Our Summary

This research paper discusses a less invasive surgery technique that is used for complex problems in the brain, ear, nose, throat, and facial areas. Traditionally, patients would be put under general anesthesia for such procedures, but this study looks at the increasing use of local anesthesia instead.

The research reviews modified dental techniques and the anatomy of the mouth, which provide a helpful guide for conducting this type of surgery with the patient awake. The study goes into detail about practical procedures for blocking four nerves in the face, relevant to this type of surgery.

The authors discuss the anatomy involved, the surgical techniques used, and potential complications for each of these nerve blocks. The blocks discussed are for the incisive foramen, the sphenopalatine ganglion, the maxillary nerve, and the pterygomaxillary fissure.

The study concludes that these techniques could make this type of surgery safer and more effective, reduce surgical risks, and increase satisfaction for patients, surgeons, and healthcare managers.

FAQs

  1. What is endoscopic endonasal surgery and what conditions does it treat?
  2. What are some of the potential complications of performing endoscopic sinus surgery under local anaesthetic?
  3. How can local anaesthetic techniques improve the safety and efficacy of endoscopic sinus surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about craniofacial surgery is to follow all pre-operative instructions provided by the surgical team, such as fasting before surgery and avoiding certain medications. It is also important to communicate any concerns or questions with the medical team and to follow all post-operative care instructions for optimal healing and recovery.

Suitable For

Patients who are typically recommended for craniofacial surgery include those with congenital craniofacial anomalies, such as cleft lip and palate, craniosynostosis, and hemifacial microsomia. Additionally, patients with traumatic injuries to the face and skull, as well as those with tumors or other abnormalities affecting the craniofacial region, may also benefit from craniofacial surgery. Other conditions that may warrant craniofacial surgery include severe facial asymmetry, facial paralysis, and obstructive sleep apnea related to craniofacial abnormalities. Ultimately, the decision to undergo craniofacial surgery is made on a case-by-case basis, taking into consideration the patient’s specific condition and overall health.

Timeline

Before craniofacial surgery, a patient typically undergoes a series of consultations with their surgeon to discuss the procedure, potential risks and benefits, and to create a treatment plan. They may also undergo pre-operative testing and imaging to assess the extent of their condition.

On the day of surgery, the patient will arrive at the hospital or surgical center and undergo pre-operative preparations, including anesthesia administration. During the surgery, the patient will be under general anesthesia, and the surgeon will perform the necessary procedures to correct the craniofacial issue.

After surgery, the patient will be monitored in the recovery room and then transferred to a hospital room or discharged home, depending on the extent of the surgery. They will be prescribed pain medication and given instructions for post-operative care, including wound care, activity restrictions, and follow-up appointments.

In the days and weeks following surgery, the patient will experience swelling, bruising, and discomfort, which will gradually improve over time. They may also undergo post-operative appointments with their surgeon to monitor their healing progress and address any concerns or complications. Overall, the goal of craniofacial surgery is to improve the patient’s quality of life and address any functional or aesthetic issues related to their condition.

What to Ask Your Doctor

  1. What are the risks and benefits of performing endoscopic sinus surgery under local anaesthetic compared to general anaesthetic?
  2. How experienced is the surgeon in performing endoscopic sinus surgery under local anaesthetic?
  3. What type of anaesthesia will be used during the procedure and how will it be administered?
  4. What are the potential complications or side effects of using local anaesthetic for endoscopic sinus surgery?
  5. How long is the recovery time expected to be after undergoing endoscopic sinus surgery under local anaesthetic?
  6. Are there any specific pre-operative or post-operative instructions that need to be followed when undergoing this type of surgery?
  7. How will pain management be handled during the recovery process after endoscopic sinus surgery under local anaesthetic?
  8. What are the success rates of endoscopic sinus surgery under local anaesthetic compared to traditional general anaesthetic techniques?
  9. How will the surgeon ensure that the patient is comfortable and adequately sedated during the procedure when using local anaesthetic?
  10. What alternative treatment options are available for the specific craniofacial condition being addressed with endoscopic sinus surgery under local anaesthetic?

Reference

Authors: Watts E, Thompson A, Pankhania M, Okonkwo O, Ahmed S. Journal: J Laryngol Otol. 2022 Aug;136(8):683-691. doi: 10.1017/S0022215121003583. Epub 2021 Nov 24. PMID: 34814956