Adil ERYILMAZ, Engin DURSUN, Güleser SAYLAM, Celil GÖÇER, Muharrem DAĞLI, Mehmet Hakan KORKMAZ

Etmoidektomili veya etmoidektomisiz endoskopik transnazal sfenoidotomi

Amaç: Enflamatuvar sfenoid sinüs hastalığında ESSH etmoidektomili veya etmoidektomisiz endoskopik transnazal sfenoidotomi ETNS uygulamasıdeğerlendirildi.Hastalar ve Yöntemler: Çalışmada ESSH nedeniyleetmoidektomili n=37 veya etmoidektomisiz n=5 ETNS uygulanan 42 hasta geriye dönük olarak değerlendirildi. Hastalar bilgisayarlı tomografi bulgularına dayanan evreleme sistemimizle sınıflandırıldı.Bulgular: En yaygın semptom postnazal akıntı idi n=37, %88.1 . Kronik sinüzite 25 hastada sinonazalpolip eşlik etmekteydi %59.5 . Beş hastada %11.9 izole hastalık vardı. On altı hastada %38.1 tutulum tektaraflıydı. Beş olguda %11.9 evre 1, 15 olguda %35.7 evre 2, 22 olguda %52.4 evre 3 hastalık görüldü. Cerrahi 68 tarafa uygulandı. Bunların 63’ündecerrahiye etmoidektomi eklendi. Etmoidektomi uygulanan hastaların sekizinde destekleyici girişime ihtiyaç duyuldu. Sekiz hastada %19 en az bir komplikasyonla karşılaşıldı. Bu komplikasyonlar şunlardı:ciddi perioperatif kanama n=2 , ameliyat sonrası erken dönem kanama n=2 , lamina papiraseada hafifyaralanma n=4 ve sineşi n=5 .Sonuç: İzole ESSH olan hastalarda etmoidektomisizETNS ile direkt yaklaşım tercih edilecek cerrahi tekniktir; diğer paranazal sinüslerde de hastalığı olanlarda ise ETNS’nin etmoidektomi ile birlikte uygulanması gerekir

Anahtar Kelimeler:

Etmoid kemik/cerrahi, sfenoid sinüzit/cerrahi, endoskopi/yöntem

Endoscopic transnasal sphenoidotomy with or without ethmoidectomy

Objectives: We evaluated endoscopic transnasal sphenoidotomy ETNS with or vvithout ethmoidecto my in patients with inflammatory sphenoid sinüs dis- ease ISSD .Patients and Methods: A retrospective revievv was conducted in 42 patients 17 males, 25 females; mean age 41 years; range 17 to 67 years who undervvent ETNS with n=37 or vvithout n=5 ethmoidectomy tor ISSD. The disase was staged according to our staging System based on computed tomography findings.Results: Postnasal drainage was the most common symptom n=37, 88.1% . Chronic rhinosinusitis was accompanied by sinonasal polyps in 25 patients 59.5% . Five patients 11.9% had isolated sphenoid disease and 16 patients 38.1% had unilateral disease.Five patients 11.9% had stage 1,15 patients 35.7% had stage 2, and 22 patients 52.4% had stage 3 dis ease. Surgery involved 68 sides. Ethmoidectomy was used in 63 sides of 37 patients, eight of whom required a supplementary procedure. At least one complication was seen in eight patients 19% , including severe peri- operative hemorrhage n=2 , early postoperative hem- orrhage n=2 , minör injuries to the lamina papyracea n=4 , and synechiae n=5 .Conclusion: İn patients with isolated ISSD, the direct approach to the sphenoid sinüs by ETNS vvithout eth moidectomy is a favorable technique, vvhereas ETNS with ethmoidectomy is necessary for patients with concurrent disease in other paranasal sinuses.

Keywords:

Ethmoid bone/surgery, sphenoid sinusitis/ surgery, endoscopy/methods,

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