Nose and paranasal diseases
Balloon angioplasty of sinuses
This method belongs to a group of minimally-invasive methods. This method consists of an introduction, through the nose, to the natural ostium of the sinuses, of a small catheter with highly-resistant balloon made of a special plastic. The surgeon monitors the location of the catheter through the endoscope. The balloon is filled with liquid under pressure of a few to more than ten atmospheres, which allows for effective declogging of sinuses, and then for rinsing the insides of sinuses removing the inflammatory discharge clogging them. After the catheter with the balloon are removed from the nose, the previously-blocked ostium remains permanently open. Otolaryngologist enters a guidewire in the sinus, together with a flexible catheter, with the balloon placed at its tip. The doctor places the balloon along the clogged ostium of the sinus, and then the balloon is pumped. After declogging the ostium of the sinus, the balloon, catheter and guidewire are removed. Thanks to application of delicate and flexible tools for the purpose of the so-called ballooning of the sinuses, the procedure has become safer and less invasive than the classic operation. The avoidance of surgical removal of tissues allows for reduction of possible bleeding. Patients recover quicker, and a risk of post-surgical complications is significantly lower.
Endoscopic procedures in the area of the paranasal sinuses
FESS - Functional endoscopic sinus surgery
This method’s aim is to reduce symptoms of paranasal sinus inflammation and/or nasal polyps.
It is a minimal surgical intervention. It is individually adjusted to the needs of each patient. It is recommended for such patients, whose treatment with intranasal medicines or antibiotic therapy does not result in any improvement. It is performed through the nostrils under general anaesthesia. It does not leave scarring on the facial skin. During the surgery, thin plates of the bone and inflamed mucous membrane are removed. During the operation, the surgeon uses special tools adapted to the procedure so that minimal scarring would occur during healing of postoperative scar in the nose which in turn enables much faster recovery. After the procedure, nose patency may be limited for maximally 2 weeks. The patient may feel slight discomfort or feel tired for some time.
FESS procedures are currently the main and modern method to treat chronic sinusitis. A patient is qualified for surgical treatment on the basis of laryngological consultation at the appointment during which a physician performs endoscopic examination of the nose. Computed tomography of the nose and paranasal sinuses is performed before the procedure, which assesses the lesions in the paranasal sinuses. The procedure is performed under general anaesthesia with the use of microsurgery of paranasal surgery accompanied by visualization. This assumption which lies behind this method is to remove lesions in the sinus ostium which cause disorders related to ventilation and drainage of paranasal sinuses. Functional endoscopic microsurgery of chronic inflammation of paranasal sinuses is a surgical technique of choice and consists in minimal surgical intervention at the initial phases of the inflammatory process. It is conducted intranasally without the necessity to cut the facial skin.
The procedure is performed under the endoscopic control which allows to remove only those tissues which are covered by the disease process while maintaining uninflamed anatomic structures intact. One of the FESS’s advantages is a short hospitalization time of the patient. The aim of the procedure is to restore proper ventilation of paranasal sinuses. Long-term persistence of disturbed ventilation is a main reason of changes in the mucous membrane and accumulation of secretion inside the lumen of the sinuses which form a basis for inflammatory process. Removal of mucous membrane covering only the inflamed tissue has a beneficial effect for the healing process and effective elimination of causes of sinusitis. FESS is conducted with the use of special microsurgical tools entered intranasally which allow for avoidance of cutting the skin on the face.
The purpose of this procedure is toremove secretion from sinuses. During puncture, sinuses are rinsed. This procedure is performed after the shrinking and anaesthetization of the mucous membrane of the lower nasal passage of the mouth. The mucous membrane of the middle nasal passage, where the natural ostium of the maxillar sinus lies, is also shrunk. A needle is entered under the lower nasal turbinate, which is then directed towards the external corner of the eye and the sinus wall, which is very think at this point, is punctured. After aspiration, the clearance of the sinus is rinsed with a solution of physiological salt and, if necessary, a certain medicine is applied. The contents removed from the sinus may be sent for microbiological or cytological testing.
Endoscope straightening of the nasal septum
Septum divides the interior of the nose. It is formed from bone and cartilage. Nasal septum should be located in the middle line of the nose. When its deviation reduces patency of the nasal cavity, it hinders the airflow. The most common cause of deviated nasal septum is an injury. This may include an injury to the nose which occurred recently or in a distant past, e.g. in the childhood, or even a perinatal injury, as the deviation may result in discomfort long after trauma regardless of the fact that lesions are often more exacerbate in time and in children deviation of the septum may increase with growth.
The most common problem reported by patients with deviated septum includes unilateral or bilateral limitation of nasal patency. Obstruction in such cases often exacerbates during the night and may result in sleep disturbances. Another symptom of deviated nasal septum may include recurring infections of paranasal sinuses.
Indications to surgery in the case of deviated septum include: difficulties in breathing through the nose, recurring diseases of paranasal sinuses or tear ducts, recurrent nose bleeds, insufficient nasal patency affecting speech, exacerbated allergic mucosal changes, cosmetic reasons in the cases of visible deviation of nasal cartilage. The aim of septoplasty is to straighten (correct) the septum. Septoplasty consists in minimal resection of cartilage and bone (e.g. only removal of ridges and spurs) as well as in careful setting of mobilized cartilage and bone skeleton of the septum in the middle line of the body. The aim of the surgery is to improve breathing through the nose, restore symmetry of the intranasal symmetry without changing its appearance, removal of nasal obstruction which reduces snoring. Usually, this procedure is performed under general anaesthesia. Surgery lasts for approx. 1 hour. It is usually performed in a one-day mode. After the surgery, swelling of the mucosa may occur and may last for 10-14 days. For over 4 days, secretion with blood may be present. The nose may be swollen and reddened. Travelling by air and exercising should be avoided for 10 days after the surgery. There are several possible complications which include: risk of nose bleeds requiring return to hospital, nose infection requiring treatment with antibiotics, sometimes perforations in the nasal septum may occur after its correction.
Plastic surgery of the nasal turbinates (conchoplasty):
Lower nasal turbinate surgery (conchoplasty) is mainly based on reduction of the turbinate mucosa volume. Currently, one of the commonly acknowledged treatment method of turbinate hypertrophy is conchoplasty performed radiosurgically. It consists in entering under the turbinate mucosa special electrodes and stimulation of soft tissues with waves of radio frequency. As a consequence, scar tissue is formed inside nasal turbinates tissue (submucosally) which leads to shrinking of turbinates and reducing their volume. Thanks to application of radiosurgery, this a minimally invasive procedure. The leading surgical technique used by us in correction of nasal turbinates is a RFITT bipolar thermoablation using the Celon apparatus. The procedure consists of low-temperature (approximately 80oC) coagulation with high-frequency waves of precisely determined range. The surgery is usually performed under local anaesthesia. The entire procedure takes 10 to 20 minutes and does not require hospitalization.