Bullotomy what is it

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Brain abscess as a complication of nasopharyngeal polyp with bilateral damage to the tympanic cavities in cats

Nasopharyngeal polyps in cats occur statistically more often in young animals under one year of age, although they can be diagnosed at a later age.

Table of contents:

Histologically, these are benign connective tissue neoplasms that have a clear boundary with surrounding tissues and are characterized by moderate growth.

The etiology of both nasopharyngeal polyps and middle ear polyps in cats is not fully understood, but a breed predisposition to this type of disease has been established in a number of cat breeds. The leading positions currently belong to representatives of the Maine Coon breed.

MRI weighted in T2 mode sagittal projection. Hyperintense signal in the nasopharynx - nasopharyngeal polyp in a 4-month-old Maine Coon kitten.

Nasopharyngeal polyps in cats are located in the nasopharynx and originate in both the Eustachian tube and the tympanic cavity. Polyps located in the tympanic cavity are usually classified as middle ear polyps, which differ in macroscopic and histological structure from nasopharyngeal polyps.

T2 weighted MRI. Hyperintense signal from a polyp located in the tympanic cavity of a cat.

Due to a long-term inflammatory process that develops both in the nasopharynx and in the middle ear as a result of invasion of the polypoid mass, various types of complications can develop, including damage to the nervous system.

MRI examination in T2 mode. Bilateral hyperintense signal in the tympanic cavities – middle ear polyps.

In chronic purulent otitis media, infection can penetrate into the brain matter by contact. Due to the close proximity to the source of infection, the inflammatory process from the tympanic cavity is usually localized superficially, i.e. in the temporal lobe. In acute otitis media, hematogenous and lymphogenous spread of infection is also possible, while an abscess can form in areas of the brain remote from the primary focus. In acute sinusitis, the infection most often spreads hematogenously. In this case, the abscess can occur in the frontal lobe of the brain without damage to the dura mater.

MRI study, T1-weighted with contrast: late (encapsulated) stage of interstitial brain abscess in a cat - hypointense signal in the center and hyperintense in the area of ​​perifocal edema, accumulated contrast agent. The outline of the capsule is clearly defined.

If the infection spreads into the skull by contact, encephalitis first develops, followed by necrosis and a defect in the dura mater with the formation of an intracranial abscess.

Due to the absence of pathogmonic symptoms of brain abscess in cats to date, the appearance of any neurological deficit is an absolute reason for urgent neuroimaging examination.

T2-weighted MRI study: contact otogenic temporal lobe abscess in a Maine Coon.

Early detection of limited inflammation of brain tissue - encephalitis, with appropriate therapy leads to reversibility of the inflammatory process. It is often not possible to identify the causative agent of infection already at the stage of a brain abscess, since in 30% of cases cultures of the abscess contents are sterile, blood cultures are sterile in 95% of cases, the cerebrospinal fluid normalizes after the formation of the glial capsule, which is a sign of false recovery. A formed capsular abscess, causing brain dislocation and the manifestation of focal cerebral symptoms, is an absolute indication for surgical treatment. In the absence or incorrectly chosen treatment tactics, pus may break through into the subarachnoid space or into the ventricles of the brain. The spread of pus in the medulla leads to damage to the stem structures of the brain, which is manifested by dysfunction of the vasomotor and respiratory centers of the medulla oblongata. This determines the onset of the terminal stage of the brain abscess, which in most cases leads to death.

Surgical treatment includes craniotomy, and removal of the abscess using a neurosurgical approach in its entirety with the capsule. The presence of a polyp in the tympanic cavity expands the scope of surgical intervention to partial bullotomy.

Removing the contents of the abscess with the capsule.

Partial right bullotomy, lateral approach.

A removed polyp of the middle ear, localized in the tympanic cavity on the right.

Video of the patient before surgery: Maine Coon, 4-year-old cat, diagnosis - right-sided brain abscess, nasopharyngeal polyp, middle ear polyps on the right and left with bilateral damage to the bones of the tympanic cavity.

Manege movements in a small circle to the right, depression of mental status, level of consciousness - severe depression, disorientation, reacts slowly to external stimuli, decreased attention, drowsiness, bilateral protrusion of the third eyelid, and horizontal nystagmus.

After surgery 2 weeks: Horner's syndrome persists, slight tilt of the head to the right.

Source: http://samarskayaluka-vet.ru/nevrologiya-i-nejrokhirurgiya.html?id=58

Bullotomy what is it

The cat is 6 years old, a Persian mix, not sterilized, we take him to the country in the summer.

In mid-June, I got into a fight with another cat, after which ear inflammation began, high fever, vestibular syndrome (nystagmus, paws moved apart, head moved in a circle) for 6 hours (they took it off with an IV in just 1 hour, put on a course of 5 times, continued inject antibiotics for 2 weeks and dexamethasone for 1 week).

2-3 weeks after the injury, the head tilted towards the affected ear. We put on antibiotics for 2 weeks, in the very first days there is improvement, but 2 weeks after the end of the course the temperature rises again, the cat becomes depressed. We start antibiotics again, there is improvement - and so on in a circle.

We’ve been living in this mode for 2 months now, and my head is still bowed. Swelling appeared once on the front right side of the neck, but went away on its own in one day. Also, the voice changed briefly (for 2-3 days): it became low, hoarse, compressed, and also returned to normal on its own.

It may be a coincidence - but after visits to two veterinarians and their examination with an otoscope, minor purulent discharge appears from the ear (levomekol helps).

To date, diagnostics have been carried out:

— X-ray shows thickening of one wall of the bulla.

— Cytology revealed no abnormalities.

— A biochemical blood test shows an inflammatory process and a “shift to the right” (perhaps I’m wrong with the terminology).

Of course, there are examinations with an otoscope, but it is confusing that one doctor says that he sees a polyp and a gray color of the eardrum, another doctor says that he cannot see anything, a third claims that, in principle, it is impossible to see the condition of the eardrum with an otoscope.

Now we are preparing for an MRI, and an ultrasound of the heart revealed an enlargement of the apex of the left ventricle to 2.89, but the doctor says that there are no contraindications to anesthesia. Now, to my fears about the bullotomy, I have added anxiety about how the anesthesia will be tolerated.

In the house, a cat is a talisman against adversity. Mice killer and thief. Fun for children. Old people have fun and joy.

Drops, etc? Or did they just give injections?

In the house, a cat is a talisman against adversity. Mice killer and thief. Fun for children. Old people have fun and joy.

X-ray of the skull 3.jpg [ 52.18 KB | Views: 3724 ]

MRI.jpg [ 72.24 KB | Views: 3663 ]

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Bullotomy what is it

Otitis of the middle and inner ear in cats and dogs. Primary secretory otitis "PSOM"

Photo1 Anatomy of the hearing aid

What can cause inflammation of the middle and inner ear?

• Infection (complications after inflammation of the external auditory concha and external auditory canal, infection from the oral cavity, nasopharynx, oncological factor, etc.)

• Long-term treatment of the animal with immunosuppressive drugs (reduction of the body’s resistance and penetration of infection into the ear)

• Injury to the eardrum (no need to clean the ear with ear sticks, nowadays there are many other ways to clean the eardrum from wax and inflammation, for example, the drug “Otoklin” was instilled and then simply removed the contents with a napkin)

• Species predisposition to this disease (brachycephalic breeds of animals, for example in Cavalier King Charles Spaniels)

What can happen to an animal with otitis media and inner ear?

• Such animals usually shake their heads violently (this symptom may also be present with inflammation of the external inflammatory process)

• Copious exudate is released from the ears. On palpation, severe pain in the entire ear space (this symptom may also be present with inflammation of the external inflammatory process)

• Nerves may be involved in the inflammation and neuralgic disorders such as Horner's syndrome, head tilt and deafness may occur due to this.

Rice. 2 Anatomy of a cat

• In dogs, otitis media usually develops due to inflammation of the external auditory canal. The external auditory canal and the tympanic cavity are lined with respiratory epithelium, which in turn leads to large production of mucus.

• During the treatment of the external auditory canal and the use of a short course of antibiotics or mycotics, it contributes to the development and persistence of infection in the internal auditory canal. Bacteriological analysis from the internal auditory canal usually shows the presence of Pseudomonas aeruginosa and Staphylococcus intermedius. And with external otitis Malasseziapachydermatis.

• In cats, as a rule, ascending otitis media develops due to the spread of infection through the oral cavity and from the upper respiratory tract. Staphylococcus intermedius is also the main microorganism in the bacteriology of the middle ear. According to mycology, fungi of the genus Malasseziaspp., Candidaspp. and Aspergillus.

• The tympanic bladder may contain mucus, pus, polyps, granulomatous inflammation, and tumor. If the infection has spread into the skull and affected the meningeal membranes and facial nerves, then neurological disorders, Horner's syndrome, miosis, ptosis, enophthalmos, nystagmus, head tilt, and circular movements are likely to appear.

• When the facial nerve is damaged, paresis or paralysis of the tissues of the ear, eyelid, and lip on the side of the process is characteristic.

• It is necessary to distinguish otitis media from a disease of the nervous system, which is also accompanied by disorders of the vestibular apparatus, such as polyneuropathy with damage to the seventh and eighth pairs of cranial nerves against the background of endocrine diseases, hypothyroidism.

• Drugs with toxic effects, aminoglycosides, fluoroquinolones. Metronidazole at a dose of more than 2 mg per 1 kg can cause bilateral vestibular symptoms.

• Trauma, deep cleaning of the auricle.

• Idiopathic disorders in cats (Horner's syndrome, facial paralysis)

Diagnosis of otitis media

• According to clinical signs (head tilt, Horner's syndrome, etc.)

• X-ray examination in two projections, but this requires a high-quality system. In any case, it is impossible to make an accurate diagnosis using radiology (it is possible to see swelling, tissue calcification, the bulla will look light in contrast to a healthy bulla)

• Computed tomography (CT) is a more reliable informative diagnostic technique, however, CT will clearly show the contours of bone structures, changes in the internal structure of the bulla will not be clear, lighter, unlike a healthy bulla.

• Magnetic resonance imaging MRI is more suitable for clarifying the diagnosis, as it will clearly show changes in soft tissue structures and the presence or absence of neoplasms

• Endoscopy of membrane and bulla

Photo 5. MRI of the head

Photo 6. MRI of the head

Photo 3. Bullotomy using endoscopic technique

• Based on the above, for an accurate diagnosis and prediction of treatment, a combination of several techniques can be recommended, CT - bone structures, MRI - soft tissue structures, endoscopy, histological analysis, bacteriology, mycology.

Primary treatment depends on the extent and severity of clinical symptoms. As a rule, an animal is examined for otitis media when there are already obvious clinical symptoms (severe purulent discharge from the ear or Horner's syndrome). And even before that, the animal is treated for otitis externa with various courses of antibiotics and hormonal drops, which subsequently leads to resistance and pathogenicity of microorganisms growing in the middle ear.

But with the advent of advanced diagnostic methods, the tactics and algorithm of actions have changed. Now in dogs and cats, endoscopic washing of the bulla is used, with the collection of material for analysis. In this regard, cats have a peculiarity, since their bulla is divided by a septum, a complete rinsing will not work, only one chamber.

• Endoscopic lavage of the ear canal and bulla

• Symptomatic treatment based on the results of tests (bacteriology, cytology, histology) Long-term antibiotic therapy for 4-6 weeks, the drugs of choice may be cephalosporins and then enrofloxacin and miconazole, Baytril®Otic emulsion for washing the bulla.

• If the eardrum is intact, a myringotomy is performed to access the middle ear and drain it.

• Osteotomy of the bulla is performed in cases of complete stenosis of the auditory canal, osteomyelitis of the tympanic bulla, unsuccessful drug treatment, and deafness.

Photo 6 Ventral approach to the bulla

Photo7 Ventral approach to the bulla

Photo 8 Ventral perforation of the bulla

Photo 9 perforation of the bulla, purulent contents in the first chamber

Photo 10 perforation of the second chamber of the bulla

• Frequent relapses of inflammation in the middle ear lead to the fact that treatment may take several months. Therefore, regular washing of the bulla is necessary. Sometimes it is necessary to install permanent drainage for more convenient washing and control.

• With a ventral cut, the formation of fistulas and seromas at the site of the incision is possible; therefore, sutures on the skin can be made at intervals for the outflow of contents. Healing will occur by secondary intention.

• After a bullotomy operation, Horner's syndrome is also possible, which will go away within a day.

• Damage to the facial nerve during surgery (in cats, more often Baconetat.2003)

• Damage to the auditory ossicles RebeccaE. Spivack,VMDetal 2010

• Excessive formation of granulation tissue, periosteal bone proliferation

Primary secretory otitis media "PSOM" in the Cavalier King Charles Spaniels, Boxers, Dachshunds and Shih Tzus.

Photo 11. Cavalier King Charles Spaniel dog

In dogs, otitis media usually develops as a consequence of otitis externa. However, in Cavalier King Charles Spaniels, primary secretory otitis has been described in many articles. Soreness and itching are the main symptoms.

During otoscopy, the external auditory canal appears unchanged, but a swollen eardrum is often visible. During myringotomy, sticky mucus is visualized. Single washings of the bulla lead to further relapses; as a rule, it is necessary to install permanent drainage.

Source: http://www.alisavet.ru/nevrologiya/14-otit-srednego.html

Otitis in cats and dogs

Author: Barynina Yu.S., veterinary dermatologist, member of the ESVD. OTITIS IN DOGS AND CATS - inflammation of the ear canal. The main causes of otitis media:

  • parasites,
  • allergies (non-food and food),
  • foreign bodies,
  • tumors
  • violations of cornification,
  • endocrine pathologies,
  • autoimmune diseases.

The doctor’s task is to identify the cause of otitis media and eliminate the bacterial and/or fungal inflammation that has arisen against its background. The first stage of diagnosis is examination and otoscopy . It is important to evaluate the condition of the ears, external auditory canals and eardrums. During the procedure, the structure, condition of the mucosa, the presence and nature of discharge, the presence/absence of foreign bodies in the lumen of the canal, the presence/absence of a neoplasm, the structure and integrity of the eardrum are assessed. Otitis media is not always an independent disease and is often observed as one of the signs of a systemic disease (for example, in the case of allergies or hypothyroidism). will examine the pet completely at the appointment , even if there are no other complaints other than the condition of the ears. The next stage is taking material for research, cytology and/or native smear . It is necessary to determine whether the cause of otitis media is parasites (mite Otodectes cynotis, etc.), and also to determine the type of inflammation of the ear canal (bacterial, fungal, mixed). Why is material taken from both ears? Two different types of inflammation can occur simultaneously in different ears. This situation often requires different medications for the right and left ear canals. How long will it take to wait for test results? Within minutes, most of them will be ready, and the doctor will give you a printed order sheet detailing the necessary procedures. The course of treatment can be completed only on the basis of a re-examination and control diagnostic studies, which are carried out every 2-3 weeks. In some cases (for example, otitis media or a tumor), special studies - X-rays, MRI, CT, video otoscopy. During video otoscopy, if necessary, a thorough instrumental sanitation of the cavity of the external auditory canal is performed, puncture of the eardrum with taking material for bacteriological culture from the middle ear cavity with rinsing, and collection of material for histological examination in case of a possible tumor. Also in practice, we encounter cases where conservative treatment cannot be effective and the only method of treatment, and surgical intervention cannot be avoided . Among them are plastic surgery or removal of the vertical ear canal, ventral bullotomy, total removal of the ear canal with bullotomy. Fortunately, our clinic has a surgeon on staff who is qualified in operations of this class. And, in conclusion, our earnest request is not to clean your ears with cotton swabs , as well as cotton wool wound on tweezers or other elongated devices! This will lead to “pushing” the secretions even deeper, and it is not uncommon for the cotton wool to come off and become trapped in the ear canal.

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Operations on the nasal turbinates

Normal natural breathing is inhalation and exhalation through the nose without any difficulty or discomfort. Unfortunately, a situation often occurs in which a person has difficulty in the normal breathing cycle and the reason for this is common pathologies in the development of the nasal turbinates.

In total, a person has three nasal conchas - the superior, middle and inferior on each side of the nasal septum. The nasal turbinates are responsible for:

Free normal breathing

Moisture and cleanliness of mucous membranes

Neutralization and warming of inhaled air

Supporting well-being and normal functioning of all body systems

Symptoms of disruption of the normal functioning of the turbinates are sometimes very similar to other common diseases of the nose and paranasal sinuses, therefore, before making a diagnosis and prescribing treatment, ENT specialists at the SL Clinic carry out extensive diagnostics using modern European equipment, which makes it possible to determine the exact cause of the patient’s symptoms in a fairly short time time.

The main complaints of patients with pathologies of the development of nasal turbinates are difficulty in nasal breathing, nasal speech, possible sensation of a foreign body in the nasopharynx (this symptom is especially characteristic of hypertrophy of the posterior ends of the turbinates), heaviness in the head, headache, strong and prolonged nasal discharge, noise in ears, problems with smell.

It is quite difficult to make a correct diagnosis based only on symptoms. It is necessary for a doctor to conduct a special study - rhinoscopy, during which hypertrophic changes in the shells and mucous membranes are revealed.

It is very important to promptly detect hypertrophy or curvature of the nasal turbinates, which disrupts the natural breathing cycle, and immediately begin to eliminate the pathology through surgical intervention.

Our Clinic uses several types of operations on the nasal turbinates, each of which has its own characteristics and advantages. During the consultation, your attending physician will select the most suitable turbinate surgery for you, based on the characteristics of the body and the clinical picture of existing pathologies. In any case, the operation will allow you to breathe deeply without pain, constant discharge and discomfort. The use of modern techniques allows ENT operations to be performed with minimal risk and maximum safety for both adults and the youngest patients.

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st. Pavlyukhina, 37

Make an appointment

The clinic premises are closed for renovation. In this regard, all our doctors receive appointments at the SL Clinic at the address: Pavlyukhina, 37.

We are located in the very center of the city, at the intersection of Sukonnaya and Spartakovskaya streets, in a building with its own parking.

Source: http://www.clinic-sl.ru/services/ent/diseases-of-the-nose-and-paranasal-sinuses/operations-on-the-turbinates/

Bullotomy in a dog

This situation requires a detailed conversation, an accurate diagnosis and thoughtful, complex, complex treatment. The material you cited is quite interesting and we have already had some thoughts on this issue. However, the effectiveness of therapy depends on the correct diagnosis. Therefore, a consultation via Skype will be the best way out and solution to the problem.

Send Skype information by email ().

Health to your pets!

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Source: http://vetpraktika.ru/questions/bullotomiya-u-sobaki

Ventral bullotomy in a cat

What worries me is that the eardrum is still missing and there is a hole in the depths of the ear canal. The auditory canal is clean, there is no visual inflammation in the canal

Now the only treatment left is antibiotic drops. The cat does not receive AB systematically for three days.

How to lead this cat further? Should we continue antibiotics systemically to prevent infection of the broken-down tympanic cavity? Or just drops? How long can the re-epithelialization process last?

I had several animals with destroyed eardrums and everything was somehow faster there. True, in those cases at least some remnants of the PD remained, but here, under the pressure of the polyp, not a trace remained of the eardrum

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Bullotomy what is it

There are a large number of terms for operations on the inferior turbinates. Laser destruction, electrocautery, submucosal vasotomy – it’s easy to get confused in these names.

A little anatomy and physiology

To understand the differences between turbinate surgeries, it is necessary to recall the anatomy and physiology of the nose. The inferior turbinates are bony protrusions on the side walls of the nose, covered with a mucous membrane with a developed submucosal layer. Numerous venous plexuses lie in the submucosal layer. The function of the turbinates is to warm and humidify the flow of incoming air.

An increase in blood supply to the venous plexuses, for example, in acute viral rhinitis, causes swelling of the shells. Because of this, the lumen of the nasal passages narrows, breathing through the nose worsens.

A constant increase in the nasal turbinates is a key problem in different types of runny nose - medicinal, vasomotor, allergic and others. In these conditions, the venous plexuses are constantly filled with blood. Surgeries on the inferior turbinates serve to solve this problem.

Why can't you just remove the turbinate?

The next important point is that the inferior turbinate cannot be removed. The feeling of full breathing depends not only on the width of the space through which the air passes. The mechanism of perception of an air stream by the human senses is generally poorly understood. When surgically cutting the fibers of the trigeminal nerve, a feeling of nasal congestion may occur when there is sufficient clearance of the nasal passages. [1]

At the same time, under the influence of menthol, there is a feeling of improved breathing, although the lumen of the airways does not increase.

Complete removal of the turbinate often paradoxically does not lead to improvement in nasal breathing. Moreover, a person may feel like their breathing has gotten worse. [1]

The trajectory of the air stream changes for the worse, chronic inflammation develops, and crusts constantly form. This means that the operation should reduce the volume of the shell, but preserve its shape and mucous membrane. Complete removal of the organ is unacceptable.

The next stage of studying the issue is familiarization with vocabulary. The terms listed below can be used in different phrases: radiofrequency reduction, laser reduction, ultrasound vasotomy, submucosal vasotomy.

Ablation – removal, cutting off.

Vasotomy is an incision of a vessel.

Conchotomy - cutting off part of the shell.

Conchopexy – fixation of the shell.

Reduction – reduction in volume.

Resection – partial removal.

Turbinoplasty – plastic surgery of the nasal concha.

The names “destruction”, “reduction”, “disintegration”, “vasotomy”, “coagulation” in relation to the inferior turbinates are often used as synonyms.

Types of operations on the nasal turbinates.

Table 1. Operations.

Galvanocautics, electrocaustics, electrocoagulation

Direct current that heats the surgical probe to a high temperature

Electrocautery is a surgical treatment method based on the heating effect of electric current. Electrocautery originates from the 19th century.

The essence of the technique in its current form: an electrode is inserted into the nasal concha, the heating of which causes a submucosal tissue burn. At the site of the burn, scarring, compression and desolation of the venous plexuses subsequently occur. The nasal concha decreases in volume.

Direct current is used to heat the electrode. The electric current does not go beyond the electrode. The current is used only to heat the tool. Cauterization occurs due to contact of a hot electrode with tissue. [3]

Radio frequency (radio wave) coagulation.

The history of high-frequency electrosurgery (radiosurgery) began in the first half of the 20th century. The first efficient high-frequency oscillator was created by Bovey in 1926.

The essence of the method: a probe is inserted under the mucous membrane of the shell. As a result of the action of alternating current, radio waves are generated that heat the surrounding tissue, causing its destruction. The venous vessels of the submucosal layer become empty, the shell decreases in volume.

The difference between radiofrequency surgery and electrocautery is that during electrocautery the probe itself is heated and the tissue is burned with it, like a “hot iron.” During radiofrequency coagulation, the tissue around the probe is heated due to resistance to the radio wave.

Coblation is a neologism made from two words: controlled ablation. ArthroCare, the company whose engineers invented the coblation technology, calls the coblator probe a magic wand. The official ArthroCare website describes coblation as a non-thermal soft tissue surgical process using radiofrequency energy. [2] Coblation is a type of radio wave surgery.

A field of “cold” plasma is formed around the operating instrument. The ions in this field have sufficient energy to destroy the bonds of organic molecules in soft tissues at relatively low temperatures. In coblation, heat is not used as a means of tissue destruction, as in traditional radiofrequency or laser coagulation. Consequently, the surgeon causes less damage to surrounding tissues. [2]

Technically, coblation of the inferior turbinates is performed in the same way as ultrasound and laser destruction - a probe is inserted submucosally into the thickness of the turbinate, destroying the venous plexuses.

Laser destruction of the nasal turbinates entered medical practice in the late 70s of the last century. During the operation, the light guide is inserted into the nasal turbinate. The energy from the laser beam causes the tissue underneath the mucous membrane to vaporize, causing the organ to shrink.

The method of ultrasonic destruction (USD) of nasal turbinates was invented by Soviet scientists Ferkelman and Vinnitsky in the early 70s. [4] During the operation, the surgeon inserts an ultrasound probe into the nasal turbinate. Exposure to ultrasound leads to limited destruction of the submucosal layer. The nasal concha decreases.

Cryodestruction is a method of exposing the inferior turbinates to low temperatures. This method of surgical treatment was proposed by Osenberger in 1970.

When the cryoprobe touches the mucous membrane, ice crystals form inside the cells, destroying the cell wall. Cryotherapy causes thrombosis of small vessels in the application area and local bleeding. All these destructive processes lead to a decrease in the nasal turbinates. [1]

Submucosal vasotomy and lateralization (lateropexy).

Submucosal vasotomy of the inferior turbinates involves purely mechanical destruction of the vessels under the mucous membrane.

In general, any submucosal destruction of the vessels of the nasal concha, be it laser or ultrasound, can be called vasotomy. Vasa is a vessel, -tomia is a cut, dissection. Thus, vasotomy means “cutting a vessel.” That’s what they sometimes say: laser submucosal vasotomy.

But when the text simply says “submucosal vasotomy”, without clarifying definitions, it usually means that the destruction was carried out by an instrument that has no other effect other than mechanical destruction. For example, with a surgical chisel.

Lateralization or lateropexy is also a mechanical maneuver. When performing it, the surgeon breaks the inferior nasal concha at its attachment point and moves it as far as possible to the side wall of the nasal cavity to make room for a stream of air.

Turbinoplasty involves removing part of the nasal concha while preserving the mucous membrane. An incision is made in the mucous membrane on the functionally inactive side of the organ, which faces the wall of the nasal cavity. Through this access, part of the turbinate tissue is removed, and the mucous membrane is put back in place.

Shaver destruction of the nasal turbinates is a surgical operation using a special instrument called a shaver (microdebrider). Shaver conchotomy is one of the synonyms for this operation. In the English-speaking world, the term “powered turbinate reduction” exists for shaving operations. Sometimes in Russian texts you can find the following translation: “reduction of the nasal turbinates using electric instruments.” This usually means that a shaver (microdebrider) is involved in the operation.

In my opinion, it is better to call a shaver not an electric, but an electromechanical instrument, so that there is no confusion with electrosurgery.

The shaver is a rotating blade paired with an electric suction. The removed tissue is immediately sucked into the device. Some otolaryngologists use a shaver exclusively under the mucous membrane, others use it to remove part of the shell along with a fragment of the mucous membrane on the side of the organ that faces the wall of the nose and downwards.

Conchotomy is the removal of part of the shell together without preserving the mucous membrane. Nowadays, surgeons in some cases practice posterior conchotomy. The hypertrophied posterior ends of the turbinates are cut off with scissors.

Which turbinate surgery is best?

I will quote the conclusion of a review article published in the journal Rhinology: “The very existence of a large number of types of operations to reduce the volume of the nasal turbinates suggests that there is no single technique that is effective in all cases. There is no "gold standard". Few surgical topics are as controversial as turbinate surgery. In general, a technique that allows you to remove a large part of an organ (turbinoplasty - translator’s note) has the most pronounced and longest-lasting effect, but is associated with a higher risk of side effects.” [1]

I will express my own opinion. Only electrocautery is morally obsolete. Indeed, cauterization with a “hot iron” is inferior to other methods in terms of sparing treatment of tissues. In my practice, I used three methods of surgical treatment: submucosal vasotomy, ultrasonic disintegration of the nasal turbinates and radiofrequency destruction. I don't see much difference in efficiency between them.

You might also be interested in reading the following articles:

1.Willatt D. The evidence for reducing inferior turbinates. Rhinology. 2009 Sep;47(3):227-36.

2. Turbinate Reduction - A minimally invasive return to normal nasal breathing. [Electronic resource]. Resource access mode http://www.arthrocareent.com/procedures/view/6-turbinate-reduction

3. Davydova S.V., Fedorov A.G. Operative endoscopy, surgical energies: electrocoagulation, argon plasma coagulation, radio wave surgery, endoclipation: Textbook. allowance. – M.: RUDN, 2008. – 146 p.

4. Pukhlik S.M., Aleksandrov A.D. Interventions on the inferior turbinates for chronic rhinitis. Rhinology No. 3, 2008.

Comments

In consultation with a doctor, we decided that we would do it using the classic method, that is, with a scalpel; the effect of such an operation would last much longer than cauterization with cold plasma or laser. To say that I was very afraid is to say almost nothing, since the operation is quite traumatic, compared to others, the healing period is longer. In the morning I went to the hospital, at lunchtime they operated on me, under general anesthesia, they gave me an injection into a vein and I fell asleep. I woke up when they were already taking me back to the room. Of course, the first day after the operation and the first night is the worst thing you have to endure, your mouth is dry, your nose hurts, you were bleeding a little, you were still hungry all day. After the operation, they pushed a fingertip with some kind of sponge inside my nose. Apparently it will not dry out or stick from the blood, by the way, then everything was removed without pain at all. But the next morning they took everything out of my nose, washed it out and LOOK, I can breathe.

To everyone who cannot decide to have this operation, DO IT!! It’s worth waiting for 1 day, but then breathing through your nose without drops.

By the way, the operation was performed under voluntary medical insurance at the 1st clinical hospital for the management of the president’s affairs, on Starovolynskaya street 10, they call it Baglynka. A very good hospital, clean, good rooms, TV, own toilet with shower in the room.

Source: http://lorsovet.info/stati/boleznipazukh/135-chem-operatii-na-nosovyh-rakovi

Vasotomy of the nasal turbinates. Submucosal vasotomy of the nose. Reviews

When the nose does not breathe due to vasomotor rhinitis or a number of other reasons, patients are often prescribed turbinate vasotomy.

This operation is designed to improve blood supply and permanently solve the problem of impaired nasal breathing.

Today, there are several techniques for performing this type of surgery. All of them have their own characteristics, advantages and disadvantages, therefore, when choosing a specific method, you must first listen to the opinion of the surgeon, who will certainly take into account all the wishes of the patient.

Nasal vasotomy: what is it? Indications for surgery

Vasotomy is a surgical method for the treatment of chronic diseases of the nose, which involves the destruction of the vessels of the nasal concha in one way or another, thereby reducing their volume.

During the operation, doctors peel off the mucous membrane and eliminate vascular (venous) bundles that cause deterioration in the patency of the air stream.

The inferior turbinates themselves are small bony protrusions located on the lateral surfaces of the nostrils.

They are covered with a mucous membrane with a pronounced submucosal layer, which is responsible for humidifying and heating the air inhaled by a person.

But in a number of diseases, swelling and hypertrophy of the nasal concha occurs due to increased blood supply to numerous vessels of the submucosal layer.

This provokes a narrowing of the passages and a deterioration in the air flow during inhalation, up to its complete impossibility.

  • vasomotor, including medicinal rhinitis;
  • chronic runny nose;
  • endocrine pathologies that provoke hypertrophy of the nasal turbinates.

The procedure can also be prescribed for children if indicated. Depending on whether both halves of the nose are affected or only one, bilateral or unilateral vasotomy can be performed.

Contraindications to turbinate vasotomy

For many patients, the only way to restore normal breathing is vasotomy; the operation has few contraindications, however, if they are present, it cannot be prescribed. This is about:

  • any acute infectious diseases;
  • purulent processes in the paranasal sinuses, ears and other parts of the ENT organs;
  • exacerbation of chronic pathologies;
  • blood diseases.

If a patient is diagnosed with chronic sinusitis, a sinusotomy may be performed before vasotomy or simultaneously with it.

What tests are taken for vasotomy? Preparing for surgery

Before the procedure, patients must undergo a series of examinations necessary to confirm the need for surgery and identify possible concomitant pathologies. Therefore, patients need:

  • take blood tests;
  • undergo rhinoscopy (endoscopic examination of the nasal cavity);
  • Ultrasound of the paranasal sinuses (echosinusoscopy);
  • sometimes CT or MRI.

2 weeks before the appointed date, it is recommended to give up bad habits, including drinking alcohol, and also stop taking anticoagulants (including Aspirin, Phenilin, etc.) if they were prescribed by other specialists to eliminate or prevent certain disorders.

Types of vasotomy: how is the operation performed?

There are several techniques for reducing the volume of the nasal turbinates. The otolaryngologist decides which one is best for the patient based on the nature of the current disease, the individual characteristics of the patient, age, etc.

Recently, classical surgical interventions are becoming a thing of the past, giving way to modern minimally invasive manipulations.

Instrumental

Open surgery is the traditional method for eliminating concha hypertrophy. Depending on the situation, the doctor may suggest treatment using one of the following techniques:

As a rule, nasal vasotomy is performed with sedation, that is, during the procedure the patient is conscious, able to communicate and follow the surgeon’s commands, but does not feel pain and is inhibited due to the administration of strong sedatives. Less commonly, the procedure is performed under local or general anesthesia.

Do blood vessels recover over time after vasotomy? Usually not, since scar tissue remains in their place, which prevents relapse.

Turbinoplasty

The method is used in severe cases and consists of removing part of the nasal concha through a small incision, although the mucous membrane is preserved.

It is extremely undesirable to completely remove these anatomical structures, since this can lead to the development of undesirable consequences, in particular, the inability to breathe through the nose, although there will be no objective reasons for such a violation.

Among all methods of surgical intervention, turbinoplasty is considered the most effective.

This operation on the nasal turbinates gives the most pronounced and lasting effect, but since it is quite traumatic, complications often arise after it.

Shaver destruction or microdebrider conchotomy

The method is classified as surgical. Its use makes it possible to perform both turbinoplasty or conchotomy, and submucosal vasotomy.

Its main difference from the classical operation is the use of a special tool - a shaver. It is a kind of electric knife: a rotating blade connected to an electric suction device, so when applied, all cut tissue is immediately removed from the surgical field.

Laser vasotomy of the nasal turbinates

This method is one of the most popular because it is low cost, has a low level of trauma and is highly effective. When removing venous plexuses with a laser, a light guide is inserted into the nasal concha, and the energy of the beam provokes evaporation of the tissue.

Radio wave disintegration of the inferior turbinates

This is one of the most modern minimally invasive methods for eliminating pathologically altered tissues and neoplasms. It involves inserting a probe under the mucous membrane that produces radio waves.

They force cells to actively oscillate, which leads to an increase in temperature to high values, coagulation of blood vessels and normalization of the size of the nasal turbinates. The method is often called radio wave destruction, conchotomy or reduction.

Coblation

Coblation vasotomy (cold plasma or molecular quantum reduction) involves the creation of a cold plasma field around a surgical instrument, which leads to the appearance of ions of a certain kind, provoking the breaking of bonds between molecules. It is one of the methods of radio wave surgery.

When using coblation, tissues are heated only to 40–70 °C. This allows you to solve existing problems with minimal damage to surrounding structures.

Ultrasonic disintegration

The destruction of the submucosal layer occurs due to the influence of ultrasonic waves. They provoke gluing of the walls of the affected vessels.

Typically, the procedure is prescribed for mild forms of hyperplasia, that is, when the inferior turbinate or both only slightly increase in volume. In other situations, there is a significant likelihood of relapse of the disease.

Vacuum resection

Its essence is the aspiration of cells of the submucosal layer with a special pump instrument by creating negative pressure.

In general, vacuum resection is a promising direction in otolaryngology and, perhaps, in the future it will be no less popular than radio wave or laser disintegration.

Cryodestruction of the nasal turbinates

The essence of cryodestruction is the treatment of the mucous membrane with a cryoprobe at an extremely low temperature. As a result, large ice crystals form in the cells, which destroy the cell membranes.

The procedure causes thrombosis of the capillaries at the site of exposure, as a result of which they become bleeding and the swelling goes away.

Electrocautery

This method involves the destruction of vascular bundles by direct electric current. Cauterization occurs by touching the affected areas with a hot electrode.

The procedure causes the tissue to scar, which leads to compression of the venous plexuses and, accordingly, a decrease in the volume of the nasal turbinates, while instant coagulation (sealing) of the vessels occurs, so the manipulation is not accompanied by bleeding. Sometimes it is also called electrocaustics or galvanocaustics.

Today, electrocautery is used less and less, as it is considered obsolete. There are many other methods that provide a more pronounced effect with less damage to healthy tissue.

Septoplasty and vasotomy

Both procedures are often combined, since congenital or acquired as a result of trauma (more often in men) septal deformations can also contribute to breathing problems.

Septoplasty involves straightening the nasal septum, which is done by removing the protruding part of the cartilage tissue or bone ridge.

Price

The cost of vasotomy depends on the type of technique used, the rating of the medical institution, its territorial location and the experience of the doctor.

In otolaryngology departments, classical surgical intervention can be performed absolutely free, but in private clinics in Moscow and St. Petersburg, eliminating hypertrophy with a laser or the Surgitron device (radio wave disintegration) can cost hundreds of rubles.

Rehabilitation after septoplasty and vasotomy

Usually recovery occurs quite quickly. The duration of the rehabilitation period depends on the method of surgery, and patients often receive sick leave for the entire recovery period.

After classical operations, the nose is packed several times. The tampons are finally removed only after dense crusts have formed.

  • visit the bathhouse, sauna, swimming pools, gym;
  • lift heavy objects;
  • run;
  • drinking alcohol.

Patients need to carefully care for their nose after any type of vasotomy and strictly follow the recommendations received from their ENT specialist.

Usually, experts recommend washing with saline solutions (Aquamaris, Physiomer, Marimer, No-sol, Dolphin, Aqualor, Salin, saline solution) several times a day and treating the mucous membranes with neutral oil, for example, vaseline, peach, sea buckthorn.

After surgical interventions, broad-spectrum antibiotics are often prescribed to prevent infection. If necessary, patients can take painkillers to relieve pain.

Possible complications after surgery

After the procedure, swelling, thick snot and crusts are almost always observed. When using a laser, radioknife or similar minimally invasive techniques, the condition normalizes in about 3–5 days, but after surgery - only after 1–1.5 months.

This explains the fact why, after a vasotomy, the nose cannot breathe again or the sense of smell has disappeared. For the final restoration of normal functioning of the nose, time is required for tissue healing, swelling elimination, etc., although sometimes patients in such cases require repeated surgery.

If patients do not follow the doctor’s recommendations, in particular, do not treat the mucous membranes with oil, adhesions (synechia) may form in the nose. Dissection of synechiae of the nasal cavity is performed surgically under local anesthesia.

Reviews

The operation was performed with a laser, it was not painful and everything was over quickly. Now I’ve been breathing normally for more than 5 years and I’m afraid to even think about returning to vasoconstrictor medications. Christina, 27 years old

They removed all this and set me free to rinse my nose with saline solutions and take antibiotics. The first results after the operation began to appear only after a week and a half, and I was finally able to feel freedom of breathing only after a couple of months. Andrey, 35 years old

It got to the point that I would not leave the house without medicine. I tried to treat the disease with many means, including folk ones. However, things only got worse. Having contacted a private clinic, I received an appointment for surgery of the inferior nasal turbinates.

The operating procedure itself takes 5-10 minutes. But before it you need to go through the appropriate doctors and undergo tests, and after it you need some period of recovery. The procedure helped me get rid of my addiction to the drops and start breathing fully through my nose. Peter,

It can be done both for a fee and on a budget. I chose the latter. True, I still had to buy a painkiller. I don't remember its name. It was a little expensive, but everything went without pain. After the operation, you can breathe only through your mouth for a day, as everything in your nose is healing.

Then the nasal airways gradually open. I was discharged from the hospital five days after the operation. I spent about a week recovering. Now I feel much better. I’m even starting to forget what chronic congestion is. Tatyana Alekseevna, 47 years old

For a long time I drank various means in order to at least briefly feel like a full-fledged person who can smell all the smells. Perhaps long-term use of drugs made me dependent on them. But now I live without medications and am very happy. Alla, 39 years old

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Specialty: Otorhinolaryngologist Work experience: 12 years

Specialty: Otorhinolaryngologist Work experience: 8 years

Source: http://nasmorkam.net/vazotomiya-nosovyih-rakovin-chto-eto-takoe-pokazaniya-k-operatsii/