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Modern Management of Sinus and Nasal Disease

The presence of sinus or nasal disease can have a major impact on some of our basic human functions such as sense of smell and taste. Many conditions can give rise to nasal blockage, with the two most common causes being sinus disease and structural deformities of the nose and septum.


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Acute and chronic sinusitis 

We have four groups of sinuses:

• Maxillary

• Ethmoid

• Frontal

• Sphenoid

Although the actual function is unclear, many disease processes can affect the sinuses. Chronic sinusitis, refractory to primary care medical therapy, is probably the most common reason to refer patients to a rhinologist. Patients present with myriad symptoms and signs that include nasal obstruction, mucopurulent rhinorrhoea, postnasal drip, sinofacial pain or headaches, anosmia, nasal congestion or chronic cough.

Medical management

Following confirmation of the diagnosis, usually from a CT scan, many patients will be successfully managed by a robust regime of medical treatment, consisting of a short course of oral steroids together with intranasal steroids combined with a Macrolide antibiotic and an antihistamine. Such aggressive medical treatment
has reduced the surgical intervention rate.

Surgical management

Symptomatic patients following failed medical therapy are managed by endoscopic sinus surgery. The obstructive sinuses are converted from being an intricate labyrinthine structure to being an ‘open-plan’ set of cavities draining into the nasal passages and allowing better access for post-operative medical treatment. Care is taken to preserve as much of the turbinate mucosa as possible so as to avoid altering laminar air flow and minimising the risk of damage in the olfactory fibres. Frequently, a septoplasty needs to be carried out at the same time for improvement of the airway and for access to the sinuses.

Balloon sinuplasty

This is a relatively new technique which employs the insertion of a guide wire through the natural ostium over which a balloon can be railroaded. Once the balloon is progressed into the frontonasal duct, it can be inflated to 12 atmospheres of pressure. This results in the expansion of the frontonasal duct but without any trauma to the surrounding mucosa thereby minimising the risk of scar tissue formation and re-stenosis. New features include drug-eluting devices which sit in the osteomeatal complex region and deliver a high concentration of steroids to the surrounding area, minimising oedema and facilitating drainage.

Image guidance surgery

In patients who have multiple previous procedures the anatomy of the sinuses can become severely distorted, making trauma to neighbouring structures a real possibility. 3D image guidance techniques reduce the risk of complications by guiding the surgeon to within 2mm of important structures, thereby avoiding complications.

Septo- rhinoplasty

Septo- rhinoplasty surgery is well recognised as one of the most complex of facial plastic surgical procedures as the surgeon has to deal with deformities of bone, cartilage and soft tissue. Complex deformities of the nose require an external rhinoplasty approach, utilising an incision between the nostrils, thereby allowing the skin to be elevated off the underlying cartilages. This technique allows full access to the septum and a large range of techniques can be used to straighten the septum and retain its new position. At the same time, manoeuvres can be utilised to provide support for the dorsum and the tip of the nose. Functional rhinoplasty often requires attention to aesthetics as well as creation of physical space for breathing.


Keywords

Mr Kalpesh Patel, Ear, Nose and Throat, ENT, nasal disease, sinus disease, nose, septum, balloon sinuplasty, septo-rhinoplasty, chronic sinustis,



Issue
Number:
16
Title:
Robotically-Assisted Weight Loss Surgery
Published:
June 2014
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Mr Kalpesh Patel

Consultant ENT Surgeon

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