Episode 56: Sinusitis Surgery… How Did They Do It? [3]
Episode 56: Sinusitis Surgery… How Did They Do It? [3]
First, I classified the patients who seemed most likely to need surgery. Honestly, if it were something like Appendicitis, I would have removed it without hesitation. If you didn’t take it out, the risk of complications was high. Besides, that was a surgery I was really good at. But this was a different case. Would the patient die without surgery? Possibly.
If you leave it untreated without antibiotics… yeah, it could happen.
But wasn’t that true for most illnesses? In a weakened host, even Sinusitis could swing the Reaper’s scythe. Especially in an era like this, without tools that could decisively support the body, such as antibiotics, the risks were far greater. Still, everything came down to probability.
Besides, I don’t trust my own surgical skills yet.
It wasn’t that I had never seen endoscopic sinus surgery before. I hadn’t intended to learn anything at the time, but during three weeks of practice, I watched it until I was sick of it. Because of my personality, I didn’t want to deal with such a small, frustrating area under pressure, so I completely ruled out ENT from my career. I stayed firm so I wouldn’t regret it later.
But what now? There was no endoscope.
Actually, what even counted as an endoscope in this era? If only such a thing existed…
“Pyeong-ah. What are you doing?”
“Ah.”
Joseph’s voice snapped me out of my thoughts. All right, I had already finished classifying the patients. In the end, there was only one person who really needed surgery. I decided to stick to Nasal Irrigation for the others. It seemed a bit excessive to operate on them. So now… it was time to practice.
“Okay. Hmm… pull it here.”
“I’m pulling.”
“Senior, hold the head steady.”
“Uh… But I’m scared.”
What did I practice with? A corpse, of course. It had to be. You couldn’t practice on a living person. That was clearly a crime. Although, to be fair, many doctors in this era were doing just that. Hard to say exactly who, but it was safe to assume… most of them.
Still, I wasn’t going to stoop to that level.
No way. I was taught better. At the very least, I still had that.
“What’s so scary?”
“Then why don’t you hold the corpse’s head?”
“No. Then who’s going to show me the surgery?”
“Ha…”
I grumbled at Alfred and picked up a chisel again. Since I didn’t have proper surgical tools, I had grabbed a real carpenter’s chisel instead.
“Haha. Now look at our Pyeong-i becoming a doctor.”
In this era, the more dangerous the equipment, the more it made you look like a professional. Seeing me work, Liston clapped. That kind of applause when I was about to chisel someone’s face open.
Anyway, I continued the surgery with Alfred holding the head steady and Joseph holding back the lips for visibility. I had already cut the upper gum with a knife. I still couldn’t see clearly, so I cut a bit more. But even as I worked, I kept wondering if this was really okay.
I don’t want to damage anything… but how else do I do it?
The easiest way would be to make an incision along the nose, peel the skin aside, crack open the cheekbone, and remove the inflamed tissue. Just thinking about it felt satisfying. But I couldn’t justify slicing someone’s face open just to treat Sinusitis. On top of that, the sutures we had were terrible. They would leave awful scars. Nylon sutures? I wished. Someone, please invent those already.
“Oh… You can actually see the bone?”
Sure, to me this was routine, but to Joseph, Alfred, and even Liston, it was an amazing sight. By adding my modern anatomical knowledge to the vague methods of the time, I was basically winging it with a decent hypothesis. And honestly? It looked legitimate. Genius, even.
“Now I’m going to break this with a chisel.”
“How do you break bones like that?”
“You saw it. It’s a hollow bone beside the nose.”
Of course, I couldn’t go in swinging from the start. I had practiced tapping lightly with the chisel beforehand. This was the first time I had seen exactly where and how deep the sinuses were laid out. If I had rushed it, I could have broken the orbital floor.
But now, I had a system.
I placed the chisel and gave it a few careful taps with the hammer. The bone cracked after just a few blows. Some fragments fell inside, which was annoying, but at least I could clearly see the paranasal sinus with my own eyes.
“And…”
“What’s in there?”
Even this corpse’s sinuses were filled with pus. Not a huge amount, but definitely enough for a Sinusitis diagnosis. A clear sign of just how much damage polluted air could do to the human body.
“Three…”
“Huh?”
“No, never mind… Let’s wipe this off first.”
Out of habit, I almost asked for suction, then realized… right. Not an option. Doctors in the twenty-first century were so lucky. Bright lights, suction, antiseptics. I sighed.
“How long do I have to keep holding this?”
“Until I tell you to stop.”
I turned to look at Colin, who had been pulled into assisting. Ever since the Rust Bell incident, he had been subdued, and Liston, being Liston, had stuck him on fire duty. I figured it was better for him to stay busy.
Colin, however, seemed to have different thoughts.
I turned back to the surgical site. Using a roughly prepared piece of gauze, I wiped the inside. The cavity was larger than expected. But the opening between the sinus and the Nasal Cavity was almost completely blocked.
This… irrigation alone isn’t going to work.
What made it worse was that the maxillary sinus was the easiest one to access. Behind it was the ethmoid sinus, which was even harder to reach. And furthest back was the sphenoid sinus, the real culprit behind most headache-causing Sinusitis.
“Well, from this point on, it’s going to be difficult. Pull better. Stop clinging to the senior and help me pull instead.”
“Uh? Uh… Can I stop looking at the skull now?”
The risk of an accident was high. The sphenoid sinus sat basically in the middle of the head. Even with twenty-first-century high-resolution endoscopes, surgery in this area could go wrong easily. I once helped a doctor-lawyer friend review some cases… and yeah, lots of accidents.
“You have to look too. Pull here, and keep checking.”
“Uh… I’m really scared.”
I wanted to monitor the situation myself to avoid causing an accident. That was why I had pre-opened the skull of this cadaver to expose the brain. After all, the roof of the Nasal Cavity was the floor of the brain. If anything went wrong, I wouldn’t be able to tell just from below. No wonder Alfred was nervous.
“What are you scared of? Now that we have anesthesia, we’ll be doing brain surgery soon too!”
Liston barked at Alfred. “Don’t be scared,” he said, and just like that, now I was the one feeling scared.
Oh no. This is bad…
I didn’t doubt Liston’s hands. The man had incredible skill, honed in the days before anesthesia. But his concepts were the problem. Brain surgery without any real understanding of the brain?
And then—
“Pyeong-ah?”
“Ugh.”
Joseph, again, brought me back to my senses. Thank you.
“Give me the pliers.”
“Ugh…”
I came to and used the pliers to break through the ethmoid sinus behind the maxillary one. There had to be a method to this. The ethmoid bone was too thin to really qualify as a bone. It shattered every time I touched it.
But just because something was easy to destroy didn’t mean it was meant to be destroyed. In the body, very few things were truly useless. I knew I needed to be careful, even if things seemed fragile.
Right… he said all you need is a hole that leads downward from here.
I remembered what an ENT friend once told me. He had mentioned it on YouTube. It was a tip so specific to ENT that I wasn’t sure if it even applied, but here we were. I followed it and broke through what looked like the ethmoid sinus.
Then I saw it: a flat bone.
Is that the sphenoid bone?
If only this were like sailing a boat. Huh? I’d be the captain of the ship.
Nobody would even know.
A nasal surgery with no visible facial scars. The best kind. The only downside was that, in this case, disinfection didn’t matter much. Think about it. You couldn’t really disinfect the inside of your nostrils. And the paranasal sinuses, though embedded in bone, were technically connected to the outside.
“This won’t work with pliers. Give me an awl.”
With that, I drilled the awl into the flat-looking bone.
Shiver.
Pus started leaking out.
“And…”
“Whoa.”
How old was this stuff? It was thick. Disgusting, but satisfying. I finally understood why people watched videos of tonsil stone removals or blackhead extractions. The only downside? The lighting was so bad I could barely see.
Still… let’s dig more.
Greedy, I used gauze with tweezers to widen the hole. I scooped out more. More white pus oozed out.
Yes. This is it.
This was it.
“And… Didn’t this guy have a terrible headache?”
There was so much that I had to wonder. Just as I was thinking that, Alfred tapped my shoulder.
Ugh.
I nearly screamed. Don’t. Tap. The surgeon’s shoulder. Not during a procedure. That was how accidents happened.
“Hey!”
“What?”
I glared at him, but noticed he looked pale. He gestured toward the patient’s head.
So I looked.
“Ah.”
“My brain’s shrunk… Is that the one you sold?”
“Ah.”
Translator’s Notes:
Appendicitis — Inflammation of the appendix. It can become fatal if the appendix bursts or causes severe infection.
Sinusitis — Inflammation or infection of the sinuses. It can cause headache, nasal discharge, facial pressure, and pain that worsens when bending forward.
Antibiotics — Medicines used to treat bacterial infections. In this historical setting, they are not yet available.
Endoscopic Sinus Surgery — A modern surgical method using an endoscope to see inside the nose and sinuses while treating sinus disease.
ENT — Ear, nose, and throat medicine, the specialty that treats conditions of those areas.
Nasal Irrigation — Rinsing the nasal passages with water or saline to remove mucus, pus, or irritants.
Orbital Floor — The bony floor of the eye socket. Damage to it can injure the eye area or nearby structures.
Paranasal Sinuses — Air-filled spaces around the nose and eyes. The maxillary, ethmoid, and sphenoid sinuses are among them.
Maxillary Sinus — A sinus located in the cheek area beside the nose.
Ethmoid Sinus — A group of small sinuses between the nose and the eyes.
Sphenoid Sinus — A deep sinus located near the center of the skull, close to important nerves and blood vessels.
Nasal Cavity — The hollow passage inside the nose through which air moves.
Antiseptics — Substances used to reduce or kill germs on skin, wounds, or instruments.
Suction — A device or technique used in surgery to remove blood, pus, or fluid from the surgical field.
Tonsil Stones — Hardened debris that can form in the tonsils.
Blackhead Extraction — Removal of clogged material from skin pores.