Endoscopic sinus surgery : experience of 60 cases

Objective: To study the quality of life in patient who underwent ESS operation. Design and setting: A prospective study conducted over a period of one(01) year; from July 2004 to June 2005 in Otolaryngology – Head & Neck Surgery Department of Shaheed Suhrawardy Medical College Hospital and Dhaka Medical College Hospital, Dhaka, Bangladesh. Results: Hospital admitted 60(Sixty) cases of ESS patients were included and analyzed. 42 cases were male; whereas 18 cases were female in this study. 21-40 years (44 cases) were the commonest age group of study people. No significant/ alarming complications were recorded during post operative period. Conclusion: Instead of all limitations, outcome of ESS is more acceptable in comparison with conventional sinus surgery. The main symptoms, like nasal obstruction, discharge, headache and facial pain get relieved off dramatically which is compatible with other recognized study.


Introduction:
Endoscopic sinus surgery (ESS) is a procedure through the nose used to remove thickened and diseased tissue that can block the sinuses.It can also be used to straighten a deviated nasal septum or remove nasal polyps.ESS is used to open the sinuses and restore normal airflow.Through the use of fibreoptic technology, ESS is far less invasive and damaging to the patient than previous forms of surgery.
Endoscopy was born when D'Esoreux demonstrated an alcohol illuminated urethroscope at the Paris Exibition in 1853 and win a prize.Reichert in 1902 published his observations on atroscopy and was the first to perform and describe minor intra sinus manipulations under endoscopic control.Hirschman was called the father of Nasal Endoscopy, who used only a 4mm diameter endoscope to examine the middle meatus and study the sinus ostea and also examined maxillary antrum via a molar tooth socket, for diagnostic purposes in 1903.During 1950s, Hopkins working at imperial college developed solid rod lens system and proximal 'cold light' source allowing better optical views greatly extended the use of endoscope.This work has been carried out on enthusiastically during the last decades and has resulted in the excellent publications of Buiter and Draf. 1 Endoscopic sinus surgery has come a long way since its introduction more than two decades ago.The development of the Hopkins telescope and the introduction of the nasal endoscopes of various viewing angles have revolutionized the way nasal and sinus diseases are approached and treated.
The diagnosis of disease within the narrow mucosa lined channels and complicated anatomy of the osteomeatal complex necessitates meticulous diagnostic evaluation.In order to accurately define this area, a combination of endoscopy and radiographic tomographic techniques is essential.Basic prerequisites include knowledge regarding mucociliary clearance and a detailed understanding of the regional anatomy.The patient diagnosed as acute sinusitis with or without intracranial complications.

Methods
Data collection : Data was collected from method a prefixed PROFORMA Data sheet.Final compilation was done and analyzed.
Data analysis : All data was analyzed by manual calculator.

Results:
Sixty cases of ESS were included in this study.All information about the cases was compiled and relevant data were analyzed and shown in tabulated form.

Complaints
No  4 The use of endoscope during ESS improves visualization, enables greater preservation of normal structures and reduces the necessity for wide exposure of operation fields. 6,7The purpose of the study is to determine the efficacy of ESS in the treatment of nose and paranasal sinus diseases that includes ethmoidal polyps, retention cysts, and antrochoanal polyps and most other benign diseases.The results suggested ESS is a safe and effective method in the treatment of children with chronic/ recurrent paranasal sinus diseases and also nasal polyps. 5 the present study maximum 44(73.33%) of patients were in the age group of 20-40 years being consistent with other studies. 6,8 e age ranges fro 10-65 years with mean age of 33 years.
Computed tomography (CT) scan of paranasal sinuses is the radiologic proedure of choice. 11,12In CT scan, the blocked OMC, mucosal thickening of paranasal sinuses, SD, paradoxical middle turbinate, agar nasi pneumatization, concha bullosa, roof of the nose, cribriform plate, and orbits were best outlined.
In this series 43(71.67%)patients were operated under GA and 17(28.33%)patients were under LA.This is simillar with the other studies. 3,6but not consistent with the other series, 8 in which study LA was selectively preferred to perform FESS.
The fundamental of ESS were performed according to the Messerklinger's technique which includes infundibulotomy, middle meatal antrostomy, anterior ethmoidectomy, posteior ethoidectomy.This procedure is similar to other studies. 2,3In this study both unilateral and bilateral procedures were done. In

Conclusion:
Endoscopic Sinus Surgery (ESS) has nowa-days acquired world wide recognition as a technique which can achieve maximum success in treatment with minimum traumatization to the patient.Hopkins rod lens telescope ensure an excellent overview; specially developed instruments also allow high-precision, traumatic procedures in the confined nasal and paransal areas.
In this study, we tried to remove all disease processes meticlously with minimum traumatization to the surrounding tissues.
Because of my study places were at Govt. hospitals, careful postoperative follow up was not always possible due to various real reasons.Some of the poor and or medically subconscious patients usually did not attend for routine postoperative follow up.
Instead of all limitations, outcome of ESS is more acceptable comparison with conventional sinus surgery.The main symptoms like obstruction, discharge, headache and facial pain get relieved off dramatically which is comparable with other recognized study.