CURRENT UPDATE ON LASER SURGERIES FOR THE NOSE

CURRENT UPDATE ON LASER SURGERIES IN ENT HEAD AND NECK

 

THE INNOVATION IN THE MANAGEMENT OF LASER SURGERIES IN ENT HEAD NECK PATHOLOGIES IS SLOWLY TAKING BIG LEAPS FROM BABY STEPS.

 

WE, IN TROPICANA MEDICAL CENTRE HAVE MADE INNOVATIVE CHANGES TO THE ART OF LASER SURGERIES IN ENT HEAD AND NECK SINCE 2009.

CURRENTLY WE CONDUCT ABOUT 1000 PROCEUDRES PER YEAR.

 

 

INTRODUCTION TO THE NOSE AND COMPLICATIONS DUE TO DISEASE

 

 

THE MAJOR FUNCTIONS OF THE NOSE ARE:

 

1) AIRWAY

2) DRAINAGE

3) PRESSURE BALANCE IN THE MIDDLE EAR

 

The Nasal Cavity is divided into the right an left side by a Nasal Septum, which is made up of cartilage and bone. The bony side walls of the nasal cavity have three structures attached to them called the turbinates. These turbinates are finger-like projections and they have a core which is bony and an outer part consisting of soft tisse.

 

 

 




Here we can see the Nasal septum in the middle of the Nose, and along the sides are the 3 turbinates, the superior, middle and inferior turbinates.



 

 

 



Side view of the Nasal Cavity showing the Superior, Middle and Inferior turbinates.

 

 

 

The Nose is the entry point of the respiratory system, and assists in breathing. Therefore the airway flow through the Nasal Cavity is very important. The airway entry is primarily through the nasal passage and secondarily through the mouth.

 

 

The direction of airway flow through the nasal cavity is 2/3rd upwards.

 

 

 

 

The factors governing the direction of airway flow in the Nose:

 

1) Nasal Valve ( inlet )

2) Nasal Septum

3) Tubinates

 

 

 

When the Nasal valve is narrow, this does not allow passive nasal airway i.e.: when a person sleeps, the nasal passage appears obstructed.

 

Nasal Septum is not straight, it is known as a Deviated Nasal Septum or a Septal Deviation. This Septal Deviation is usually influenced by enlarging turbinates, which are due to:

 

1) Allergy

2) Non-Allergy

 

 

The Septal Deviation can occur from birth till 18 years of age, until the full maturity of the nose.

 

(Hence, children must be managed early to avoid Septal Deviation that may lead to surgery in later life).

 

THE NASAL OBSTRUCTION LEADS TO SINUS DRAINAGE OBSTRUCTION LEADING TO SINUSITIS, EAR BLOCKED SENSATION (OCCASIONAL VERTIGO LIKE SENSATION), POST NASAL DRIP SORE THROAT WITH PERSISTANT NOCTURNAL COUGH AND TONSILLITIS. (DETAILED EXPLANATION BELOW)

 
 



Deviated Septum. Notice the enlarged inferior turbinate on the left side.
 

 

Deviated Nasal Septum into the left side of the nasal cavity.

 

 

 



Right Septal Deviation

 

 

 

 

Paranasal Sinuses are air-filled cavities surrounding the nasal cavity, which are layered by the breathing and living skin called as mucosa. The mucosa produces mucous (clear fluid felt and seen in the nostril).

 

The mucous drains through small openings in a very narrow space in the nasal cavity with the help of ciliary movement on the mucosa (blanket of tiny hair brushing the mucosa towards the ostium).

 

 

 



The Paranasal Sinuses.



 



Normal Mucous Drainage



When a patient has a nasal block (due to a bent nasal bone or enlarged turbinates) leading to an inflammation of the sinus mucosa (commonly due to viral infection), the inflammation causes obstruction to the ostium resulting in the stagnation of the mucous.

 

When the mucous is stagnated for long, it gets a secondary infection with bacteria that causes pus to flow out of the sinuses. This condition is known as Sinusitis.

 

Sinusitis can be acute (sudden shortduration of onset) or chronic (long standing).

 

In acute, the patient may experience throbbing facial pain with fever with mucopus (post nasal drip with greenish colour) that drips down the throat. Chronic may just be constant post nasal drip with occasional pus and sore throat.

 

 

 

The Eustachian Tube which is commonly known as the Auditory Tube, connects the nasopharynx (back of the throat) to the middle ear. These tubes help to maintain air pressure in the ears.

 

 



The Eustachian Tube connecting the Nasopharynx to the Middle Ear.
 



 



Side view of Eustachian Tube opening the Nasopharynx.
 







Eustachian Tube opening at the Nasopharynx.
 



Narrow Eustachian Tube with enlarged Adenoids in the Nasopharynx.



During allergies or sinus infection, the mucosa around the Eustachian Tube can get swelled up and collapse causing the opening of the tube to get blocked at the nasopharynx.. This is due to post nasal drip flowing over these areas.

 

When the Eustachian Tubes are blocked:

 

1) There are pressure changes in the ears, and can lead to fluid collection in the middle ear causing middle ear dysfunction.

2) The pressure changes in the middle ear can influence the movement of water within the semicircular canals (balancing organ), thus causing positional vertigo (especially upwards and downwards).

 

 

 

The post nasal drip, infected / non infected can irritate the posterior pharyngeal wall (throat) hence causing inflammation of the mucosa called Pharyngitis (Sore Throat). This can present as a painful throat or persistent cough. This can lead to swelling of the tonsils called as Tonsillitis.

 

Pharyngitis with Tonsillitis can cause dysphagia with fever. In some large tonsils, it can cause airway obstruction.

 

 

 





Pharyngitis (Sore Throat).



Pharyngitis (Sore Throat)

 

 

 

 

 

 

 

 

 






Picture of throat with a pair of normal looking Tonsils.





 

 





Picture of throat with very large infected Tonsils.



 

The Tonsils are collections of lymphoid tissue (part of the immune system) that are located near the back of the throat. They produce antibodies along with the adenoids to help assist the body fight against bacteria and viruses, causing respiratory infections.

 

The are small initially at birth and gradually increase in size till 8 or 9 years of age, when they are actively fighting infections. After this age, they start to shrink and their role is diminished and they are not needed in the protective mechanism of the body.

 

There is no evidence to support a significant role of the tonsils and adenoids in immunity. Medical studies have shown that children who have their tonsils and adenoids removed suffer no loss whatsoever in their future immunity to disease or ability to ward off infections.

 

Tonsillectomy is a surgical procedure to remove the tonsils. The following are recommended as indications for consideration of tonsillectomy for reccurent acute sore throat in both children and adults:

 

When do we treat sore throats due to recurrent tonsillitis:

 

1) The episodes of sore throat are disabling and prevent normal function.

2) Seven or more well documented, clinically significant, adequately treated sore throats in the preceding year.

 

The common myth:
 

1) Will I lose my immunity? No

2) Will I lose my voice? No

 

 

THE NON TOUCH 3 ‘D’ TECHNIQUE .

THIS IS A NEW TECHNIQUE AND WAS COINED IN 2009 BY ME.

 

LASER SURGERIES TO THE NOSE ARE DONE USING ENDOSCOPE AND CAMERA.

THIS ENABLES US TO HAVE A DIRECT VISUALIZATION OF THE AREA.

THE LASER PROBES HAVE STRAIGHT AND SIDE PORTS TO ENABLE THE DELIVERY OF THE LASER BEAMS TO THE SPECIFIC AREA .

THE LASER ENABLES US TO FIRE THE LASER BEAM FROM A DISTANCE WITHOUT CAUSING ANY TRAUMA TO SURROUNDING TISSUE .

THIS ALSO HELPS TO PERFORM SURGERIES IN NARROW AND FAR AWAY STRUCTURES (ADENOID, POSTERIOR PHARYNGEAL WALL ,EUSTACHIAN TUBE OPENINGS , NASOPHARYNGEAL MASS , VOCAL CORDS ,AIRWAY ETC)

IT REDUCES ANY DIRECT INFECTION DUE TO NON PROBE CONTACT WITH THE NASAL MUCOSA

 

PREPERATION OF PATIENT FOR SURGERY AND SAFETY DURING SURGERY ARE VERY IMPORTANT

 

 

 

SCENE IN THE OPERATING THEATRE

·         THE PATIENT'S FACE IS COVERED WITH A WET CLOTH

·         LASER MACHINE

·         EYE PROTECTOR

 

COMMON PROCEDURES PERFORMED IN TROPICANA MEDICAL CENTRE

 

ØENDOSCOPIC LASER NASAL VALVEPLASTY

( NASAL VALVE )

NASAL VALVE IS THE AREA WHERE THE SEPTUM MEETS THE SIDE WALL OF THE NOSE.

THIS AREA IS VERY IMPORTANT FOR BREATHING AS IT WORKS A SENSOR.

NARROWING OF THIS AREA (< 10-15°) MAY CAUSE AIRWAY OBSTRUCTION.

THIS AREA IS GENERALLY MISSED OUT NOT ADDRESSED IN SEPTAL DEFORMITY CORRECTION.

THIS AREA IS OF UTMOST IMPORTANCE DURING NASAL SEPTAL CORRECTION AND DURING NASAL AIRWAY SURGERY.

THE CORRECTION IS DONE BY ADDRESSING THE NASAL TIP AND TO CORRECT THE ANTERIOR DORSUM OF THE SEPTUM AND OR THE UPPER LATERAL CARTILAGE THAT COMES INTO CONTACT WITH THE SEPTUM.

CO2 LASER IS VERY HANDY IN CORRECTING BOTH SMALL DEFECTS OF THE NASAL VALVE WITHOUT ANY OPEN SURGERY

THE LATERAL WALL NEEDS TO BE CORRECTED BY MAKING A SMALL INVERTED'V' SHAPED DEFECT TO ENABLE A SMALL WIDENING OF THE NASAL ANGLE.

LEFT NASAL VALVE NARROW

 



DURING SURGERY



NASAL WIDENING



1 MONTH POST LASER VALVEPLASTY

PRECAUTION

- THE DEFECT MUST BE SMALL TO AVOID NASAL VALVE COLLAPSE

-THE DORSUM OF THE NASAL SEPTUM MUST BE CORRECTED WITH PRECISION AND MUST AVOID EXCESSIVE MUCOSAL DAMAGE OF THE DORSUM, THIS IS TO AVOID NASAL SKIN DAMAGE AND PREVENTING SKIN NECROSIS

 

 

 

 

 

ØLASER TURBINOPLASTY

 

 

 

WHO NEEDS LASER ASSISTED TURBINOPLASTY?

• CHILDREN

• ADULTS

 

WHY DO WE DO TURBINOPLASTY?

• RECURRENT NASAL BLOCK NOT RESPONDING TO NASAL SPRAY OR ORAL MEDICATION

• NASAL BLOCK LEADING TO SINUSITIS / RHINOSINUSITIS

• NASAL BLOCK CAUSING RECURRENT EAR BLOCKAGE (EUSTACHIAN TUBE DYSFUNCTION)

• YOUNG CHILDREN WITH BAD NASAL SEPTAL DEVIATION, NOT ABLE TO BREATHE WELL, AWAITING FOR PERMANENT SEPTAL SURGERY AT LATER DATE (AFTER AGE OF 18 YEARS)

-PEOPLE WHO DEVELOP FREQUENT BAROTRAUMA DURING FLIGHT OR DEEP SEA DIVING

-NASAL OBSTRUCTION CAUSING SNORING AND SLEEP APNOEA

 

WHAT BENEFITS DOES LASER ASSISTED TURBINOPALSTY HAVE?

• LESS PAIN

• FASTER RECOVERY

• SAFER THAN THE CONVENTIONAL METHODS

• WELL DEFINED SHAPING OF THE TURBINATES (3'D' RECONSTRUCTION)

• LESS BLEEDING COMPARED TO CONVENTIONAL METHODS

• PRESERVING THE FUNCTION OF THE MUCOSA

• MINIMAL TRAUMA TO THE MUCOSA STRUCTURE

• NO EXTENSIVE NASAL PACKING NEEDED POST SURGERY

• LOW INCIDENCE OF EXTREME NASAL PASSAGE DRYING (ATROPHIC RHINITIS) OR EMPTY NOSE SYNDROME)

• REDUCE SIGNIFICANT NASAL ALLERGY SYMPTOMS

-LESS USAGE OF ANTIHISTAMINE OR NASAL SPRAYS POST SURGERY

 

WHAT ARE THE RISKS INVOLVED?

• MINIMAL RISK

• LESS THAN THE CONVENTIONAL (OLDER) METHOD

 

WHAT IS A GOOD AGE?

-NO AGE LIMIT

 

 

BEFORE LASER SURGERY

 

 

 

3 MONTHS AFTER SURGERY

 

 

PROCEDURE

·         DISCUSS WITH THE DOCTOR

·         UNDERSTAND THE PROCEDURES IN DETAIL.

·         DAY CARE PROCEDURE / ADMIT OVER NIGHT

·         SURGERY DONE UNDER LOCAL OR GENERAL ANAESTHESIA

·         PATIENT IS INTUBATED DURING SURGERY (AIR WAY TUBE PLACED FOR BREATHING)

·         ALL LASER PRECAUTION TAKEN DURING THE PROCEDURES

·         TIME TAKEN IS ABOUT 20 TO 30 MINUTES PER TURBINATE (TOTAL TIME NEEDED IS ABOUT 1 HOUR)

·         POST SURGERY

·         ONCE THE PATIENT IS CONSCIOUS, PATIENT CAN EAT NORMAL DIET

·         FOLLOW UP IS AFTER 5 DAYS TO 1 WEEK DEPENDING ON THE TYPE OF COMBINATION SURGERY DONE.

·         PATIENT HAS TO SPRAY NASAL DECONGESTANT AND NASAL DOUCHING WITH SALINE TO CLEAR THE NASAL PASSAGE FOR ABOUT 1 TO 2 WEEKS

·         RHINOWASH IS A GOOD NASAL CLEANSING DEVICE

·         BACK TO NORMAL DUTY ( SCHOOL OR WORK ) IN 1 WEEK

 

 WHAT TYPE OF LASER IS USED?

CO₂ LASER

 

 

 

ØLASER ENDOSCOPIC LASER SEPTOPLASTY
 

WHO NEEDS LASER ENDOSCOPIC LASER SEPTOPLASTY?

•CHILDREN

•ADULTS

WHY DO WE DO ENDOSCOPIC LASER SEPTOPLASTY?

• NASAL BLOCK DUE TO DEVIATED NASAL SEPTUM

• NASAL SEPTAL DEVIATION LEADING TO SINUSITIS / RHINOSINUSITIS

• NASAL SEPTAL DEVIATION LEADING TO RECURRENT EAR BLOCKAGE (EUSTACHIAN TUBE DYSFUNCTION)

• YOUNG CHILDREN WITH BAD NASAL SEPTAL DEVIATION, NOT ABLE TO BREATHE WELL, AWAITING FOR PERMANENT SEPTAL SURGERY AT LATER DATE ( AFTER AGE OF 18 YEARS)

• PEOPLE WHO DEVELOP FREQUENT BAROTRAUMA DURING FLIGHT OR DEEP SEA DIVING

• NASAL SEPTAL DEVIATION LEADING TO OBSTRUCTION CAUSING SNORING AND SLEEP APNOEA

WHAT BENEFITS DOES LASER ENDOSCOPIC LASER SEPTOPLASTY HAVE?

•LESS PAIN

•FASTER RECOVERY

•SAFE

 

•ABLE TO DEFINE THE SHAPE OF THE SEPTUM WITH PRECISION

 

•LESS BLEEDING COMPARED TO CONVENTIONAL METHODS

 

•PRESERVING THE FUNCTION OF THE NOSE

 

•AVOIDING EMPTY NOSE SYNDROME

 

•MINIMAL TRAUMA TO THE MUCOSAL STRUCTURE

 

•NO EXTENSIVE NASAL PACKING NEEDED POST SURGERY

 

•LOW INCIDENCE OF EXTREME NASAL PASSAGE DRYING (ATROPHIC RHINITIS)

 

•LESS ANALGESIC POST SURGERY

 

•CAN BE DONE FOR SMALL AND MODERATE SEPTAL DEVIATION

 

•CAN BE DONE UNDER LOCAL OR GENERAL ANAESTHESIA

 

•CAN BE DONE FOR CHILDREN

 

 

 

WHAT ARE THE RISKS INVOLVED?

· MINIMAL RISK

· LESS THAN THE CONVENTIONAL (OLDER) METHOD

· NO SEPTAL PERFORATION

 

WHAT IS A GOOD AGE?

· NO AGE LIMIT

LARGE SEPTAL DEVIATION TO THE LEFT

 

1 MONTH POST LASER SEPTOPLASTY

 

PROCEDURE

•DISCUSS WITH THE DOCTOR

•NEED TO LOOK FOR AN EXPERIENCED DOCTOR DEALING WITH LASER AND HAS PERFORMED MANY SUCCESSFUL SURGERIES

•UNDERSTAND THE PROCEDURES IN DETAIL.

•DAY CARE PROCEDURE / ADMIT OVER NIGHT

•SURGERY DONE UNDER LOCAL OR GENERAL ANAESTHESIA

•FOR THE GENERAL ANAESTHESIA, THE PATIENT IS INTUBATED DURING SURGERY (AIR WAY TUBE PLACED FOR BREATHING)

•ALL LASER PRECAUTION TAKEN DURING THE PROCEDURES

•TIME TAKEN IS ABOUT 20 TO 30 MINUTES (DEPENDING ON THE EXTEND OF DEVIATION CORRECTED)

•CAN BE DONE AS A SOLE PROCEDURE OR IN COMBINATION WITH LASER TURBINOLASTY, WITH LASER ADENOIDECTOMY OR DURING FESS (SINUS SURGERY)

•THE PROCEDURE IS DONE FOR MINIMAL OR MODERATE SEPTAL CARTILAGE DEVIATION.

•THIS PROCEDURE IS DONE UNDER GENERAL ANAESTHESIA

•A SMALL VERTICAL INCISION IS MADE AT THE SITE OF DEVIATION OR ANTERIORLY AND THE MUCOPERICHONDRIUM (COVERING OF THE SEPTAL CARTILAGE) IS ELEVATED AND THE CARTILAGE IS EXPOSED.

•THE SITE OF DEVIATION IS IDENTIFIED, USING CO₂ LASER; THE DEVIATION IS REDUCED TO A SATISFACTORY SHAPE.

•THE MUCOPERICHONDRIUM IS THEN SUTURED WELL.

•IF A SMALL INCISION IS MADE FOR A SMALL DEVIATION OR A LOCALISED SMALL SPURS, THE MUCOPERICHONDRIUM IS THE LEFT IN APPROXIMATION TO COVER THE SEPTUM WHICH IS CORRECTED (THIS IS SUFFICIENT TO ENABLE CLOSURE OF THE MUCOPERICHONDRIUM) THUS AVOIDING ANY SEPTAL PERFORATION

ADVANTAGES OF RAISING THE MUCOPERICHONDRIUM (SKIN LINNG OF THE SEPTUM) ARE MULTIFOLD!!!!!!!!!!

1) IT EXPOSES A GREAT AREA TO WORK

2) IT SECURES THE BLOOD SUPPLY AND RETAINS THE COVER FOR THE SEPTAL CARTILAGE PREVENTING SEPTAL PERFORATION.

3) IT ALLOWS CORRECTION OF THE NASAL TIP (NASAL VALVE AREA). THIS AREA IS GENERALLY NOT ADDRESSED DURING SEPTAL CORRECTION, THUS CAUSNG NASAL OBSTRUCTION

4) ALLOWS THE SURGEON TO HAVE A PANORAMIC VIEW OF THE SEPTAL CORRECTION DONE

5) IN CHILDREN SEPTAL SPURS ARE CORRECTED WITH MINIMAL RAISING OF THE MUCOPERICHONDRIUM, THIS IS TO AVOID ANY SEPTAL GROWTH ARREST. THIS METHOD ALLOWS EARLY CORRECTION OF THE NASAL AIRWAY THUS ALLOWS THE SINUSES TO GET SUFFICIENT VENTILATION REQUIRED FOR THE GROWTH OF THE SINUSES (IMPORTANT FOR THE FACIAL COSMETIC OUTCOME)

POST SURGERY

• ONCE THE PATIENT IS CONSCIOUS (REGAINED FROM THE ANAESTHESIA) THE PATIENT CAN EAT NORMAL DIET

•FOLLOW UP IS AFTER 5 DAYS TO 1 WEEK DEPENDING ON THE TYPE OF COMBINATION SURGERY DONE.

•PATIENT HAS TO SPRAY NASAL DECONGESTANT (IF A COMBINATION SURGERY IS DONE) AND NASAL DOUCHING WITH SALINE TO CLEAR THE NASAL PASSAGE. CURRENTLY WE USE RHINOWASH TO DOUCHE THE NOSE(RHINOWASH IS A GOOD NASAL CLEANSING DEVICE)

•BACK TO NORMAL DUTY (SCHOOL OR WORK) IN A FEW DAYS (IF IT IS A SOLE PROCEDURE)


NASAL AIRWAY SPLINT / STENTS
  



Nasal Airway Splint

 

THE NASAL AIRWAY SPLINT IS DESIGNED TO PROVIDE SEPTAL SUPPORT AND ALLOW NASAL BREATHING POST-OPERATIVELY THROUGH THE INTEGRAL AIRWAY. THE FLEXIBLE SPLINTS CAN BE SUTURED THROUGH THE PREFORMED HOLES ON THE TIP OF THE SPLINTS FOR STABILIZATION. THE MATERIAL IS CLEAR, MEDICAL-GRADE SILICONE.

 

 

INDICATIONS FOR USE:

 

TO MAINTAIN A NASAL AIRWAY WHILE PROVIDING SUPPORT FOLLOWING SURGERY AND TO PREVENT NASAL SYNACHAE

 



NASAL STENTS IN PLACE AFTER SURGERY



NASAL STENT IN PLACE AFTER SURGERY -
To be removed after 10 days

 

 

  

 

 

 

Ø ENDOSCOPIC LASER ASSISTED ADENOIDECTOMY

 

 

 

 

 

Adenoids present in the Nasopharynx.

 

WHO NEEDS LASER ASSISTED ADENOIDECTOMY?

• CHILDREN

• SOME ADULTS

 

WHY DO WE DO ADENOIDECTOMY?

•  RECURRENT ADENOID INFECTION

•  ENLARGED ADENOID CAUSING SNORING AND SLEEP APNOEA

•  ENLARGED ADENOID CAUSING RECURRRENT MIDDLE EAR INFECTION

• RECURRENT UPPER RESPIRATORY INFECTION DUE TO BLOCKAGE OF MUCOSAL DRAINAGE LEADING TO POST NASAL DRIP FROM NOSE TO THROAT

•  PEOPLE WHO DEVELOP FREQUENT BAROTRAUMA DURING FLIGHT OR DEEP SEA DIVING

• CHILDREN WHO MOUTH BREATH AND HAS NOISY BREATHING (STERTOR)

 

WHAT BENEFITS DO LASER ASSISTED ADENOIDECTOMY HAVE?

•  LESS PAIN

•  FASTER RECOVERY

•  SAFE

• WELL DEFINED REMOVAL OF ADENOID WITHOUT ACCIDENTAL INJURY TO THE CERVICAL VETEBRA

• PARTIAL REMOVAL OF ADENOID FOR RECURRENT EUSTACHIAN TUBE OBSTRUCTION

•      LESS BLEEDING LESS INCIDENCE OF PHARYNGEAL STENOSIS

•      LESS INCIDENCE OF EUSTACHIAN TUBE INJURY

 

 

WHAT ARE THE RISKS INVOLVED?

• MINIMAL RISK

• LESS THAN THE CONVENTIONAL (OLDER) METHOD OF REMOVING

  ADENOID

WHAT IS A GOOD AGE?

• NO SPECIFIC AGE

 

LARGE ADENOID BEFORE SURGERY

 

 

1 WEEK POST LASER SURGERY

 

 

 

 

PROCEDURE

•DISCUSS WITH THE DOCTOR

•DAY CARE PROCEDURE OR AS AN INPATIENT WITH OVER NIGHT STAY

•SURGERY IS DONE UNDER GENERAL ANAESTHESIA

•PATEINT IS INTUBATED (AIR WAY TUBE PLACED FOR BREATHING)

DURING SURGERY

•LASER PRECAUTION TAKE DURING ALL LASER PROCEDURES

•TIME TAKEN IS ABOUT 15 MINUTES

•POST SURGERY – ONCE THE PATIENT IS CONSCIOUS, PATIENT CAN EAT

NORMAL DIET

•FOLLOW UP IS AFTER 5 DAYS TO 1 WEEK.

•BACK TO NORMAL DUTY (SCHOOL OR WORK) IN 1 OR 2 DAYS

 

  

Ø LASER FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS)

 

THIS PROCEDURE IS NEW AND IS VERY REWARDING

 

1) OPENING OF THE UNCINATE PROCESS

2) OPENING OF THE OMC

3) REDUCTION OF THE ETHMOID AIR CELLS

4) REDUCTION OF THE MIDDLE TURBINATES

5) OPENING OF THE FRONTAL RECESS
 

 

As mentioned earlier, paranasal Sinuses are air-filled cavities surrounding the nasal cavity, which are layered by the breathing and living skin called as mucosa. The mucosa produces mucous (clear fluid felt and seen in the nostrils).

 

The mucous drains through small openings in a very narrow space in the nasal cavity (between the turbinates).

 

 

 

 



Normal Drainage of Paranasal Sinuses

 



 

With the enlarged turbinates and/or deviated nasal septum, the normal drainage of the paranasal sinuses gets blocked. The long standing block leads up to collection and filling of mucous in these sinuses causing Sinusitis.

 

 



A Normal CT Scan of the Paranasal Sinuses that are clear.

POST NASAL THICK MUCOUS DISCHARGE


 

POST NASAL THICK MUCOUS DISCHARGE

Thick mucous seen at the sinus openings




Functional Endoscopic Sinus Surgery is a surgical procedure that is done to restore the normal functioning of the sinuses.

 

 

CONVENTIONAL SINUS SURGERY

Large sinus cavities causing retention of mucous which leads to persistent post nasal drip and nocturnal cough.

 

 

 

The surgery involves maintaining the patency of the opening into the sinus and removing any obstructions surrounding it. The sinus cavities are not widened as this allows normal mucosal movement through the natural opening.

 

 

 

LASER SINUS SURGERY
Natural Sinus openings can be seen clearly without any obstruction to the airway.

LASER SINUS SURGERY
Sinus openings are widened without opening the sinus cavities.

POST LASER SINUS SURGERY
Natural sinus openings are opened without opening the sinus cavities

 

  

 

 

OTHER NASAL PROCEDURES

1) RELEASE OF SYNACHAE

2) EXCISION OF NASAL LESIONS (SMALL TUMORS)

3) MAKING INCISIONS ON THE NASAL MUCOSA

4) IN ALLERGIC RHINITIS, BY REMOVING A LAYER OF THE NASAL MUCOSA WITH LASER REDUCES THE NASAL ALLERGY BY A SIGNIFICANT PERCENTAGE> THAN 70 -90% (LOCAL STUDY IN TMC)

 

 

 

 

Ø LASER TONSILLECTOMY

 

 

PROCEDURE

 

THIS PROCEDURE CAN BE DONE EITHER AS A DAY CARE PROCEDURE OR AS ADMITTED TO THE WARD. THE PROCEDURE IS DONE UNDER GENERAL ANAESTHESIA. IT USUALLY TAKES ABOUT 15-20 MINUTES.

 

 

ADVANTAGES

• MINIMAL PAIN
• MINIMAL BLEEDING
• EARLY RECOVERY

POST SURGERY CARE


FIRST ONE WEEK -

• SOFT DIET, NON-SPICY, NON-HOT DIET
• PROPER HYDRATION
• ANALGESICS AS PRESCRIBED
• NO ACTIVE SPORTS / ACTIVITIES

SECOND WEEK -

• NORMAL DIET
• NO RESTRICTION OF LIFESTYLE
• BACK TO WORK / SCHOOL
• ABLE TO FLY / NO TRAVEL RESTRICTIONS

During Surgery - Tonsil removed, clean dry wound

Close up on the 4th Day Post Surgery - showing slough in a clean wound

4th Day Post Surgery - clean wound

1 Week Post Surgery - excellent healing

 

CAUTION

 

• LASER PROCEDURE IS VERY DELICATE
 
• IT REQUIRES SUFFICIENT TRAINING AND PROPER UNDERSTANDING OF THE PROCEDURE AND ANATOMY
 
• PROPER IMPLEMENTATION OF A SOUND PROTOCOL IS NECESSARY.
 
• ALTHOUGH THE RISK IS SMALL, THIS IS GAUGED BY THE EXPERIENCED HANDS, IN THE UNTRAINED HANDS IT CAN BE GRAVE!!

 

 

 

SUGGESTIONS

 

FOR THOSE WHO WANT TO VENTURE INTO LASER SURGERIES, THE BEST METHOD IS TO TRAIN UNDER SUPERVISION AND TO ATTEMPT SMALL LESIONS BEFORE EMBARKING INTO THE ADVANCED PROCEDURES.

FOR PATIENTS WHO WANT TO KNOW MORE, PLEASE KINDLY CONTACT ME AT TMC - 03 62871075.


FUTURE PLANS

TO DO MORE PROCEDURES UNDER LOCAL ANAESTHESIA

 

IT IS A WEAPON AND CAN CAUSE SERIOUS HARM IF USED AS A TOY !!!!

 

 

 

 

 

 

 

DR. BALACHANDRAN APOOO

 

CONSULTANT ENT HEAD NECK SURGEON LASER SURGEON

 

TROPICANA MEDICAL CENTRE

 

KOTA DAMANSARA

 

MALAYSIA

 

03 62871111

 

bala.entlaser@gmail.com

 

 

 

Edited By -

 

DR. KIRTI JUNEJA

 

MBBS

 

ENT TRAINEE (ON CLINICAL ATTACHMENT)

 

TROPICANA MEDICAL CENTRE

 

KOTA DAMANSARA

 

MALAYSIA

 

kirtijuneja89@gmail.com