ENDOSCOPIC MICROSURGERY
With the endoscope, otolaryngologists have obtained not only another very precise diagnostic tool (imagine a tiny eye that can see inside the nose and throat), but also a very useful instrument for surgical treatment of conditions of the nose and paranasal sinuses (maxillary sinuses, ethmoids, sphenoid and frontal sinus), the base of the scull and in certain cases, of the brain.
Many conditions that until now required severe and painful surgical intervention involving several days of hospitalization are now treated painlessly, and without external scarring or bandaging on the nose. Hospitalization is 24 hours the most
Which conditions can be treated?
The following conditions can be treated with endoscopic microsurgery: chronic or recurrent sinusitis; nasal polyps; mucocels; nasal bleeding; benign nasal tumours (and in certain circumstances malignant tumours); some types of headaches; scull base diseases (CSF leaks, encephaloceles, pituitary adenomas etc.) or eye and lacrimal sac diseases (overproduction of tears, endocrine orbitopathy, tumours extended to the eye).
The advantages of endoscope microsurgery
Besides being much easier on the patient (24 hour hospitalization at most, no visible scars, painless procedures, little or no need for removing packing bandages from the nose after surgery), microsurgical procedures with a screen ensure, with greater accuracy, radical removal of only the damaged area, without destroying healthy tissue. As a consequence, when nasal polyps, for example, are removed, the possibility of their reappearance is practically eliminated (thus with fewer relapses).
Also, endoscopic procedures are usually low scale (therefore less severe), because as evidence has shown, when normal drainage of discharge is restored to the sinuses and the rest of the paranasal cavities, it is generally enough for the radical treatment of their disease.
Lastly, with the use of a small «dilation balloon» to open the paranasal cavities, the procedure is even less invasive and in keeping with the spirit of Functional Microsurgery «the less, the best». Greater precision, and consequently safety, in the operating theatre can be achieved with a special instrument, Navigator, which gives precise orientation at any time during the operation, in the labyrinth of the nose, sinuses and scull base.
With the simultaneous use of radio frequencies it is possible to also treat other incidental problems, such as difficulties breathing and bouts of insomnia. Absence from work is reduced to the minimum and does not exceed more than a few days.
Pre-surgery monitoring
Apart from the basic tests, two others are deemed necessary for pre-surgery monitoring:
- an endoscopic examination of the nose, which is simple, completely painless and can be done in the doctor’s office, and
- a CT scan of the paranasal cavities.
Post-surgical care
These operations require essential post-surgical observation by the doctor so that healing occurs under the best possible conditions, and functioning of the nose is restored to normal as quickly as possible. With this objective, the region is meticulously cleaned out by the surgeon. Usually, the patient visits the surgeon 2-4 times within the first month after the operation.
Complications
In the hands of experienced surgeons, complications are rare and always fewer and milder than those observed in procedures carried out by conventional surgical methods. In the worse case, the hospital stay is extended by one day.
Success rates
In chronic or recurrent sinusitis such as maxillary sinusitis, frontal sinusitis, ethmoiditis or sphenoidal sinusitis, a retreat of the symptoms (headaches, heaviness in the face, dizziness, difficulty breathing, nasal discharge) is observed at a rate higher than 85%, if the post-operative patient is asked a year after surgery. Sometimes headaches do not diminish and this is considered to probably occur because the headaches may not have been only due to paranasal disease, but also to migraines and/or neuralgia.
Nasal polyps are known to possibly recur. This happens at a much smaller rate in the case of one or two big ones, and more often in a mass of polyps (in other words profuse small polyps that occupy all the nasal cavity). However, it has been proven that precise radical removal of polyps and good ventilation of the area where polyps develop in combination with sporadic use of topical spray, post-surgical observation and timely cleaning of the areas in which the small polyps tend to reproduce (which can be carried out easily and simply in the doctor’s surgery with an endoscope), not only extend the time by a great degree of their reappearance, but most importantly, leaves the patient without annoying symptoms for a long period of time.
In other procedures ( nasal or brain tumors, CSF leaks, operations of the orbit etc.) the success rate is proportionate to the relevant surgery performed with conventional methods, with the difference that cost and trouble for the patient are much less.
