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Image Guided Sinus Surgery
Image-guided systems are essentially like GPS (global positioning satellite) systems for the anatomy of your head. These systems are used to aid the surgeon in the confirming the location of critical structures when the interior of the nose and sinuses is distorted by unusual anatomy or prior surgery.
To use the image-guidance navigation system, a CT scan of the sinuses, is performed using a specific navigation system protocol. For some systems, a special mask or markers are placed on your face during the scan to serve as reference points. The CT scan is transferred to a disk, which is then loaded into the image-guidance computer.
During surgery, a detection array or a mask is placed on the patient's head. The CT scan images loaded into the system are then calibrated to the patient's anatomy using set pre-set reference points, which may be the mask or markers or specific anatomic points on the face. The position of the sinus surgery instruments can then be tracked by the computer by integrating the information detected from the patient's pre-set reference points and comparing it to the information on the CT scan map.
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Septoplasty is surgery to correct any problems in the nasal septum, the wall inside the nose that separates the nostrils.
Most patients receive general anesthesia before septoplasty. This will make you unconscious and unable to feel pain. Some have the surgery under local anesthesia, which numbs the area to block pain. You will stay awake if you have local anesthesia. Surgery takes about 1 to 1 ½ hours. Patients usually go home the same day.
Your surgeon will make a cut inside the wall on one side of your nose.
- The mucus membrane that covers the wall will be lifted up.
- Then your surgeon will remove or move any cartilage or bone that is causing the blockage in the area.
- After this, your surgeon will put the mucus membrane back in place. This membrane will be held in place by stitches, splints, or packing material.
The main reasons for this surgery are:
- To repair a crooked, bent, or deformed nasal septum that blocks the airway in your nose. People with this condition usually breathe through their mouth and get infections on their nose.
- Uncontrollable nosebleeds
- To repair a hole in the nasal septum. This is called nasal perforation.
You will meet with your anesthesiologist (the doctor who will give you your anesthesia medicine and monitor your condition before, during, and right after your surgery. You will discuss your medical history to help determine the right amount and type of anesthesia to use. You may be asked to stop eating and drinking after midnight the night before the procedure.
Be sure you tell your doctor or nurse about any medicines you take, even drugs, supplements, or herbs you bought without a prescription. Also tell your doctor if you have any allergies or if you have a history of bleeding problems.
You may be asked to stop taking any drugs that make it hard for your blood to clot 2 weeks before your surgery. Some of these are aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and some herbal supplements.
You will go home on the same day as surgery. After surgery, both sides of your nose may be tightly packed (stuffed with cotton materials) so you do not get nosebleeds. Usually this packing is removed 24 to 36 hours after surgery.
Most septoplasty successfully straighten the septum. Breathing often improves.
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Endoscopic Sinus Surgery
Who Qualifies for Endoscopic Sinus Surgery?
Patients with chronic sinus problems documented by x-ray who do not respond to medical therapy are candidates for endoscopic sinus surgery. Symptoms of sinus disease can include facial pain, above or below the eyes or in the temples, fullness or pressure, blocked nasal breathing, persistent nasal odor, postnasal drainage or drip, and occasional headaches. Occasionally sinus problems can cause hoarseness due to drainage or cough. Patients with polyposis almost always have sinus disease because polyps block sinus drainage. However, many of these symptoms can occur in the absence of sinus disease. Allergy and chronic nasal congestion are examples of problems causing symptoms similar to sinusitis, but not helped by endoscopic surgery. Your doctor is capable of deciding whether or not you have sinusitis.
Most people who have proven sinus disease do not need surgery, but can be treated medically using antibiotics, nasal irrigations, nasal hygiene, nasal steroid sprays, or perhaps allergy treatment. Your doctor can best decide appropriate medication.
Surgery may be necessary if medical therapy is not successful. Usually this is due to an infected or inflamed area does not clear up with antibiotics or returns when antibiotics are stopped.
What is Necessary to Find Disease Which is not Responsive to Medical Therapy?
Previous records of care, especially sinus X-rays or CT scans, are very helpful. During your visit a full head and neck examination will be performed with special attention to your nose and sinuses. It may be necessary to perform a CT scan of the sinuses to further evaluate sinus disease and to act as a surgical map pointing to disease that needs removal.
If surgery is necessary, surgery will be scheduled as an inpatient or outpatient depending on your overall health. Your doctor may recommend using a special computer guidance system during surgery to increase the safety of the procedure in difficult situations. This usually requires an additional CT scan of the sinuses wearing a special headset. If you are given a headset, please bring this with you on the day of your surgery.
What is Endoscopic Sinus Surgery?
Endoscopic sinus surgery differs from conventional intranasal surgery in that is stresses careful diagnostic work-up to identify precisely the cause of the problem. Sometimes an office exam with an endoscope or CT scan may identify disease that ordinarily would not have been found.
The principle of endoscopic surgery is that when the underlying cause of disease is found, that problem is corrected eliminating more extensive surgery. Secondary problems will usually resolve when the primary problem is corrected. This usually requires continuous medical therapy antibiotics, nasal irrigations, and nasal sprays after surgery to improve this reversible disease with less surgery. Usually the main area of obstruction is the ethmoid sinus into which all other sinuses drain. The nasal linings do not function properly for several months while adjusting to the new anatomy after surgery. This necessitates vigilant nasal hygiene and sporadic medical therapy.
The advantage of endoscopic sinus surgery is that, in general, less surgery is needed, normal tissue is preserved and precision surgery can be performed without nasal packing. The result is faster healing and less discomfort postoperatively.
Sinus surgery is most commonly done under general anesthesia. Any patient undergoing outpatient surgery should understand that hospitalization might be necessary if any problems occur. Usually nasal packing is not required, but return visits are necessary after surgery to clean the sinus cavities and monitor the healing process. Please take your prescribed pain medication prior to your postoperative visits to make the cleaning procedure more comfortable. These visits are routinely scheduled every 7-14 days until the nose is healing well and then less frequently. You will participate in your care by taking prescribed medications and irrigating your nose with salt water at least four times per day. If packing is required, you will return in a few days after surgery for removal.
Occasionally further endoscopic surgery may be necessary for disease which recurs. Endoscopic sinus surgery, while a marked improvement in the treatment of sinus disease, does not always cure everyone. Some patients, especially those with nasal polyps may have recurrent disease.
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