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Image-Guided
Sinus Surgery
BERNARD TAWFIK, MD ♦ IDEL MOISA, MD
Diplomates, American Board of Otolaryngology
Specializing in
Adult and Pediatric
Disorders of the
Ears, Nose, Throat and Neck
Sinus Infections and Nasal Allergies
Endoscopic Sinus Surgery
Computer Image Guided Surgery
Balloon Sinuplasty
Sleep Apnea
Snoring
Head & Neck Surgery
Thyroid Gland
Parathyroid Glands
Salivary Glands
Oral Cavity
Larynx
Esophagus
Acid Reflux Disease
Pediatric ENT
Hearing and Balance
Voice and Swallowing
FEESST
Trans-Nasal Esophagoscopy
Laryngeal Video Stroboscopy
Affiliations
New York University School of Medicine
Glen Cove Hospital
Winthrop University Hospital
ProHealth Ambulatory Surgery Center
DayOp Center of Mineola
Computer Image-Guided Endoscopic
Sinus Surgery
Functional Endoscopic Sinus Surgery is based on the theory
that the best way to obtain normal, healthy sinuses is to open
their natural passages into the nose. Once improved drainage
is established, the diseased sinus lining can return to a more
normal state, and further infections tend to subside.
Functional Endoscopic Sinus Surgery involves the insertion
of a very thin, fiberoptic endoscope into the nose for a direct
visual examination of the openings into the sinuses.
Visualization at different angles allows micro-instruments to
remove abnormal tissues from different regions of the nose
and sinuses. This outpatient surgery is usually performed
through the nose, resulting in no external scars, and only
mild discomfort. Several technological advances, including
Computer Guided Surgery and Powered Instrumentation,
have further refined Functional Endoscopic Sinus Surgery.
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The close proximity of the nasal sinuses to the brain and
eyes is a matter of concern for the sinus surgeon. Computer
Guided Surgery is helping to alleviate this concern. This
near-three-dimensional mapping system uses CT scans to
show the exact position of the surgical instruments during
surgery. In this way, surgeons can navigate surgical
instruments through complex sinus passages more precisely.
Patients usually undergo a CT scan prior to surgery with a
special headset. This information is stored on a disc where
image reconstruction is performed. During surgery, the
patient’s actual CT scan is viewed on a monitor. As the
surgeon uses various surgical instruments inside the nose
and sinuses, they can be viewed in relation to the patient’s
sinus CT scan. In this way, the proximity of the surgical
instruments to the eyes and brain can be monitored
throughout the operation. Although computer image
guidance enhances Functional Endoscopic Sinus
Surgery, it is usually not required or indicated in
routine cases. This technology is generally
recommended for severe chronic sinusitis, revision
sinus surgery associated with altered anatomy, or in
the setting of unusual sinus anatomy, making
typical surgery difficult. It is also useful for selected
cases involving sinus tumors, as well as in certain
congenital defects.
Computer image guidance is a
near-three-dimentional mapping
system that uses CT scans to
show the exact position of
surgical instruments during
Functional Endoscopic Sinus
Surgery.
The American Academy of Otolaryngology - Head & Neck Surgery
Policy Statement
The American Academy of Otolaryngology - Head and Neck Surgery recently developed the
following policy statement regarding the intra-operative use of computer image-guided sinus
surgery:
The American Academy of Otolaryngology - Head and Neck Surgery endorses the intraoperative use of computer guided imaging systems in appropriately selected cases to assist the
surgeon in providing localization of anatomic structures and increasing patient safety. Examples
of indications in which use of computed-aided surgery may be deemed appropriate include:
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Revision sinus surgery
Distorted sinus anatomy of development, postoperative, or traumatic origin
Extensive sino-nasal polyposis
Pathology involving the frontal, posterior ethmoid and sphenoid sinuses
Disease abutting the skull base, orbit, optic nerve or carotid artery
Cerebrospibal fluid rhinorrhea or conditions where there is a skull base defect
Benign and malignant sino-nasal neoplasms
Powered Instrumentation
Powered Instrumentation is another advance in the management of patients suffering from
chronic sinusitis. This technology allows access of small drill-like instruments to each of the
sinuses in a minimally invasive fashion. This technique delicately removes diseased tissue while
preserving the normal sinus lining, thereby more completely restoring normal sinus function.
Powered Instruments may be used as part of Functional Endoscopic Sinus Surgery, with or
without Computer Image-Guided Surgery.
Summary
The close proximity of the paranasal sinuses to the brain and eyes is a matter of concern for the
sinus surgeon. Computer Image-Guided Endoscopic Sinus Surgery is helping to alleviate this
concern. A near-three-dimensional mapping system uses CT scans to show the exact position of
surgical instruments during endoscopic sinus surgery, allowing surgeons to more precisely
navigate surgical instruments through the complex sinus passages.
In summary, important technological advances in the surgical approach to the paranasal sinuses
involving endoscopic techniques, computer image-guidance and powered instrumentation can
offer relief to patients suffering with chronic sinusitis. Today, sinus surgery is often faster,
gentler, and more thorough. Patients can expect quicker recovery and a shorter operating time.
Individuals may often return to work, school, and social activities within a few days.
This newsletter is provided in the interest of medical education and is not intended as medical advice.