The report of anastomosis of 35 cases of ruptured inferior lacrimal canaliculus, the result shows that: after extubation in March, lacrimal duct flush is patent without epiphora; in 2 cases after silicone tube removal for 1 month, rearranged successfully, 3 months after extubation, lacrimal duct flush is patent without epiphora; in 1 case after silicon tube fell off for 2 months and no replacement, there are little tears in lacrimal passages; in 1 case after removing drainage strips for 1 week, placement failed the next day, operation failure. There is no case of lacrimal punctum fissure occurred in this group, lower eyelid and lacrimal point without inner, valgus deformity. Follow-up 2 months to 5 years after extubation of anastomosis, 33 cases were cured, 1 case improved, 1 case failed, operation success rate of 94.3%.
Discussion:
3.1 Broken ends, which is the key to success. Operation microscope with adequate hemostasis, wound, the operative field fully exposed, understanding of the lacrimal duct anatomic location and patience are necessary conditions for successful finding of the end. If direct search method is not successful, use lacrimal sac incision method.
3.2 Selection and fixation of support material, ideal lacrimal duct support indwelling time is silica gel, because of its good histocompatibility, smooth surface, soft texture, it can effectively prevent the occurrence of inflammation of lacrimal punctum, not cutting lacrimal punctum, easy fixation, favoring mucosal epithelial cells crawl, effectively preventing scar contracture at the anastomosis export, creating conditions for lacrimal duct recanalization. Indwelling time more than 3 months, the lacrimal canaliculi spend scar period, favoring lacrimal duct recanalization.
3.3 For the broken end anastomosis using 5 - 0 2 - 3 silk suture needle, a line should be evenly distributed, well placed, moderate elastic ligation, suture not through the lacrimal canaliculus, lest accentuate anastomotic scar formation, increasing the likelihood of lacrimal duct stenosis. Medial and lower eyelid suture of the wound, attention should be paid to on the layer and counterpoint, suture depth and degree of tightness, to reduce the lower eyelid and lacrimal point deformity.
Received date: 2005 - 05 - 12 to date: 2005 - 07 - 12, editor: Cheng Chun
Middle turbinate surgery treatment of ethmoidal nerve syndrome report of 18 cases by Fan Qingsong, Wang Heping, Zhang Degui (Department of Otolaryngology, Jiangsu Xuzhou First People's Hospital, Xuzhou 221002)
Abstract: Objective To explore the anterior ethmoidal nerve syndrome and related factors corresponding operation treatment method. Method for analysis of 18 patients' sinus CT image, the middle turbinate surgery treatment. Results CT below middle turbinate anatomy of bony structure variation (15/18), 6 cases of postoperative headache disappeared in 2 cases, significantly reduced. Conclusion The middle turbinate anatomy of bony structure variation and anterior ethmoidal nerve syndrome pathogenesis are relevant, middle turbinate surgery and partial middle turbinate resection have similar results.
Keywords: middle turbinate; plastic surgery; the middle turbinate; anatomic variation of CLC: R765.6 document code: A article ID: 1000 - 2065 (2005): 04 - 0348 - 02
Anterior ethmoid nerve syndrome mainly presents as headache, previously treated with partial middle turbinate resection due to bleeding, but the operation was complicated and postoperative complications included impaired sense of smell, causing pain to patients. Since 1995, our department has used middle turbinate functional plastic surgery to treat the disease in 18 cases, achieving satisfactory curative effect, reported as follows now.
1 Data and Method
1.1 Clinical data In 18 patients, 8 were male, 10 female, age 12 ~ 56, 1 ~ 12 years history. Forehead pain in 16 cases, two temporal pain in 2 cases, the pain was persistent in 5 cases, 13 cases of nasal intermittent; acid swells to 3 patients, nasal root pain in 4 cases, unilateral orbital corner discomfort in 3 cases, foreign body sensation, visual fatigue of eyes in 2 cases, due to levator palpebrae heavy, with early fatigue (18:00 to 19:00) in 1 case of nasal obstruction, sleep habits; small amounts of viscous mucus in 6 cases, 3 cases of olfactory loss. Examinations of the nasal cavity: 18 patients with olfactory sulcus stenosis, 9 cases of unilateral, bilateral in 9 cases, stenosis occurs in middle turbinate under 6 cases before the free edge of the free edge of the front, more than 4 cases, 5 cases of 3 cases of middle, rear. High deviation of nasal septum in 9 cases, 6 cases of inferior turbinate enlargement. With a little adrenaline 1% tetracaine cotton sheet is adhered on the narrow part, the pain disappeared in 14 cases, 4 cases were significantly reduced. 18 cases of x-ray Korotkoff position examination showed no abnormality. CT: display of middle turbinate and nasal compartment space narrow, interrupt or partially disappeared. A narrow long 5 ~ 30IIll31 range, globular part 5 ~ 10toni, 10 ~ 30mm of vertical plate part; wherein the bone in 15 cases, abnormal soft tissue density in 3 cases. Narrow parts: 1 middle turbinate mucosal hypertrophy of spherical parts, UGG Laarzen Online, in 2 cases, connective tissue hyperplasia 1 case (combined with intraoperative findings identified). Author: Fan Qingsong (1970 - ), male, Jiangsu Lianshui person, attending physicians.