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International Physician Update
| OTOLARYNGOLOGY-HEAD & NECK SURGERY |
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A Less-Invasive Way to Reopen Sinuses
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| Using high-tech mapping systems, surgeon Andrew Lane reopens sinuses with a less-invasive endoscopic approach. |
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When Julia Yablonski’s doctor told her she’d have to have major, open surgery to unblock a frontal sinus, the 66-year-old Gainesville, Virginia, woman sought a second opinion.
Through the Internet, she learned Hopkins was a top place to go. Yes, the passageway into the sinus did need to be enlarged, head and neck surgeon Andrew Lane, M.D., told her.
But rather than make an incision on her face, he could take a minimally invasive approach, threading an endoscopic tube through her nose to the sinus. What you do is essentially remove any bottlenecks within the sinus,Lane explains.
“It’s all through the nose, so you don’t leave any scars.
But what makes an endoscopic approach possible in such cases, Lane adds, is a high-tech mapping system that allows him to see sinus structures he would normally only be able to see in an open surgery. Called stereotactic computer-assisted surgical navigation, this system operates much like a GPS, or global positioning system. Stray too close to the thin layer of bone between the frontal sinus and the brain with an endoscopic tool, for example, and warning lights on a computer screen put you safely back on course.
The frontal sinuses are considered high-price real estate because you’ve got the brain above you, the eyes to the side. Knowing precisely where you are is very important, Lane says. So it adds to the safety of the operation and also allows you to be more aggressive in what you do.”
The endoscopic approach, Lane adds, reduces the risk of scarring–the enemy of sinus surgeons–that comes with an open procedure. Tear the lining of a sinus or expose bone and the resulting scarring may clog sinus passageways soon after they’ve been reopened. “Get the surgery done right the first time,” says Lane, noting that most of his cases are patients who have failed sinus surgery at other hospitals. “Once you start this process of scarring, it’s impossible to undo.
Using the image-guided endoscope, Lane was able to minimize such scarring and reopen Yablonski’s frontal sinus. Left untreated, he notes, her sinuses would continue draining improperly, likely resulting in a painful buildup of bacteria and recurring infections. The enlarged opening, he adds, also allows antibiotics to reach her sinuses, to attack the underlying sinusitis conditions.
“He was successful,” Yablonski says. “He feels confident my sinuses will stay open.”
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