Referat

CONCHOTOMY SURGERY
Sekti Joko S.I
Supervisor : Dr. Riece H, Sp.THT-KL(K)

Introduction

Nasal obstruction concha hypertropy(inferior)

Nasal obstruction quality of life Epidemiology in Europe 20% of the population with chronic nasal obstruction e.c hypertrophy conchae Management: conservative treatment, surgery Surgery procedure conservative failed

Introduction
Objective : Explaining conchotomy management with several surgical techniques

Anatomy

Anatomy of conchae

Epithelial columner pseudostratifield ciliated goblet cells 3 layers : medial mucous (thicker), lateral mucous & bone Mucous contains venous sinosoid, limphocytes , gld.mucoserous Sinosoid erectil tissue, influenced by autonomic Nasal gland hyperactivity changes in temperature, humidity, irritation, impaired vasomotor

Pathogenesis
Nose complex organs that controls the air flow, volume, pressure, temperature and humidity The flow is too low / high obstruction sensation. Cycle of nasal nasal constriction and dilation in the inferior conchae, occurring every 2-7 hours.

Pathogenesis

Turbulence flow physiological function, moisturize and regulate airway resistance

Pathogenesis
Enlargement conchae depend on the addition of the lamina propria size (venous sinosoid, lymphocytes & gld.mucoserous) Construction post sinusoid dilatation of sinusoid anostomosis adding in capilary arteriole blood flow enlargement cochae

Diagnosis
Anamnesis: nasal obstruction rhinorrhea headache, heaviness in the head smelling disorders post nasal drip hearing loss Physical examination:

Anterior rhinoscopy: size and surface of conchae (local vasoconstrictor)

Diagnosis
Physical examination : anatomic abnormalities nasal discharge Supported examination : Nasoendoscopic Rhinomanometry Radiological examination is not absolute etiologic

Diagnosis
Yanes et al, enlarged of inferior conchae: A. Achieving a line between the lateral nose with nasal midlle B. Passing some of the nasal cavity C. Achieving nasal septum

Rinoskopi anterior hipertrofi konka

Management

Objective: To resolve a complaint nasal obstruction, reducing the size of the conchae Medical treatment:

Underlying etiology Antihistamines, decongestants, corticosteroids, mast cell stabilizers and immunotherapy

Surgical treatment

Technical Surgery

In general : lateral position (position change), resection and coagulation. The porpose of surgery improve nasal breathing and maintained physiological functions.

Technical Surgery
Lateropotition (lateral out fracture) :

infracture medial to lateral with instrument panel. Tendency return to its medial position short term outcome

Technical Surgery
Total Turbinectomy :

Bone resection of conhae in the insertion. infracture bone to the medial and upper conchae mucosal resection with scissors along the insertion angle close to the lateral nasal

Technical Surgery
Partial Turbinectomy :

Resection 1/3 anterior or posterior conchae Resection bone and mucose completely 1,52 cm

Technical Surgery
Submucosa Turbinektomy :

Vertical incision 3-4mm on the head of inferior conchae disection submucosa from medial side and inferior elevated

Technical Surgery
Submucosa resection with lateral out fracture Resect submukosa continued bone infracture of concha to lateral Goyal et al The best result improvement in symptoms and physiology of the nose

Technical Surgery
Inferior Turbinectomy :

Incisions 2-3cm anterocaudal bone of conchae mucoperiosteal flap released from the bone Resection of lateral mucose and bone 2cm The rest of mucoperiost flap to be scrolled neoturbinate

Laser
CO2 lasers, Nd:YAG and dioda Light waves emitted from 9.60 to 10.60 m and mainly absorbed by water Advantages : local anesthesia, reduce bleeding, minimal tissue traumatic Improperly conducted at hypertrophy conchae with changes in bone structure.

Radiofrequency

Monopolar electrocautery / bipolar radiofrequency (Somnoplasty and Coblation) Objective controled coagulatif submucosal necrosis fibrosis, contracture and tissue volume reduction. Submucosal fibrosis embeding mucosa to the periosteum, reducing blood flow volume reduction

Electrocoagulation

Objective damaged mucous of conchae Electrocautery inserted into the inferior conchae submucosal tissue, using a spinal needle longitudinally

Argon plasma coagulation

Delivered by argon ionization. The distance between the tip applicator with a tissue 2-10 mm with a non-contact method.

Cryotherapy

Protoside nitrogen probe placed on the surface of the free edge of the conchae and the medial surface for 2 minutes at a temperature of-800C. Insert the tampon merocel for 3 days

Vidian Neurectomy Endoscopy 00 posterior of media conchae seem attachment of cochae with the lateral nasal wall. Vertical incicion 20-30 mm (5mm anterior in middle conchae insertion) Dissection mukoperiosteal with the elevator up to the crest etmoidalis perpendikular os palatine close to the surface of the resected with bone fragments / conchae cartilage / septum fixation with glue fibrin

Summary

Diagnose of hypertrophy conchae the history, anterior rhinoscopiy, & nasoendoscopy. With complaints nasal congestion. The treatment with conservative & surgery Selection of operative techniques depend on etiology, the condition of conchae, experience and skill of the operator and the availability of surgery instrument.

THANK YOU

Qoute of the day

Do what you can, with what you have, where you are

Theodore Roosevelt