English Sekti PENATALAKSANAAN Konkotomii

7/31/2019 English Sekti PENATALAKSANAAN Konkotomii

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CONCHOTOMY SURGERY

Sekti Joko S.I

Supervisor : Dr. Riece H, Sp.THT-KL(K)

Referat


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Introduction

Nasal obstruction concha hypertropy(inferior)

Nasal obstruction quality of life

Epidemiology in Europe 20% of the

population with chronic nasal obstruction e.chypertrophy conchae

Management: conservative treatment, surgery

Surgery procedure conservative failed


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Introduction

Objective :

Explaining conchotomy managementwith several surgical techniques


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Anatomy


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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, impairedvasomotor


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Pathogenesis

Nose complex organs that controlsthe air flow, volume, pressure,

temperature and humidity The flow is too low / high obstruction

sensation.

Cycle of nasal

nasal constrictionand dilation in the inferior conchae,occurring every 2-7 hours.


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Pathogenesis

Turbulence flow physiological function,

moisturize and regulate airway resistance


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Enlargement conchae depend on the additionof the lamina propria size (venous sinosoid,

lymphocytes & gld.mucoserous)

Construction post sinusoid dilatation of

sinusoid anostomosis adding in capilary

arteriole blood flow enlargement

cochae

Pathogenesis


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DiagnosisAnamnesis:

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)


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Diagnosis

Yanes et al, enlarged of inferior conchae:

A. Achieving a line between the lateral nose withnasal midlle

B. Passing some of the nasal cavity

C. Achieving nasal septum

Rinoskopi anterior hipertrofi konka


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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


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Technical Surgery

In general : lateral position (position change),

resection and coagulation.

The porpose of surgery improve nasal

breathing and maintained physiological

functions.


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Technical Surgery

Lateropotition (lateral out fracture) :

infracture medial to lateral with instrument

panel.

Tendency return to its medial position short

term outcome


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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 lateralnasal


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Technical Surgery

Partial Turbinectomy :

Resection 1/3 anterior or posterior conchae

Resection bone and mucose completely 1,5-

2 cm


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Technical Surgery

Submucosa Turbinektomy :

Vertical incision 3-4mm on the head of inferiorconchae disection submucosa from medial

side and inferior elevated


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Technical Surgery

Submucosa resection with lateral out fracture

Resect submukosa continued boneinfracture of concha to lateral

Goyal et al The best result improvement in

symptoms and physiology of the nose


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Technical Surgery

Inferior Turbinectomy :

Incisions 2-3cm anterocaudal bone ofconchae mucoperiosteal flap released from

the bone

Resection of lateral mucose and bone

2cm The rest of mucoperiost flap to be scrolled

neoturbinate


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Laser CO2 lasers, Nd:YAG and dioda

Light waves emitted from 9.60 to 10.60 mand mainly absorbed by water

Advantages : local anesthesia, reduce

bleeding, minimal tissue traumatic Improperly conducted at hypertrophy

conchae with changes in bone structure.

R di f


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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

El t l ti


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Electrocoagulation

Objective damaged mucous of conchae

Electrocautery inserted into the inferior

conchae submucosal tissue, using aspinal needle longitudinally

A l l ti


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Argon plasma coagulation

Delivered by argon ionization.

The distance between the tip applicator

with a tissue 2-10 mm with a non-contactmethod.

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


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Vidian Neurectomy

Endoscopy 00 posterior of media conchae

seem attachment of cochae with thelateral 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 / conchaecartilage / septum fixation with glue fibrin


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Summary

Diagnose of hypertrophy conchae thehistory, anterior rhinoscopiy, &nasoendoscopy. With complaints nasalcongestion.

The treatment with conservative & surgery

Selection of operative techniques depend

on etiology, the condition of conchae,experience and skill of the operator and theavailability of surgery instrument.


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THANK YOU


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Qoute of the day

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

Theodore Roosevelt
http://www.goodreads.com/author/show/44567.Theodore_Roosevelthttp://www.goodreads.com/author/show/44567.Theodore_Roosevelt

English Sekti PENATALAKSANAAN Konkotomii

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