WHEN SHOULD YOU CONSIDER ENDOSCOPIC SINUS SURGERY?
Sinus surgery should be considered if medication fails to adequately relieve symptoms and the individual's quality of life continues to suffer. The need for surgery may be due to recurrent attacks of acute Sinusitis or longer term symptoms associated with Chronic Sinusitis. Most sinus operations are now performed utilizing an endoscope or telescope placed inside the nose through the nostril attached to a tiny TV camera which enables the surgeon to view structures and tissue on a TV screen. The term applied to such sinus procedures is Endoscopic Sinus Surgery, or ESS. Patients are generally asleep for the procedure and go home the same day. This will be discussed with you. Packing of the nose is rarely done. There is generally minimal pain and the recovery is often quick. Patients are often able to go out and to work within a few days, however physical exertion is limited for about 10-14 days.
The goal of the surgery is to correct any structural problems within the nose and sinuses as well as to eliminate blockage by removing thickened tissue in the ostiomeatal pathways therefore creating wider drainage channels. This will invariably improve nasal and sinus function. The patient will be often placed on medications to control inflammation and swelling and the medications are often continued until tissue healing is nearly complete. The healing process requires a number of visits to the office so that we can observe the status of the tissues and determine when to discontinue your medication. However, the patient is generally feeling well within a very short period after the procedure although the nasal breathing will take a few weeks to a month to improve substantially.
These procedures, if properly performed generally yield excellent results with significant improvement in function and quality of life. However, as discussed within this web site, patients with allergic and environmental problems will often require management by one of our nasal sinus allergy specialists.
Computer Assisted or Image Guided Sinus Surgery
Left - a view of a surgical suite with the telescope in patient's nose attached to a camera which transfers the image of the nose to a TV screen. Such an image is seen on the Right with a surgical tool in the nose
Computer Assisted Sinus Surgery (CASS) or Image Guided Sinus Surgery (IGS) is a system that integrates a high speed computer and the surgical instruments. This equipment, in combination with an endoscope and TV monitor, permits the surgeon to visualize the surgical instruments at all times within the sinuses based on the anatomy of the CT scan taken before surgery. This tracking system also correlates movement of these instruments. The surgeon therefore obtains instant feedback concerning the location of the surgical instruments within the various sinuses correlated to the individual's preoperative medical images, or CT scan. This real time information permits more thorough and precise surgery.
Computer assisted sinus surgery as seen during a sinus operation.Right lower quadrant is a picture of an instrument in a sinus cavity.The remaining 3 quadrants demonstrate the location of the tip of this same instrument, where the two yellow lines intersect, on the actual CT scan of this patient. As the instrument moves during surgery the location on the scan also changes continuously. There is no additional radiation associated with this method of visualizing the sinuses.
The video below will enable you to view how computer assisted sinus surgery functions. The term image guidance is also sometimes used for this technique.
The video below displays the intranasal telescopic view on the lower right screen and the other 3 images are the CT scan of the same patient which is actively moving with the telescopic view.