抄録
Chronic rhinosinusitisis a commonly encountered disease in the field of otolaryngology, and with the advances in therapeutic technologies, cure has been achieved in many cases. However, in patients with a handicap, the standard drugs cannot be administered and the technically complex endoscopic sinus surgery (ESS) cannot be performed on account of medical and/or social reasons in some cases. Use of a navigation system lends useful support for ESS in cases with marked anatomic modifications. We present a case of navigation-guided ESS in a patient of chronic rhinosinusitis with severe skull deformation and motor and intellectual disabilities.
The patient was a 20-year-old man who had undergone brain surgery for traumatic intracranial hemorrhage at the age of 10 months. He was subsequently left with the sequelae of epilepsy, spasticity limb palsy, and serious motor development deficits, and had scoliosis, cervical retroflexion, and flattening of the left side of the face with growth.
He was hospitalized at our institution in the department of pediatric neurology for acute respiratory failure. He had a history of rhinorrhea and postnasal drip, and was referred to our hospital because CT revealed advanced pansinusitis on both sides. As conservative medical management was considered to be potentially insufficient, surgery was scheduled. Use of the navigation system helped in making the approach route safer and avoiding dangerous manipulation in the area of anatomic deformity. Although the patient developed mycoplasma pneumonia and recurrence during the first postoperative year, both resolved with conservative medical treatment for one month. Subsequently, these problems did not recur and the postoperative progress was good.
