Chronic sinusitis sufferers from southern Gauteng now have the option of minimally invasive surgery on their doorstep.
Mediclinic Vereeniging is now offering navigation-assisted functional endoscopic sinus surgery (FESS) to bring relief to patients with inflamed or acutely infected sinuses (sinusitis), as well as to remove nasal polyps (polypectomy) and open blocked sinuses.
Detailed surgery possible with technology
Otorhinolaryngologist (ear, nose and throat or ENT surgeon) Dr Fanelesibonge Mdletshe recently conducted the first navigation-assisted functional endoscopic procedure at Mediclinic Vereeniging. This procedure is invaluable for conducting safe, intricate surgery, sometimes just millimeters away from critical anatomical structures such as the brain, the eyes, nerves and arteries.
In select cases, this type of sinus surgery can be done with the assistance of a tool designed for neurological and sinus-related procedures. The system uses radiology images of the sinuses and brain (usually from magnetic resonance imaging (MRI) or computerised tomography (CT) scans), which are loaded onto a screen for the surgeon to view to help navigate intricate areas during the surgery, while using a nasal endoscope,” says Dr Mdletshe.
An endoscope is an inspection instrument comprising a thin rod with lights and a lens, which is used to look deep into the body without making incisions in or around the patient’s nose.
“Because we are working in the nose at the base of the skull, which is very close to the brain, the radiology images help us see where these important structures are while we are doing sinus surgery so we can avoid injury these areas in complex cases where there are structural changes.
Having access to these images helps the surgeon navigate in areas that are very close to the brain, the optic nerve, eyes and large vessels. It is very important to know where these structures are while conducting surgery to avoid damage or injury.”
This endoscopic procedure is not suitable for all sinus procedures, explains Dr Mdletshe, but rather the more complex cases. Some cases can be cleared without the need for navigation, providing these cases do not involve surgery near the eyes or the base of the brain.
Infective sinusitis and who is most at risk
Sinusitis can be caused by a viral, bacterial or fungal infection.
“Sinusitis can be infective and non-infective. Infective sinusitis is most commonly the result of a virus, such as a common cold. Air-borne viruses enter one’s system through the nose, which is the gateway to the sinuses,” she says.
“The nose is like the security gate and main street at an estate, it serves as a filter and humidifier of air with the sinuses being all the little streets leading off from there. It is all connected, so if you get an intruder entering through the gate, it’s going to eventually affect everybody on the estate. So, when you have a viral infection, it will affect the whole mucosa, the pink covering of the inside of the nose, leading into the sinuses.”
Viral infections can affect anyone, but those most at risk are the very young and the elderly. Bacterial sinus infections are most common in people who are immuno-compromised and/or can be superimposed on viral infections.
The third type of sinus infection is a fungal infection, which are a bit more complex and can take on many forms, notes Dr Mdletshe. “There are fungal infections which occur in people with low immunity, and fungal infections that are associated with allergies and which are more of a chronic disease. Finally, you get the weird and wonderful infections like protozoal infections, which don’t occur very often.”
The most common type of infective sinusitis is viral sinusitis, which is usually self-limiting and can normally be treated symptomatically. Most of the patients Dr Mdletshe operates on have bacterial sinusitis, fungal sinusitis and allergic disease leading to polyps in the nose.
Allergies and your sinuses
There is also non-infective sinusitis, the biggest group of which is allergies, such as people with hayfever, who sneeze considerably in spring when the pollen-count is high – or sometimes all year round, depending on their offending allergen or trigger. Hayfever sufferers can develop swelling inside the nose, which can also develop into polyps or grape-like growths inside the nose and sinuses.
Dr Mdletshe explains that with hayfever-related sinusitis, the first treatment is always medical with topical intranasal corticosteroids, antihistamines and nasal douches commonly used to reduce inflammation and improve nasal function.
In select cases that are resistant to medical therapy, we conduct endoscopic surgery to remove polyps/growths and clear the nasal passages for better breathing and improvement of smell sensation.
Benefits to patient and surgeon
The value of navigation-assisted FESS to the patient is that the surgery does not leave a scar. “In the past, a cut would have to be made on their face to access the sinuses,” says Dr Mdletshe. There is still a place for open surgery of the sinuses under certain limited circumstances as the trend is now towards minimally invasive surgery.
For the surgeon, the tool provides them with access to places they would otherwise be unable to reach safely. “For example, through endoscopic surgery, we can remove cancerous growths and tumours from the skull base, together with other surgeons, such as neurosurgery and ophthalmology teams using the sinuses and then orbit as access points.”