Kirurško liječenje kroničnog rinosinusitisa

master's thesis

• Author: Iva Drobec
• Mentor: Goran Geber (mentor)
• Committee member: Goran Geber
• Committee member: Robert Trotić
• Committee member: Davor Vagić
• Granter: University of Zagreb; School of Dental Medicine; (Chair of Otorhynolaringology); Zagreb
• Defense date and country: 2015-07-10, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Dental Medicine; Oral Surgery

Abstract

Nove smjernice Europske akademije za alergologiju i kliniĉku imunologiju „EAACI“ koje su sadrţane u dokumentu EPOS-a (European Position Paper on Rhinosinusitis and Nasal Polyps) kroniĉni rinosinusitis definiraju prisutnošću dvaju ili više simptoma od kojih je jedan nazalna opstrukcija/blokada/kongestija ili nazalna sekrecija (prednja ili postnazalna), a od ostalih simptoma moţe biti prisutna liĉna bol ili pritisak te smanjen ili potpuni gubitak osjeta njuha uz uvjet da simptomi traju dulje od dvanaest tjedana.
Dijagnoza se postavlja na temelju anamneze dopunjene kliniĉkim pregledom. Od kliniĉkog pregleda vaţna je rinoskopija i endoskopija nosa kako bismo procijenili stanje sluznice, sekreta, anatomske strukture i prisutnost polipa. Brisom nosa dokazujemo uzroĉnike te se primjenjuje antibiotik u fazi egzacerbacije. Ukoliko je indicirano kirurško lijeĉenje, potrebno je uĉiniti CT paranazalnih sinusa. CT snimkom uoĉavamo anatomske varijacije koje se smatraju predisponirajućim ĉimbenikom uz alergije, imunodeficijenciju, mikroorganizme te poremećaj mukocilijarnog transporta.
Kirurško lijeĉenje indicirano je kod neodgovarajućeg uĉinka medikamentozne terapije. Operacijom se mogu ispraviti anatomski predisponirajući faktori te proširiti ušća sinusa radi bolje ventilacije i drenaţe sinusa. Prvi odabir operacijske tehnike je funkcionalna endoskopska kirurgija (FESS). Operacija je obiĉno fokusirana na ostiomeatalni kompleks – podruĉje srednjeg nosnog hodnika u koje se otvaraju prednji etmoidi, maksilarni i frontalni sinus. Obiĉno se uĉini i etmoidektomija koja podrazumijeva uklanjanje interetmoidnih koštanih septa, takoĊer radi bolje
ventilacije sinusa. Ukoliko se endoskopskim putem ne moţe ukloniti cjelokupni patološki problem, indiciran je otvoreni kirurški pristup paranazalnim sinusima.

Abstract (english)

The new guidelines of the European Academy of Allergy and Clinical Immunology (EAACI) contained in the document European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) define chronic rhinosinusitis as the presence of two or more symptoms one of which is nasal obstruction/blockage/congestion or nasal secretion (frontal or postnatal), while other symptoms may include the presence of facial pain or pressure, or reduced or complete loss of the sense of smell provided that the symptoms last longer than twelve weeks.
The diagnosis is based on a history of a supplemented clinical examination. Importantly, the clinical examination should include a rhinoscopy and endoscopy of the nose in order to assess the condition of mucosal secretions, the anatomical structure and the presence of polyps. Nasal swabs reveal causes and is followed by the administering of antibiotics in the exacerbation phase. If surgical treatment is indicated, a CT scan of the paranasal sinuses is to be conducted. CT scans reveal anatomical variations that are considered a predisposing factor along with allergies, immunodeficiency, microorganisms and a disorder in mucociliary transport.
Surgical treatment is indicated if drug therapy is inadequate. Surgery can correct anatomical predisposing factors and expand the opening of the sinuses for their better ventilation and drainage. The first choice of surgical techniques is functional endoscopic surgery (FESS). The operation is usually focused on the ostiomeatal complex – an area of the meatus nasalis medius in which the front ethmoid, maxillary and frontal sinus are opened up. Ordinarily, a ethmoidectomy is carried out which involves removing the interetmoidal bone septa, also for better
ventilation of the sinuses. If an endoscopy cannot remove the entire pathological problem, an open surgical approach is indicated for the paranasal sinuses.

• Keywords: funkcionalna endoskopska kirurgija
• Keywords (english): functional endoscopic surgery
• Language: croatian
• URN:NBN: urn:nbn:hr:127:896274
• Study programme: Title: dental medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica dentalne medicine (doktor/doktorica dentalne medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2016-04-01 08:18:14