Aprile Vol.2 N° 1 - 2006 - Salute per tutti

1° Corso ISPLAD, Milano 2005
Clinica Otorinolaringoiatrica dell’Università di Milano
La diagnosi endoscopica
nella patologia rinosinusale
Un nuovo stent (ET-WASH) nella chirurgia etmoidale
della poliposi nasale
Claudio Guastella
SUMMARY
The place of endoscopy in the rhinosinusal
pathology. A new stent
(ET-WASH) for ethmoidal surgery of
nasal polyposis
Endoscopy is indicated for the investigation of persistent or recurrent nasal discharge
that does not respond to simple treatment. This procedure allows close inspection
of the lesion, and facilitates other methods such as histology, microbiology,
cytology, and measurement of ostial patency and mucociliary transport.
The importance of direct observation of the morphology and natural colour of normal
structures becomes ever more evident. Its regular use has greatly enriched our
knowledge of anatomy, physiology and pathology of the nasal cavity and paranasal
sinuses. Surgery with endoscopic guidance improves surgical precision, reveals deep
seated lesions by a minimally invasive approach, and allows lesion shown by radiography
to be examined.
The treatment of nasal polyposis is still debated, but previous studies agree that,
when surgery is necessary, it must be accompanied by appropriate local and general
medical therapy administered pre- and/or postoperatively.
Paranasal sinus surgery can cause wounds in areas in which bone is not covered by
mucosa and tends to granulate. The location and size of these areas vary, and depend
on preoperative anatomy and the type and extent of surgery. The speed of individual
recovery depends on local and systemic factors. Local inflammation slows down tissue
repair and destroys wide areas of mucosa, which heal with anomalous scar formations
leading to a deficit of muco-ciliary clearance that predisposes patients to
local relapse.
In an attempt to reduce these complications, we have developed a new ethmoidal
stent (ET-WASH) which is applied at the end of surgery. The aim of this study was
to verify the tolerability of the device, and its advantages in terms of allowing targeted
local corticosteroid therapy, reducing synechiae, preserving ventilation, cleansing
of the surgical cavity, and reducing the recurrence of polyps.
KEY WORDS: Endoscopy, Nose, Polyposis, Stent
I ntroduzione
Per migliorare la diagnosi delle cavità
nasosinusali e della regione rinofaringea la diagnostica
in Otorinolaringoiatria attualmente
utilizza endoscopi a fibre ottiche di tipo rigido
o flessibile.
L’endoscopia, consente di visualizzare sedi non
altrimenti direttamente esplorabili, miglioran-
do decisamente la diagnosi, ottimizzando i criteri
di scelta terapeutica, medica o chirurgica,
per il trattamento delle principali affezioni
naso sinusali.
Gli strumenti sono realizzali in una unica guaina
con i fasci di fibre ottiche che formano il
canale luminoso e il canale ottico. II canale
Journal of Plastic Dermatology 2006; 2, 1 41