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Endoscopic-Assisted Antral Washout

 

 Coakley trocar used in this procedure.  Above - the cannula, below - the sharp end of the device use to prick and make the opening of the medial wall of the antrum.

Attached cannula sleeved into the trocar.  The trocar will be removed and the sleeve left in place for irrigation once antral cavity placement of the tip confirmed.

 Snapshot of Coakley trocar in-situ (arrow) with its tip inside the maxillary sinus. 

(S - septum, IT - inferior turbinate)

The puncture wound (arrow) at completion of procedure which will close naturally upon healing.  (S - septum, IT -inferior turbinate)

Maxillary Sinus Balloon Sinuplasty with Sinus Irrigation

Figure 1 

 

Figure 2 

 

Figure 3 

 

 Figure 4

 

Figure 1: Endoscopic view prior to balloon procedure.

Figure 2: Balloon sinuplasty being performed using SPIN system and LUMA guidewire.

Figure 3: Mucopus and infectious material being flushed out.

Figure 4: Procedure completed once the exited saline from dilated ostium becomes clear. 

 

MT - middle turbinate, S - nasal septum, dashed line - uncinate process surface anatomy, star - mucopus, X - saline irrigation exited from dilated ostium.  NB: this patient had endoscopic sinus surgery years ago and has recurrent infection.

The XprESS Multi-Sinus Dilation System by Entellus Medical, Inc.

Illumination of Paranasal Sinus

An illumination of right maxillary sinus for confirmation of correct entry and positioning before the balloon andvancement and inflation.  Similar illumination is seen in frontal sinus but least visible in sphenoid sinus.

Sphenoid Sinus Balloon Sinuplasty with Sinus Irrigation

In-Office Balloon Dilatation, Ethmoidectomy and Turbinate Reduction

Uncinectomy by Using Endonasal Surgical Instruments

 

Honour of this surgery to Professor Prepageran Narayanan

from University of Malaya Medical Centre

Powered Instruments: The Microdebrider

An example of microdebrider by Medtronic

 

This device is has becomes widely-used during endoscopic nasal surgery and very useful in removing mass lesions including polyps.  Specimen can be collected by siphoning the debrided materials into a collector bottle attached to the suction tube.  It is an alternative biopsy method to cold instrument usage.

 

Microdebrider tip showing the inner rotating serrated blade

in "close" [left figure] and "open" position [right figure]. 

Biopsy was taken prior to polyps removal.

 

 

Video showing biopsy of nasal polyps.  Prior local infiltration

with marcain/adrenaline was given.  Adequate tissue and deeper biopsy

need to be taken especially in suspected malignancy and inverted papilloma.

 

 

Video showing polypectomy by using microdebrider.  This device sucks and cut the polyps at the same time whenever the foot paddle pressed.  The direction of the cutting blade must be seen to ensure safety.  The speed can be varied depending on how much pressure exerted on the foot paddle.

Frontal Sinus Polyp

Figure shows polyp of left frontal sinus (P) surrounded by hyperplastic mucosa (+).

Mucocoeles of The Paranasal Sinuses

FESS: Ethmoid Mucocoele

Sphenoid Sinus: Mucous Retention Cyst vs Mucocoele

Sphenoid Mucocoele

Endoscopic Surgical Approaches To Sphenoid Sinus: Fungal Sinusitis

Live Surgery Sinus Forum 2011- Balloon Sinuplasty

Maxillary Sinus Balloon Sinuplasty

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