Surgical Hints

• This is not "smash and grab" surgery. Rather, it requires good preparation, analysis of CT scans, and a thorough knowledge of the anatomy and attention to detail in surgical technique.

• Stay back with the endoscope. By doing this you will maintain perspective and reduce the splattering of blood on the end of the endoscope.

• Introduce instruments ahead of the endoscope to avoid scuffing the anterior one-third of the septum. Care taken during the first 15 minutes of a procedure is a good investment as it will avoid the frustration of the scope becoming coated with blood every time it is introduced past an abraded anterior one-third of the nose.

• Endoscopy does not provide stereoscopic vision, so it is important to use landmarks (middle turbinate attachment, middle meatal antrostomy, frontal recess, roof of the sphenoid) and stay back with the scope to allow as many of these to be seen as possible.

• Stop if visibility is poor. Either work on the other side or place 6 mm ribbon gauze soaked with a vasoconstrictor (1 : 10 000 epinephrine) in position. If the bleeding is excessive, curtail the procedure.

• Do not remove or grab anything that you cannot see clearly (this also applies to the microdebrider).

• It is easier to use a 0° endoscope for most operating, as then you do not inadvertently operate where you do not want to. At the limits of the visual field via an angled endoscope, there is foreshortening and it is possible to be working much higher up than you imagine. This is in part due to the excellent wide range of the new scopes that span approximately 30° outside the axis of the scope; for example, using a 45° scope you may be working at 75° (45° + 30°) from the axis of the endoscope.

• It is safer to initially stay medial to the medial wall of the maxillary sinus, below the take-off of the middle turbinate from the cribriform plate and below the level of the roof of the sphenoid sinus. This "block" of cells contains most of the sinuses, and it is safe to remove tissue in this area.

• If you have not removed any polyps for some time during the surgery, consider whether you are making progress or just increasing your chance of producing a complication.

• Do not instrument around the territory of the anterior ethmoid artery if there are polyps in that area and you cannot readily identify landmarks.

• Respect the mucosa of the frontal recess. Use through-cutting instruments rather than tearing or pulling mucosa. Preserve mucosa so that the result ing cavity at the end of surgery is lined. This not only reduces cicatrization of the frontal recess, it also speeds up healing and the return of mucocili-ary function.

• Preserve all the olfactory mucosa if at all possible.

• Gently lateralize the middle turbinate after a thorough ethmoidectomy if there are polyps medial to the middle turbinate.

Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

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