Endoscopic Endonasal Surgery at the Yaounde General Hospital-Cameroon: Case Study of 30 Operated Patients

Abstract

Introduction: Endoscopic endonasal surgery is currently a validated therapeutic modality in most nasal sinus disorders. In developed countries, this practice is common and sees the indications constantly reviewed; In sub-Saharan Africa, this surgical technique is popularized. The external pathways are morbid and not very functional. In our daily practice at the Yaounde General Hospital (YGH), this technique is still in its infancy. Gradually it’s entering our habits and sees its indications increases. Through this study, we are reporting readily available data from our experience. Objectives: The objective was to study the practice of endoscopic endonasal surgery in our setting. Patients and Method: This was a cross-sectional, descriptive, retrospective study. The site of study was the ear-nose and throat service of Yaounde General Hospital. The study was conducted from January 2013 to December 2020, for an 8 years basis. The sampling was consecutive. We included in this study all patients operated on for a nasal sinus disease by the endoscopic endonasal modality. We excluded patients with incomplete files, as well as those who had a complementary transfacial approach during the same operation. The data were collected on prepared questionnaire. Data analysis is done with ssps 23.0 software. Results: We recruited 30 cases, out of a total of 330 interventions carried out in our department. The prevalence of this surgery in our activity was 9%. Male and female had equal ratio of 50%. The most represented age group was 30 - 40 years (33.3%). All the patients had a facial sinus CT scan, we did not note any anatomical variant as risk. Two patients of our sample size had a history of sinus surgery, treated externally. Chronic maxillary sinusitis was the surgical indication in 36.7%, followed by Killian antro-choanal polyps in 13.3%, nasosinus polyposis in 13.3% and all performed under general anesthesia. The most performed procedure was unilateral mean meatotomy with 43.33% followed by bilateral mean meatotomy with 20%, ethmoidectomy 13.3%, bimeatotomy 10%. The admission lasted for 2 days. 100% of patients had a previous nasal tamponade at the end of the intervention. The tamponade was removed on the second postoperative day in 100% of patients. 16.7% of patients presented with complications of low abundance postoperative bleeding. All patients noted clinical improvement over the initial symptoms postoperatively. Conclusion: Endoscopic endonasal surgery is experiencing slow but certain progress in our daily practice. The operated patients are young, chronic maxillary sinusitis is the main indication, the most performed procedure is the unilateral mean meatotomy. The operation goes uneventful with satisfactory prognosis. A study with a larger sample is necessary in order to refine our results. The practice remains limited by the technical platform, which needs to be strengthened, in order to optimize the practice.