For many patients with chronic inflammatory sinusitis, endoscopic sinus surgery has brought great relief, although the close proximity of major nerves, blood vessels and the brain means that surgeons must be especially cautious and conservative.
In a live internet broadcast April 8, 2005, a surgeon at Wake Forest University Baptist Medical Center will perform endoscopic sinus surgery using sophisticated image-guidance technology, which has significantly improved the safety and effectiveness of the procedure. The technology uses computer imaging to guide the surgical instruments around vital structures, such as orbital tissues, the optic nerve, the internal carotid artery, and the skull base – any of which can be a scant millimeter away.
Brian L. Matthews, M.D., associate professor of surgery-otolaryngology and of pediatrics at Wake Forest Baptist, will perform the procedure, known as functional endoscopic sinus surgery (FESS), in a live internet broadcast at noon on Friday, April 8. J. Whit Mims, M.D., will host the webcast.
Matthews, who has been performing the image-guided procedures for more than five years, explained, “What we are trying to do is to preserve those natural areas of cilia transport and let them function better by simplifying the anatomy.”
For patients with chronic sinusitis, meaning chronic inflammation within the sinuses, “Surgery in combination with appropriate medical treatment to control this inflammatory reaction is usually beneficial for these patients,” Matthews said. FESS is used to clear polyps from the sinuses, and the surgery is followed by systemic steroid therapies.
About the Procedure
Candidates for surgery meet three main criteria:
1. Inflammation in their sinuses is visible on a CT scan.
2. They have symptoms from this inflammation, such as facial pain and pressure, nasal congestion, nasal discharge, post-nasal drainage, cough, ear pressure and fatigue.
3. Their inflammation fails to clear with medical treatments, including antibiotics, anti-inflammatories, antihistamines, and steroid nasal spray.
The outpatient procedure is performed through the nose. The primary instrument Matthews uses is a microdebrider, which, unlike forceps, doesn’t strip out the mucosa but instead makes a clean cut and suctions at the same time, making it easier to see the surgical site.
Image guidance, such as the BrainLAB system Matthews uses, makes the procedure much safer. The system’s computer uses CT data taken from the patient to make a 3-D reconstruction of the patient’s head. Using facial contour for reference points, it can localize the surgical instruments to within a millimeter-and-a-half. This information, combined with visual landmarks, make the extraction much more precise.
“You can’t rely on it totally to prevent problems,” Matthews said. “But it substantially increases, particularly in very difficult cases, our ability to know exactly where we are and to be more thorough in our removal of inflammatory mucosa.”
Matthews said patients generally experience minimal discomfort following the surgery, which is performed under general anesthetic. “We want them to take it easy for a couple of weeks, simply because of the risk of bleeding.”