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Abstract
Endoscopic sinus surgery procedure using CO2 laser and/or microresector for paediatric and adult chronic sinusitis with antrochoanal polyp (ACP), with long-term follow-up, was examined. Twelve children and 13 adults underwent the surgical procedure.
The following two techniques were used to remove the antral portion of an ACP with a 70° endoscope:
(1) CO2 laser - The base of the ACP was vaporized and removed via an enlarged natural ostium with a pipe-guide handpiece with a deflective tip.
(2) Microresector - The ACP was resected via an enlarged natural ostium and/or nasoantral window opened under the inferior turbinate with the curved and straight blade of a microresector.
In the endoscopic follow up for 10 to 57 months, no patient who underwent the primary surgery required reoperation for ACP recurrence. One out of the seven patients who underwent secondary surgery required a revised operation with microresector and CO2 laser.
Key Words: Nasal Polyps; Laser Surgery; Surgical Procedures, Operative; Endoscopes; Treatment Outcome; Antrochoanal poly; Microresection
Introduction
The emerging technology of endoscopy and surgical instruments allows otolaryngologists to perform a variety of surgical procedures in nose and sinus surgery. Recently, endoscopie sinus surgery has been widely done to treat chronic sinusitis; however the surgical procedure of how to manipulate the maxillary sinus is still controversial.
We previously made a preliminary report on the surgical procedure for endoscopie sinus surgery using CO2 laser and/or microresector for chronic sinusitis with antrochoanal polyp.1 In this paper, more cases and longer follow up were examined to evaluate the previous preliminary report.
Materials and methods
Twelve children with ages ranging from seven to 14, and 13 adults with ages ranging from 27 to 67, underwent the present surgical procedure as primary (18 cases) or secondary (seven cases) endoscopie sinus surgery for chronic sinusitis with antrochoanal polyp. This was performed under general anaesthesia in four children (seven, 10, 10, and 11 years old) and local anaesthesia in eight older children (11 to 14 years old), and in all 13 adults.
The nasal mucosa was shrunk and anaesthetized using gauze strips impregnated with 10 per cent cocaine. For local anaesthesia, 0.5 per cent lidocaine hydrochloride with epinephrine (1:200 000) was injected into the mucosa tissue of the nose. After ethmoidotomy under an endoscope, the...