Sinonazal Cerrahiler
Özet
Sinonazal cerrahiler, kulak burun boğaz hekimlerinin en sık uyguladığı ve nazal septum, konka, fonksiyonel endoskopik sinüs (FESC), beyin omurilik sıvısı (BOS) rinore, optik sinir ile orbital dekompresyon ameliyatlarını içeren operasyonlardır. Nazal septum cerrahisinde, medikal tedaviye yanıt vermeyen burun tıkanıklığı, kanama ve sinüzit gibi endikasyonlarla septoplasti veya submukoz rezeksiyon teknikleri uygulanmaktadır. Konka cerrahisinde ise mukoza korunarak alt konkanın küçültülmesi hedeflenir ve radyofrekans, koterizasyon ile submukoz rezeksiyon gibi yöntemler öne çıkar. FESC, kronik sinüzit ve nazal polipozis gibi sinüs patolojilerinin tedavisinde; unsinektomi, etmoidektomi, sfenoidotomi ve frontal sinüzotomi gibi aşamalarla gerçekleştirilir. Endoskopik BOS rinore cerrahisi, kafa tabanı defektlerinin otolog veya allogreftlerle onarılmasını sağlarken, büyük defektlerde açık cerrahi veya pediküllü nazoseptal flepler tercih edilir. Son olarak, endoskopik optik sinir dekompresyonu travma veya pseudotümör serebriye bağlı görme kayıplarında kemik kanalı rahatlatmak amacıyla yapılırken, endoskopik orbital dekompresyon ise Graves oftalmopatisi ve travma gibi durumlarda intraorbital basıncı düşürmek için kullanılan, komplikasyonu az ve güvenilir bir yöntemdir.
Sinonasal surgeries are among the most frequently performed procedures by otolaryngologists, encompassing nasal septum, turbinate, functional endoscopic sinus surgery (FESS), endoscopic CSF rhinorrhea repair, and optic nerve or orbital decompression. Nasal septum surgery, which includes septoplasty and submucosal resection, is indicated for nasal obstruction unresponsive to medical treatment, epistaxis, and sinusitis. Turbinate surgery aims to reduce the size of the inferior turbinate while preserving the mucosa, utilizing methods such as radiofrequency, cauterization, and submucosal resection. FESS is applied in paranasal sinus pathologies like chronic sinusitis and nasal polyposis, involving steps such as uncinectomy, ethmoidectomy, sphenoidotomy, and frontal sinusotomy. Endoscopic CSF rhinorrhea surgery allows the repair of skull base defects using autologous or allograft materials, whereas open surgery or pedicled nasoseptal flaps are preferred for larger defects. Finally, endoscopic optic nerve decompression is performed to relieve pressure within the bony canal during vision loss caused by trauma or pseudotumor cerebri, while endoscopic orbital decompression is a safe, low-complication method used to reduce intraorbital pressure in conditions like Graves' ophthalmopathy and trauma.
Referanslar
Fettman N, Sanford T, Sindwani R. Surgical management of the deviated septum: techniques in septoplasty. Otolaryngol Clin North Am 2009;42(2): 241–52, viii.
Sam P. Most, Shannon F. Rudy. Septoplasty Basic and Advanced Techniques. Facial Plast Surg Clin North Am. 2017 May;25(2):161-169.
Kennedy DW, Hwang PH. Rhinology: diseases of the nose, sinuses, and skull base. New York: Thieme; 2012.
www.astimrinit2009.org,panel 2 septum cerrahisi, Prof.Dr.Orhan Özturan,sf 39
Gian Chand , Muhammad Shafiq, Atif Khan, The comparative study of submucosal resection of nasal septum under local and general anaesthesia, J Pak Med Assoc,2012 Oct;62(10):1020-2
Prepageran N, Lingham OR. Endoscopic septoplasty: the open book method. Indian J Otolaryngol Head Neck Surg 2010;62(3):310–2.
J Jared Christophel , Charles W Gross, Pediatric septoplasty, Otolaryngol Clin North America 2009 Apr;42(2):287-94
Goode RL, Pribitkin E. Diagnosis and treatment of turbinate dysfonction. 2nd Ed. Alexandria: american Academy of otolaryngology-Head Neck Surgery Foundation, inc., 1995
www.astimrinit2009.org,panel 2 konka cerrahisi, Prof. Dr. Semih Öncel,sf 43
Back L,Hytönen M,Malmberg H ,Ylikoshi JS.Submucosal bipolar radiofrequency thermal ablation of inferior turbinates :A long term follow up with subjective and objective assesment.Laryngoscope 2002 ;112:1806-12
Moore GF, Freeman TJ, Ogren FP. Extenden follow up of total inferior tirbünate resection for relief of cronic nasal obstruction Laryngoscope 95:1095-1099 , 1985.
Kızılkaya Z,Ceylan K,Emir H ve ark.Comparison of radiofrequency tissue volumereduction and submucosal resection with microdebrider in inferior türbinate hypertrophy.Otolaryngol Head Neck Surg,2008;138(2)1476-81.
Mabry RL. Inferior turbinoplasty. Laryngoscope 92:459-463,1982
Alnatheer AM, Alkholaiwi F. Concha Bullosa of the Inferior Turbinate, Cureus. 2021 Oct 28;13(10)
K.J.LEE Essential Otolaryngology Dokuzuncu Baskı; 413-439
Meco C, Oberascher G. Comprehensive algorithm for skull base dural lesion and cerebrospinal fluid fistula diagnosis. Laryngoscope 2004;114(6):991-9
Daniel Simmen Nick Jones, Doç .Dr. M.Haluk Özkul, Endoskopik Sinüs Cerrahisi El Kitabı ve Genişletilmiş Uygulamaları 2009 ;55-69
Kennedy DW. Functional endoscopic sinüs surgery: Concepts, surgical indications and instrumentation In:Kennedy DW, Bolger WE,Zinreich SJ. Diseases of the Sinuses: Diagnosis and management .Hamilton, ON: B.C. Decker Inc;2001: 211-221
Kenndy DW. Functional endoscopic sinus surgery: Anesthesia, technique, and postopera tive management.In: Kennedy DW, Bolger WE, Zinreich SJ. Diseases of the Sinuses: Diagnosis and Management. Hamilton, ON : B.C. Decker Inc:2001:197-210.
Schick B, Ibing R, Brors D, Draf W. Long-term study of endonasal duraplasty and review of the literature. Ann Otol Rhinol Laryngol 2001; 110(2):142-7
Schlosser RJ, Bolger WE. Nasal cerebrospinal fluid leaks: critical review and surgical considerations. Laryngoscope 2004;114(2):255-65.
8. Castelnuovo P, Mauri S, Locatelli D, Emanuelli E, Delu G, Di Giulio G. Endoscopic repair of cerebrospinal fluid rhinorrhea: learning from our failures. Am J Rhinology 2001;15(5):333- 42. 29.
Locatelli D, Rampa F, Acchiardi I, Bignami M, De Bernardi F, Castelnuovo P. Endoscopic endonasal approaches for repair of cerebrospinal fluid leaks: nine-year experience. Neurosurgery 2006;58(4 Suppl 2):ONS-246- 56.
Draf W, Schick B. How I do it: Endoscopic-microscopic anterior skull base reconstruction. Skull Base 2007;17(1):53-8
Harvey RJ, Nogueira Jr JF, Schlosser RJ, Patel SJ, Vellutini E, Stamm AC. Closure of large skull base defects after endoscopic transnasal craniotomy. Clinical article. J Neurosurg 2009;111(2):371-9.
Harvey RJ, Parmar P, Sacks R, Zanation AM. Endoscopic skull base reconstruction of large dural defects: a systematic review of published evidence. Laryngoscope 2012;122(2): 452-9.
Meco C, Arrer E, Oberascher G. Efficacy of cerebrospinal fluid fistula repair: sensitive quality control using the beta-trace protein test. Am J Rhinology 2007;21(6):729-36.
Özer S, Çelebi Ö.Ö., Tarlan B, Önerci T.M Transnazal Endoskopik Optik Dekompresyon- Travmatik Optik Nöropati, Turkiye Klinikleri J E.N.T.-2013;6(4)
Levin LA, Beck RW, Joseph MP, Seiff S, Kraker R. The treatment of traumatic optic neuropathy: the International Optic Nerve Trauma Study. Ophthalmology 1999;106(7):1268-77
Acheson JF. Optic nerve disorders: role of canal and nerve sheath decompression surgery. Eye (Lond) 2004;18(11):1169-7
Zoumalan, Christopher I., Michael Kazim, and Richard D. Lisman. Endoscopic orbital decompression. Operative Techniques in Otolaryngology-Head and Neck Surgery22.3 (2011): 223-228.
Kennedy, David W., et al. "Endoscopic transnasal orbital decompression."Archives of Otolaryngology–Head & Neck Surgery 116.3 (1990): 275-282.
Binnetoglu A, Demir B, Yumusakhuyulu AC, Baglam T, Sarı M, Transnazal endoskopik orbital dekompresyon: 24 Hastayı içeren Klinik deneyimimiz,KBB Forum 2016:15-2
Antoszyk JH, Tucker N, Codere F: Orbital decompression for Graves disease. Ophthalmic Surg. 23:516-21,1992.
Carter KD, Bartley RF, Hessburg TP, Musch DC: Long term efficacy of orbital decompression for compressive optic neuropathy of Graves' eye disease. Ophthalmology 98:1435-42, 1991
