Dixon H S
Laryngoscope. 1976 Dec;86(12):1796-814. doi: 10.1002/lary.5540861203.
Potential complications, morbidity, treatment failures and "nasal cripples" make one cautious about advising radical sinus surgery. Though antibiotics have greatly reduced the need for radical surgery, some patients do not respond to conservative treatment. Reviewed is pertinent literature concerning treatment of chronic, refractory sinusitis in children, particularly intranasal antrostomy. Medical treatment for chronic sinusitis precedes surgical intervention. Allergic history, nasal cytology and radiographic examination are essential. Since principles of adequate surgical drainage and ventilation have long been established, controlled antrostomy procedure is done with the aid of the operating microscope, creating a nasal mucosal flap. A new instrument is presented---a self-retaining stabilized retractor speculum which allows adequate visualization with the microscope while protecting the mucosal flap and freeing both hands for the procedure.
潜在的并发症、发病率、治疗失败以及“鼻腔致残”使得人们在建议进行根治性鼻窦手术时持谨慎态度。尽管抗生素已大大减少了根治性手术的需求，但一些患者对保守治疗没有反应。本文回顾了有关儿童慢性难治性鼻窦炎治疗的相关文献，特别是鼻内上颌窦造口术。慢性鼻窦炎的药物治疗先于手术干预。过敏史、鼻细胞学检查和影像学检查至关重要。由于充分的手术引流和通气原则早已确立，借助手术显微镜进行可控的上颌窦造口术，制作鼻黏膜瓣。介绍了一种新器械——一种自固定稳定牵开器窥镜，它能在使用显微镜时提供充分的视野，同时保护黏膜瓣，并使双手在手术过程中得以解放。
