Sinusitis Solutions
What is New In Surgery

The excellent visualization of the surgical site has extended the surgical application of image-guided sinus surgery from the management of inflammatory disease of the paranasal sinuses to the following indications which have had successful results. They include:

Image-Guided Orbital Decompression

This image-guided application involves the surgical removal of the medial orbital wall's removal (shown at right), to accommodate the increased volume of the orbital muscles with the fat and vascular contents in the region of the anterior and posterior ethmoid sinuses. This can be further extended to partial removal of the orbital floor through the nasal cavity. The following schematic diagrams and endoscopic views will demonstrate the surgery. This procedure is valuable in treating patients having thyroid disease with exophthalmos where significant dramatic results could be obtained by surgery. This procedure is electively performed after consultation with an ophthalmologist. The visual fields and the visual acuity should be carefully checked in evaluating patients with this disorder prior to surgery.

Image-Guided Closure of C.S.F. Leaks / Resection of Base of Skull Tumors

The image-guided closure of the cerebrospinal fluid leak from the anterior skull base can be successfully performed by direct visualization of the site of the leak. This is usually performed with computer-aided technology and tissue adhesives like the fibrin glue and tissue graft in the form of temporalis fascia and conchal cartilage. Our results have been very encouraging and the advantage is in the avoidance of a formal craniotomy and the attendant postoperative care. Because of the various techniques involved in the surgery, each patient must be evaluated on an individual basis preoperatively.

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Image-Guided Decompression of the Optic Nerve

The technique of optic nerve decompression is based on the identification of the optic nerve in the posterior ethmoid sinus or the sphenoid sinus. This should be performed by surgeons who are familiar with anatomy in this area, and special instrumentation is necessary for successful completion of sugery. The technique is most useful in optic nerve decompression secondary to thyroid ophthalmopathy, traumatic optic nerve entrapment or optic nerve injury with compression in tumor resections at the orbital apex.

Image-Guided Resection of Tumors of the Pituitary Gland

The image-guided techniques in resection of tumors of the pituitary have been recently applied with exciting results. The technique is based on the transnasal use of the sphenoid sinus surgical approach and removal of the sella bony wall and resection of the tumor. The defect is usually closed well with fibrin glue and muscular tissue, thus decreasing the postoperative stay in the hospital and also the incidence of morbidity.

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Eustachian Tube Balloon Dilatation Surgery

Eustachian tube dysfunction is a common complaint among patients presenting to the otolaryngologist. Typical symptoms include aural fullness or pressure, tinnitus, and a sensation of being ā€œunderwater,ā€ and a history of recurrent or chronic otitis media may be present. Otitis media is highly prevalent in young children, partly as a result of developmental Eustachian tube anatomy. In contrast, recurrent ear infections prompt further workup, including consideration of Eustachian tube dilation. Another complaint that may raise suspicion of Eustachian tube dysfunction is the onset of symptoms during a change in atmospheric pressure, as in commercial air travel, with a subsequent inability to equilibrate the middle ear pressure. The symptoms of Eustachian tube dysfunction may produce discomfort and may have an impact on auditory function.

Management of Eustachian tube dysfunction typically includes medical therapy, which may be antihistamines, intranasal corticosteroids, and noninvasive autoinflation maneuvers. Patients with uncontrolled symptoms typically undergo myringotomy with placement of pressure equalization tubes. An alternative is direct surgical management of the Eustachian tube dysfunction. Addressing disease contributing to Eustachian tube dysfunction have included adenoidectomy, septoplasty, turbinectomy, and endoscopic sinus surgery.

Balloon dilation of the Eustachian tube is a relatively new concept aimed at addressing cases of Eustachian tube dysfunction that have not responded to medical therapy. Balloon dilation has been successfully employed as a modality in endoscopic sinus surgery.

Balloon dilation of the Eustachian tube is a relatively new surgical procedure that shows promise for the treatment of Eustachian tube dysfunction in carefully selected individuals. Advantages include ease of use, employment of existing endoscopic instrumentation, and compatibility with other endonasal procedures.