich ihrer technischen Details jedoch zum Teil erheblich voneinander unterscheiden. Nachdem wir selbst seit mehr als 3 Jahren eine eigene Technik in Abwandlung der von Prades 1977und Neto 1979angegebenen anwenden (von Ilberg, May 1987, scheint es uns an der Zeit, Einzelheiten der Diagnostik, der mdikation, des operativen Vorgehens sowie unsere Erfolge, Miferfolge und Komplikationen zu berichten.…”