Medical advances such as endoscopes and image-guided surgery have made this once invasive and potentially scarring procedure more patient-friendly, more targeted and more effective than ever before.
Sinuses are air cavities in the bony walls surrounding the nasal passages. Sinuses are drained and ventilated by small openings called ostia. Infection to these sinuses usually occurs with any common cold caused by bacteria or viruses. Most cases of such sinus infections (as in the common cold) recover spontaneously in a few weeks. Sinusitis which fails to resolve in a few weeks tends to occur (and recur) more commonly in individuals with/who:
- Structural abnormalities (e.g. enlarged nasal turbinates, a deviated nasal septum or structurally narrow sinus openings)
- Nasal polyps
- Allergic rhinitis
- Live in polluted environments
- Respiratory airways and swallowing may be affected if there is a large tumour
Treating acute sinusitis is the same as treating any common cold. In prolonged sinusitis cases, treatment would involve medical management of allergies and lifestyle changes (such as smoking cessation and avoidance of exposure to pollution). Surgery may be considered in cases of structural abnormality or nasal polyps which compromise drainage and ventilation of the sinuses, causing recurrent or chronic sinusitis.
Before the advent of the now-standard endoscopic sinus surgery (ESS), sinus surgery was performed by surgeons using headlight beams, peering up the nostrils, often with large incisions on the facial skin and bones to gain access to deeper structures. ESS uses an endoscope inserted through the nasal passages, without any surface incision, to operate on a wide variety of different pathology and diseases in the nasal passages and sinuses. Recent instrumental advances allow us to also operate on the base of the skull, brain and eyes (working together with brain or eye surgeons).
Even very complex and extensive surgery may be performed with the endoscope, without external scarring, swelling, superficial trauma or pain and with reduced blood loss. The hospital stay is also greatly reduced. Patients can usually be discharged the same day or after one night in hospital. ESS is commonly used for:
- Removing nasal polyps
- Removing blockages in the nose by correcting a deviated nasal septum, reducing nasal turbinates, and widening and creating sinus outflow tracts.
- Treatment of nasal neuralgia or sinus headache caused by pressure on a sensory nerve
- Treatment of sinus barotrauma (sinus pain that sometimes occurs on flights or scuba diving)
- Removal of benign or cancerous tumours of the nasal cavity or sinus
- As an approach to the base of the skull, brain and eyes
Image-Guided surgery (IGS) has become widely used in the last two decades. IGS involves the feeding of data from CT or MRI scans (taken before the surgery) into a computer system, which creates a 3-D ‘map’ of the sinuses and surrounding structures. The surgeon uses the IGS in real time during surgery. IGS shows exactly where the tip of the instrument is. It can identify structures even when proper visualisation is obscured by severe inflammation, swelling, mucopus or blood. This provides extra safety during surgery, particularly in complex surgeries and revision cases where the normal anatomical landmarks have been violated. IGS is very similar to using a GPS to navigate through unfamiliar territory.