الفهرس 
subject and methodsOnly 14 pages are availabe for public view
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Abstract
Summary
The ability of the otolaryngologist to diagnose sinus disease with accuracy was markedly enhanced with the introduction of the computed tomogram. With the addition of endoscopic equipment for visualization, surgical techniques have been improved to allow the majority of
procedures to be performed.
Complications occurring after endoscopic sinus surgery, are classified into major, involving the orbit and intracranial structures, and minor, involving the naso-sinus structures. The most common complication reported, appears to be lateralization of the middle turbinate, which can cause scaring with synechia and closure of the ethmoids and frontal and maxillary sinus ostium so the handling of the middle turbinates and prevention of lateralization appears to be the key to avoiding problems in the postoperative period, ensuring successful outcome for the patient, and thus is an important aspect of endoscopic
sinus surgery.
In our study we aimed at analyzing the cause of lateralization of middle turbinate and the effect of use of spacers as a method of prevention. Of a 30 patients underwent FESS, we use anesthesia tube cut to size as a spacer in 15 patients.
In our study, in the group of no spacer, we have the following results regarding the synechia, mild synechia occurs in 33.33% of the
study group, moderate synechia occurs in 46.66% of the study group, and sever synechia occurs in 20% of the study group.
Regarding the spacer group in our study, mild synechia occurs in 86.7% of cases, moderate synechia occurs in 13.3% of cases, and there is no cases with sever synechia.
In analyzing the lateralization of the middle turbinate in the postoperative period, its cause becomes obvious. With removal of the uncinate process, a raw surface is created on the lateral wall of the nasal cavity. Instrumentation of the lateral aspect of the middle turbinate, result
in a raw denuded surface of this area.
The importance of mucosal preserv9tion during functional endoscopic sinus surgery (FESS) has been well described to prevent postoperative syneachia formation.
To prevent wound surfaces from opposing each other within the middle meatus, a variety of spacers is available.
The usage of silastic sheet or anesthesia tube of appropriate size inserted into the middle meatus, maintain their shapes and can be secured in position by suturing them with a silk suture to maintain its position and prevent its falling into the nasopharynx. This technique results in decreasing the synechia formation and also decrease the lateralization of
the middle turbinate.
Even when the surgical technique has been meticulous, the
importance of postoperative care cannot be overemphasized. Endoscopic debridement in the office setting and mechanical self-debridement with intranasal saline irrigation should minimize syneachia. Thorough
preoperative planning, careful intraoperative technique, and postoperative endoscopic debridement are all integral parts of the multi-step regimen
for treating sinus disease.
The ideal solution would seems to be the preservation of the turbinates by a method of stabilization until re-epithelization of the lateral wall of the nasal cavity and middle turbinate has taken place.