Trẻ em xơ nang bị xơ nang có viêm xoang mãn tính, mặc dù nhiều người không có triệu chứng. Bệnh lâm sàng quan trọng rơi vào hai loại: (1) đau đầu với những thay đổi viêm mạn tính, và (2) polyposis có hoặc không có hình mucocele. Trước khi các kỹ thuật nội soi, can thiệp hạn chế cho trẻ em với polyposis lớn | 420 Surgical Atlas of Pediatric Otolaryngology Preparation A videotape of the nasopharynx during connected speech is viewed immediately before the operation to determine the level of attempted velopharyngeal closure. Anatomic landmarks are identified on the tape that can be used to locate this level in the patient. The patient is positioned on a shoulder roll to maintain hyperextension of the neck. Procedure A mouth gag is inserted and the patient is placed into suspension. The posterior pharyngeal wall is visualized and palpated to identify any significant vessels in the operative field. Red rubber catheters are placed transnasally and brought out through the mouth to symmetrically retract the soft palate. Landmarks identified on the videotape that localize the exact site of nasopharyngeal escape are identified in the patient. Proposed incision lines are infiltrated with 1 lidocaine with 1 100 000 units epinephrine to affect vasoconstriction. The incisions entail rectangular flaps encompassing each posterior tonsillar pillar. A horizontal incision is made connecting the medial limbs of the incisions at the level of velopharyngeal closure Figure 18 9 . The soft palate may be split in the midline to facilitate visualization within the nasopharynx. The mucosa is incised to the prevertebral fascia on the medial incisions. The palatopharyngeus muscle is incorporated into the flap. Lateral dissection is limited in the area of the tonsil. After making the transverse incision at the level of velopharyngeal closure the surrounding tissue is elevated superiorly to create a bed within which the flaps may be inset. Inferior dissection is avoided to prevent insetting the flaps below the level of velopharyngeal closure. The base of each flap is undermined superiorly and laterally to effectively narrow the lateral velopharyngeal walls when the flaps are rotated medially. The donor sites are closed with interrupted 3-0 Vicryl sutures. The inferior edge of each flap is medially .
