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9. Endoscopic paranasal operation for pediatric sinusitis
P.P.H.
Aramaki
“Dept. of Otolaryngology, gology, Kyoto Prefectural
/ Int. J. Pediatr.
Otorhinolaryngol.
Kyoto First Red Cross University of Medicine
37 (1996)
Hospital;
295
287-296
bDept. of Otolaryn-
Sinusitis in children is refractory to treatment and tends to be intractable. Paranasal sinuses are immature in children, therefore radical operation, such as the Caldwell-Luc operation, are not indicated. Fourteen children under 15 years of age underwent endoscopic sinus surgery (ESS) at our department, in the last 3 years. The ostiomeatal complex was removed to obtain an adequate opening of the middle meatus and anterior ethmoid sinus. Prior to ESS, adenotomy and tonsillectomy were performed to improve the narrow upper respiratory tract in children. Macrolides and anti-allergic agents were administered postoperatively. In five patients, sinusitis recurred and reoperation was performed. Mucosaledema and polyps were found in 80%, while purulent fluid was noted in 20% of sinuses. The maxillary and anterior ethmoid sinuses were the spaces with predominant lesions. There were less pathologic changes in the posterior ethmoid, frontal, and sphenoid sinuses. Large choanal polyps were often present in patients with recurrent sinusitis. These patients may have constitutional factors to develop polyps. Recurrent sinusitis also occurred more frequently in patients whose postoperative topical therapy was insufficient. In the treatment of child sinusitis, postoperative therapy, such as nasal nebulization, irrigation, and administration of macrolides, are important. Children should be followed up more carefully than adults after ESS.
9. Endoscopic paranasal operation for pediatric sinusitis Shin-chi Haruna”, Masashi Ozawa”, Kazuyasu Asaib, Mitunori roshi Moriyamab “Dept. of Otorhinolaryngology, Doai Memorial yngology, Jikei University of A4edicine
Hospital;
‘Dept.
Yoshimi”,
Hi-
of Otorhinolar-
We performed endoscopic operation in 18 patients (5-15 years) with sinusitis which failed to improve by conservative therapy for longer than 3 months. In operation, we used endoscopes with a diameter of 2.7 mm and 4 mm, and Moriyama’s type forcepts for endonasal operation. Taking into consideration the age of patients, modified endonasal sinus surgery (MESS) was performed for patients aged 10 years or less, which the anterior ethmoidal sinus, ostium of the maxillary sinus and nasofrontal duct are widely opened to promote sinus ventilation. For patients aged 10 years or older, MESS were applied to 14 patients and in five patients who were relatively older and severe pathologic, the posterior esthmoidal sinus was opened. In four patients, adenotonsillectomy were also performed to improve constriction of the upper airway. After operation, CT imaging revealed opening of ostium of maxillary sinus and nasofrontal duct in all patients, and improvement in paranasal shadow and subjective symptons. Endoscopic operation using various thin forceps was able to mini-
296
P.P.H.
Aramaki
/ Int. J. Pediatr.
Otorhinolaryngol.
37 (1996)
287-296
mize invasion and enabled accurate manipulation of lesions. However, because pathological condition of pediatric sinusitis is unstable, and their parasinus are developing, it is important to select an appropriate surgical method taking their age into consideration.
Aramaki
“Dept. of Otolaryngology, gology, Kyoto Prefectural
/ Int. J. Pediatr.
Otorhinolaryngol.
Kyoto First Red Cross University of Medicine
37 (1996)
Hospital;
295
287-296
bDept. of Otolaryn-
Sinusitis in children is refractory to treatment and tends to be intractable. Paranasal sinuses are immature in children, therefore radical operation, such as the Caldwell-Luc operation, are not indicated. Fourteen children under 15 years of age underwent endoscopic sinus surgery (ESS) at our department, in the last 3 years. The ostiomeatal complex was removed to obtain an adequate opening of the middle meatus and anterior ethmoid sinus. Prior to ESS, adenotomy and tonsillectomy were performed to improve the narrow upper respiratory tract in children. Macrolides and anti-allergic agents were administered postoperatively. In five patients, sinusitis recurred and reoperation was performed. Mucosaledema and polyps were found in 80%, while purulent fluid was noted in 20% of sinuses. The maxillary and anterior ethmoid sinuses were the spaces with predominant lesions. There were less pathologic changes in the posterior ethmoid, frontal, and sphenoid sinuses. Large choanal polyps were often present in patients with recurrent sinusitis. These patients may have constitutional factors to develop polyps. Recurrent sinusitis also occurred more frequently in patients whose postoperative topical therapy was insufficient. In the treatment of child sinusitis, postoperative therapy, such as nasal nebulization, irrigation, and administration of macrolides, are important. Children should be followed up more carefully than adults after ESS.
9. Endoscopic paranasal operation for pediatric sinusitis Shin-chi Haruna”, Masashi Ozawa”, Kazuyasu Asaib, Mitunori roshi Moriyamab “Dept. of Otorhinolaryngology, Doai Memorial yngology, Jikei University of A4edicine
Hospital;
‘Dept.
Yoshimi”,
Hi-
of Otorhinolar-
We performed endoscopic operation in 18 patients (5-15 years) with sinusitis which failed to improve by conservative therapy for longer than 3 months. In operation, we used endoscopes with a diameter of 2.7 mm and 4 mm, and Moriyama’s type forcepts for endonasal operation. Taking into consideration the age of patients, modified endonasal sinus surgery (MESS) was performed for patients aged 10 years or less, which the anterior ethmoidal sinus, ostium of the maxillary sinus and nasofrontal duct are widely opened to promote sinus ventilation. For patients aged 10 years or older, MESS were applied to 14 patients and in five patients who were relatively older and severe pathologic, the posterior esthmoidal sinus was opened. In four patients, adenotonsillectomy were also performed to improve constriction of the upper airway. After operation, CT imaging revealed opening of ostium of maxillary sinus and nasofrontal duct in all patients, and improvement in paranasal shadow and subjective symptons. Endoscopic operation using various thin forceps was able to mini-
296
P.P.H.
Aramaki
/ Int. J. Pediatr.
Otorhinolaryngol.
37 (1996)
287-296
mize invasion and enabled accurate manipulation of lesions. However, because pathological condition of pediatric sinusitis is unstable, and their parasinus are developing, it is important to select an appropriate surgical method taking their age into consideration.