Pterygopalatine Fossa Injection With Positive Pressure Reduces Blood Loss During Endoscopic Sinus Surgery

Objective: Since 1980's,fuctional endoscopic sinus surgery (FESS)has been widely applied all over the world, now it is considered the best surgical method to treat chronic sinusitis and nasal polyps. The surgical technique is becoming more and more skillful. As to other operation, there exists complications too. Bleeding during operation is still a very important factor affecting surgical prognosis. In order to reduce blood loss during operation, many methods have been explored. All these methods had reduced blood loss. Nasal bleeding during operation is still a main problem disturbing doctors. In order to further reduce blood loss, petrygopalatine fossa injection with positive pressure was used. Materials and methods: 65 patients included in the study, those patients must meet the following conditions:1,Age ranged from eighteen to fifty,there were chronic sinusitis and/or nasal polyps;2, individuals who need nasal septum reconstruction were excluded;3, there is no diseases which affect patients' blood coagulation function such as hypertension, rheumatic lesion, urophthisis et.Female patients must not in the period of inter- menstrual before operation. All patients received anti- inflammatory therapy for 5 to 7 days with penicillin or cefazolin, intranasal steroids spray. Sinus CT scan and nasal endoscopy were taken to decide operation procedure in all patients. The operation was performed under local anesthesia. Before operation, 20ml lidocaine was injected to one side's pterygopalatine fossa, the other side with 2ml. A comparison of bleeding was made between left and right side. The surgical procedures were performed along the guidelines described by Messerklinger . Patients with nasal polyps were operated with uncinate process excision,polypec- tomy, ethmoidotomy, maxillary sinusotomy and uncinate process excision. Chronic sinusitis patients were operated with uncinate process excision , ethmoidotomy, maxillary sinusotomy. When necessary,the following procedures could be added:frontal sinusotomy, sphenoidotomy and partial middle turbinectomy。Results:A reduction of bleeding was found in sixty-two patients out of sixty-five patients. Blood loss reduction was found in patients with chronic sinusitis by 35.9%, nasal polyps by 42.1%,recurrent nasal polyps by 39.9%,with an average of 40.6%。In the experimental sides, the average blood loss during operation was 68.06±30.93ml, the average operating duration was 36.6±8.73minutes。Among them, in chronic sinusitis patients, the average blood loss was 43.36±12.41ml,the average operating duration was29.07±5.23 minutes; in nasal polyps patients, the average blood loss was 60.24±18.9ml,the average operating duration was 36.72±7.51minutes; in recurrent nasal polyps patients, the average blood loss was 113.43±22.76ml,the average operating duration was 43.79±8.68 minutes; in the contralateral side, the average blood loss during operation was 114.57±51.44ml, the average operating duration was 45.8±8.64minutes。Among them, in chronic sinusitis patients, the average blood loss was67.71±19.19ml,the average operating duration was 39±6.36minutes; in nasal polyps patients, the average blood loss was 103.76±20.61ml,the average operating duration was 45.62±7.37minutes;in recurrent nasal polyps patients, the average blood loss was 189±53.06ml,the average operating duration was 53.07±8.38minutes.There was statistic significance between two groups in bleeding amount and surgical duration(P<0.01).There was no complications during pterygopalatine fossa injection with positive pressure.Conclusion: Pterygopalatine fossa injection with positive pressure could significantly reduce blood loss during operation.