Nasal and/or sinus surgery may be indicated for treatment of a variety of common conditions that we see at the California Sinus Centers. Surgery is generally indicated only after a patient has failed medical treatment.
Septoplasty: A septoplasty is a surgical procedure to correct a deviated septum. The nasal septum is made of cartilage and bone and divides the nasal cavity into two sides. Sometimes the nasal septum is crooked, and a portion of it may block the nasal airway. This is referred to as a “deviated septum.” The most common reason for recommending a septoplasty is for relief of nasal obstruction, although it may be recommended for other select causes as well. Septoplasty may be recommended alone, or in combination with other procedures such as inferior turbinate reduction or endoscopic sinus surgery.
Turbinate reduction: Turbinates are structures on the side walls of the inside of the nose that are made of bone and soft tissue. They warm and humidify the air as it passes through the nasal passages. Sometimes, the inferior turbinates can become swollen and enlarged, causing obstruction of airflow through the nose. The swelling can sometimes be reduced by the use of medications such as topical nasal steroid sprays, or other allergy medications. If they remain enlarged and continue to cause nasal obstruction, a patient may be a candidate to consider a procedure to reduce the size of the inferior turbinates.
Endoscopic sinus surgery: also referred to as “functional endoscopic sinus surgery (FESS)”, is a minimally invasive form of sinus surgery using small rigid nasal telescopes (nasal endoscopes) and small instruments to open the sinuses. The development of fiberoptic nasal endoscopes in the 1950s and subsequent refining of surgical techniques in the 1970s has led to great advances in surgical treatment of patients who suffer from sinusitis. Endoscopic sinus surgery may be indicated in patients who fail to clear chronic sinus infections with medical treatment or for those whom have recurrent episodes of sinusitis caused by anatomic narrowing of the sinus openings. Endoscopic sinus surgery may also be indicated for removal of nasal polyps, or certain types of nasal tumors.
Endoscopic sinus surgery has some advantages over traditional open sinus procedures. The surgery is almost always performed entirely through the nostrils, so there are no visible scars on the face. There is generally less resection of tissue, so that healing is usually faster, and there is less postoperative pain and bleeding. Nasal packing is rarely used. In most cases, it is performed as an outpatient procedure.
Image guided navigation: Image guided navigation is similar to a global positioning system (GPS) for the sinuses. This technology has been a significant advance in the field of endoscopic sinus surgery and skull base surgery. An image guided CT scan or MRI provides the map for the system, and a computer constantly calculates the position of certain trackable sinus instruments in relation to a patient’s sinus anatomy. This is helpful to surgeons as they navigate close to neighboring structures such as the eye and brain that surround the sinus cavities.
While image guidance has been increasingly used in sinus surgery, it may not be required in all cases. Some types of cases that image guidance may be particularly useful are in cases of difficult sinus anatomy, patients with a history of previous sinus surgery, nasal polyps, cerebrospinal fluid leaks, and tumors of the skull base.
Endoscopic skull base surgery: The skull base refers to the area along the bottom of the brain, including the brain and underlying bone, which is located next to the nose and sinuses. Over the last decade, technological advances and improved surgical techniques have allowed tumors and other abnormalities located in this area to be accessed through the nose and sinuses using endoscopes and cameras similar to those used in endoscopic sinus surgery. This minimally invasive approach allows surgeons to treat many difficult to reach tumors without facial incisions or openings in the skull.