Nose, Para Nasal Sinus & Endoscopic Skull Base Surgery

A variety of diseases can affect the nose and paranasal sinuses. There are several paired paranasal sinuses, including the frontal, ethmoid, maxillary and sphenoid sinuses. The most common problem is sinusitis. Tumors arising from the nose and paranasal sinuses and trauma to the nose are other affilictions of the nose. Diagnosis is made by radiology and endoscopy. Treatment can be conservative or surgical. Endoscopic Sinus Surgery is the mainstay of most forms of surgical intervention.

Inflammatory Diseases of the Sinuses

Sinusitis or Rhinosinusitis is inflammation of the paranasal sinuses. It can be due to infection, allergy, or autoimmune issues. Most cases are due to a viral infection and resolve over the course of 10 days. It is a common condition. There are two types, acute and chronic. Acute sinusitis is very common. Roughly ninety percent of adults have had sinusitis at some point in their life. Headache/facial pain or pressure of a dull, constant, or aching sort over the affected sinuses is common with both acute and chronic stages of sinusitis. Treatment can be conservative or by Endoscopic Sinus surgery.

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Tumors of the Nose and Paranasal Sinuses

Tumors of the nasal cavity proper are approximately evenly divided between benign and malignant neoplasia, with inverting papilloma predominating in the benign group and squamous cell carcinoma in the malignant. Up to 44% are attributed to occupational exposures, including nickel, chromium, isopropyl oils, volatile hydrocarbons, and organic fibers that are found in the wood, shoe, and textile industries. In addition, human papillomavirus can be a cofactor. Treatment is mostly by surgery followed by radiotherapy and chemotherapy.

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Functional Endoscopic Sinus Surgery

Functional endoscopic sinus surgery (FESS) is the mainstay in the surgical treatment of sinusitis and nasal polyps. FESS is a relatively recent surgical procedure that uses nasal endoscopes (using Hopkins rod lens technology) through the nostrils to avoid cutting the skin. Telescopes with diameters of 4mm (adult use) and 2.7mm (pediatric use) and with a variety of viewing angles (0 degrees to 30, 45, 70, 90, and 120 degrees) provide good illumination of the inside of the nasal cavity and sinuses. High definition cameras, monitors and a host of tiny articulating instruments aid in identifying and restoring the proper drainage and ventilation relationships between the nose and sinus cavities. All the sinuses can be accessed at least to some degree by means of this surgery: The frontal sinuses located in the forehead, the maxillary sinuses in the cheeks, the ethmoid sinuses between the eyes, and the sphenoid sinuses located in the back of the nasal cavity at the base of the skull.

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Endoscopic Skull Base Surgery

Endoscopic surgery for the skull base where ENT surgeon works together with a neurosurgeon, provides minimally invasive access. More recently, further specialization combined with advanced training and techniques have allowed the paranasal sinuses to be a relatively low-morbidity approach to selected tumors even inside the skull or brain. This can be divided into:
- approaches to the anterior cranial fossa
- approaches to the mid cranial fossa
- approaches to the posterior cranial fossa
- access to the infratemporal fossa (incl. pterygopalatine fissure)
- access to the sella turcica
- orbital access
- optic nerve access

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