1.How to perform cauterisation of Little's area vessels safely?
Several techniques available for this purpose including trichloroacetic acid (TCA) application and using bipolar diathermy.
Topical nasal spray given prior to procedure and allowed to take effect sufficiently.
Nasal introitus and vestibular area protected from accidental injury by inserting aural speculum of appropriate size. Nasal speculum do not provide circumferential cover from surrounding structures.
Good illumination is important and provided by headlight or nasal endoscope.
Make cotton tip applicator of just adequate size necessary and apply TCA to visible prominent vessels. The applied area will turn white and patient may feel temporary burning pain.
Do one side at a time if bilateral lesion exist; the other side can be done after 3-6 weeks.
Commercialized applicator can be used if available. Low wattage bipolar diathermy is an alternative and must be insulated well except its tip.
2. How to perform antral washout safely?
Nasal cavity need to anesthetized and decongested adequately.
The curve trocar with its sharp cannula is directed towards the tragus of ipsilateral side.
The point of insertion at inferior meatus can be visualized better with the aid of an endoscope. This would be around 2 cm behind the head of inferior turbinate.
The antrum will be entered after a short 'give'.
The introducer is then withrawn and irrigation started until washout fluid became clear.
The first sample of irrigation taken for culture and sensitivity tests.
Paranasal X-ray can give clue to the thickness of the medial wall of maxillary sinus.
Unsuccessful attempt can be due to sclerotic changes, improper direction of the trocar, or blunt trocar tip.
Consult senior person and consider repeating the procedure under general anaesthetic.
Potential injury to nasolacrimal duct opening can occur if the entry point is too posterior and upward.