New innovations in sinus surgery technology

June 11th, 2017

Sinus surgery is an old, old discipline — in fact, it probably dates back to the ancient Egyptians.^[1] Over time, as technology and anatomical understanding have improved, so have surgical techniques. What used to be an extremely invasive procedure that required long recovery times has become a modern, efficient form of surgery using state-of-the-art devices and innovative techniques.

Endoscopic sinus surgery

The nasal endoscope was developed in the 1950s, and it changed the whole approach to the procedure; today, it is fundamental to sinus surgery.^[2] During functional endoscopic sinus surgery (FESS), the focus is on removing only the problematic tissue and opening up the airway. This way, diseased mucosa can return to normal and good sinus function can be achieved.^[2]

The endoscope itself is a slim instrument that is inserted into an opening in the body — in this case, the nostril — enabling a doctor to see inside the body without using incisions.

During FESS, the doctor uses the images relayed by the endoscope to guide tiny surgical instruments into the sinus cavity, where he or she removes tissue that is abnormal or obstructive. This means less extensive surgery for the patient, often with less loss of “good” tissue.^[2]

Image-guided sinus surgery AKA surgical navigation

In order to accurately guide doctors as they navigate patients’ unique sinus anatomy, an innovative advancement in endoscopic sinus surgery, called image-guided sinus surgery, was introduced. This procedure is very precise, thanks to a “map” of the patient’s own sinuses that’s created in advance.^[3]

For image-guided sinus surgery to work, this map must be accurate and detailed. Before the procedure the patient undergoes a thorough imaging procedure, either a CT scan or an MRI. During surgery, a special computer tracks the movement of the endoscope and surgical instruments against the map of the patient’s sinuses.

Balloon sinus dilation

Another sinus surgery advancement is called balloon sinuplasty,^[4],[5] a technique to open up blocked sinuses that was first marketed in 2005. In balloon sinuplasty, also called balloon dilation, the doctor first inserts a guide wire into the affected sinus. When the guide wire is in place, a balloon device is passed along the wire, and once it is positioned in the narrowest part of the sinus cavity that needs to be opened, it is inflated for a short time. Bone tissue is fractured, and moved outward. Afterward, the sinus passage is wider, allowing the sinuses to ventilate and drain.

Balloon dilation can be done alone or in conjunction with traditional endoscopic sinus surgery. Balloon dilation is not suitable for all patients or for all cases of sinusitis. When it is appropriate, it is looked upon favorably by both the American Rhinologic Society and the American Academy of Otolaryngology-Head and Neck Surgery.

Medicated, dissolvable sinus stent

The PROPEL^® sinus stent is another innovation intended to optimize recovery following endoscopic sinus surgery. Once the sinus is opened by the surgeon, the stent is inserted into the sinus that has been operated on, and it helps hold the sinus cavity open. As it does so, it also delivers anti-inflammatory medicine to the sinus tissue. The medicine is released for about 30 days. As the stent delivers drug it will dissolve over a 30 to 45 day period.^[6]The PROPEL sinus stent is proven to improve the outcomes of surgery by holding the sinuses open and treating the underlying inflammation.^[7]

Innovation in the ENT space is constantly evolving. Physicians and researchers are working to deliver ever-better surgical outcomes to patients, and technology continues to speed this process up and make advancements possible.