Navigation-Assisted Surgery in Chronic Sinusitis

Dr. Franz Windisch

Medical fields:
ENT

Specialisations:

• Ear surgery improving hearing ability, anti-inflammatory ear surgery
• Endoscopic paranasal sinus surgery including navigation-assisted surgery methods
• Functional and aesthetic nose surgery
• Pediatric ENT
• Diagnosis and treatment of snoring and sleep apnoea syndrome
• Endoscopic lacrimal duct surgery
• Throat surgery including tumor surgery
• Microscopic larynx interventions

When is sinus infection considered chronic?

If the symptoms of sinusitis such as pressure over the forehead, the eye sockets, the maxillary sinuses, the back of the head, as well as yellowish-greenish discharge from the nose persist for 2-3 weeks despite adequate therapy, or if inflammatory episodes occur several times a year and no lasting freedom from symptoms can be achieved, then we speak of chronic sinusitis.

A special form of inflammation is the so-called polyposis nasi, in which the nasal cavity can be obstructed by proliferation of the mucous membrane in such a way that there is a high level of suffering as a result of obstructed nasal breathing.

What treatment methods are available?

Bacterial inflammation should be treated with antibiotics accordingly. Decongestant nose drops should only be given in the acute phase for a maximum of one week, otherwise you will get used to them very quickly. Cortisone-containing nasal sprays, which only have a local effect in the nose and do not get into the rest of the body, show a good effect if they are used for several weeks.

In individual cases, such as pronounced nasal polyposis, oral administration of cortisone tablets may also be necessary. Any concomitant allergy should also be treated.

In which cases is surgical treatment of the paranasal sinuses indicated?

If the aforementioned therapeutic measures do not help and the symptoms persist, an operation will make sense. Today, in most cases, this is carried out as minimally invasive procedure performed by use of an endoscope – a thin camera rod with a light – which is introduced through the nostrils in order to view the nasal cavities; a skin incision is only necessary in exceptional cases.

It is a surgical principle that is tailored to each patient with the aim of protecting the mucous membranes as much as possible.

What is the advantage of navigation-assisted procedures?

With this procedure, a virtual three-dimensional model is generated from the image data set of the computer tomography of the paranasal sinuses and displayed on an additional screen during the operation. This model is calibrated to the patient by touching landmarks on the facial surface using a registration tool.

In this way, the position of the instruments in the surgical field can be displayed during the operation. This gives additional security in addition to the obligatory anatomical knowledge of the surgeon. In this way, complications are largely avoided and the operation can be carried out much more precisely.

For the reasons mentioned, such systems are being used more and more frequently.

How long does the hospital stay and convalescence usually last?

Usually patients stay in the hospital for one to two nights. Immediately after the operation, nasal breathing may be slightly impaired, this is caused by the formation of crusts in the wound area. If necessary, these encrustations are gently removed by the surgeon using local surface anesthesia.

After two weeks the patient is able to return to work. Air travel is not recommended for 10-14 days after surgery.

For which other indications is this technology used in ENT surgery?

For surgery on the anterior skull base, combined neurosurgical interventions and interventions on the lateral skull base are among the additional areas of use for navigated surgery.