Finally we can reach a point where we can reach a conclusion and implement a treatment plan.

Simply put, you may have rhinitis, in which case you'll need to use medication and perhaps do some lifestyle changes, or you may have sinusitis for which an operation may be indicated. Or you may have both conditions or you may have polyps which may demand both forms of treatment. There may also be additional factors, like a deviated nose septum or dental material in the maxillary sinus which may require additional management.

Chronic and reoccurring sinusitis (and some forms of facial pain or "sinus headaches") are almost always caused by obstruction of the openings or drainage pathways of the sinuses. There are several small anatomical structures which may need too be removed to unblock these openings. These structures can usually be identified on your CT scan and will have been pointed out to you during our detailed study of the CT.

The procedure which is done to open the sinuses is called Functional (because it restores the natural drainage and funtion of the sinuses) Endoscopic (because it is done with a little telescope through the nostrils) Sinus Surgery or FESS in short. It is a very delicate procedure and is best done by an experienced surgeon who knows the importance of working carefully and delicately in order to preserve as much as possible of the normal structures (this is probably one of the most important factors for a good result; aggressive surgery can ruin your nasal function forever). Your surgeon should also have a very good understanding of your specific pathology and your unique anatomy, which comes from studying your CT scan.

The extent of your surgery will be tailored to the causes and extent of your sinusitis and to your anatomy. Some of the sinuses which may need to be opened, are in very close relation to the floor of the brain and to the eye socket, eye muscles and vision nerve (you can read more about this in my blog page on sinusitis). In order to avoid damage to these structures, operations may sometimes be abandoned before completion for the sake of safety. One of the sinuses, namely the frontal sinus, is very difficult and technical to reach and to open properly. The opening of this sinus can be extremely difficult to find, the floor of the brain can easily be damaged in the process and the surgeon can sometimes think that he has opened it while, in fact, it may still be blocked by an eggshell-like dome.

In order to help me do these operations more safely and more completely, I do all the extended operations with surgical navigation (Stealth Surgery). This means that I have a special computer (called a Stealth Station)  which follows my instruments inside your sinuses, showing me on your pre-loaded CT scan exactly where I am and where I need to go when orientation becomes difficult with the endoscope alone. We are awaiting delivery of a brand new Stealth Station at Cormed (in the interim, we are renting one from Medtronic).

In short this translates into:

- better safety

- more complete operation

- more finesse

- better long term results

(You can read more about surgical navigation in FESS surgery here and here)