Chronic Sinusitis – For those patients who are unable to benefit from anti-allergic measures and medications, surgery becomes an important consideration in management. The simplest form of surgery is a sinus washout done under local anaesthesia. The cheek sinuses are irrigated to wash out pus within the sinuses, and to open the sinus ostia by forcing the irrigation fluid through it. 

Some common Rhinosinusitis cases seen on CT scans

Improving sinus drainage with surgery

Sinus surgery aims to restore sinus health by:

  • Opening up blocked and narrowed sinus openings
  • Removing diseased & abnormal tissue from within the sinuses (eg nasal polyps)

Functional Endoscopic Sinus Surgery (FESS) hastens recovery

FESS is a minimally invasive surgery done through the nose without any external cuts on the nose or face.   It may be used for the treatment of:

  • Sinus Infections 
  • Chronic sinusitis Headaches and Congestion
  • Fungal sinusitis
  • Nasal polyps
  • Complications of sinusitis

FESS surgery is performed though a computer imaging guidance system (IGS) with video attachment to the endoscope that allows the surgeon to look at a video monitor while operating. It is less of a physical strain on the surgeon. The FESS surgeon can spend a longer time on the operation with increased safety and better outcomes for the patient.

Computer Aided Navigation Sinus Surgery improves surgical precision

  • Allows surgeon to use high resolution CT scan imaging data to navigate precisely and safely in the patient’s sinuses during surgery
  • CT scans use X-rays to product images
  • Allows the surgeon to see into the patient’s sinus anatomy with X-ray vision!
  • Helps surgeon confirm his position in the patient’s sinuses
  • Every point in the patient’s sinuses has an x, y & z coordinate (real coordinates)
  • Image guided surgery works by matching and co-relating the real coordinates with the virtual coordinates
  • Produces 3D localisation information for navigation during surgery 
  • Allows surgeon to identify & avoid danger areas in the patient’s anatomy
  • Enhances the safety of sinus surgery 

(For a better understanding of who image guidance system is used in a sinus surgery, please watch video explanation listed at the end of this page.. video 7)

Surgeons, like pilots, need good navigation. Occasionally, in complex sinus operations, surgeon need to identify the eye optic nerve, carotid blood vessels, nasolacrimal duct, and base of skull. In these instances, computerized navigation instruments are available to lend a guiding hand. Computer navigation is particularly useful if the anatomical structures in the sinuses are distorted by developmental factors or previous surgery. It gives the surgeon good navigation to chart the course within the complex labyrinth of the nose and sinuses.

Endoscopic Rod Improves visualisation

The Hopkin’s endoscopic rod which is made of glass rod lenses with fibreoptic bundle allows more accurate diagnosis of the causes of sinusitis and enhance surgeon’s ability to perform sinus surgery by peering through the nostrils instead of having to make unsightly facial incisions.

Vacuum suction Microdebrider improves surgery safety

Microdebrider is an oscillating vacuum shaver (or microdebrider) often used during sinus surgery. This surgical instrument works like a hybrid between a vacuum cleaner and a hair trimmer. The trimmer chops off unwanted abnormal tissues, while the vacuum suction clears away unwanted debris and blood from the area of operation.

Advantages of the Microdebrider

  • Allows the surgeon to remove diseased tissue in a precise manner.
  • Cuts tissues sharply, without causing tearing and shearing that would have resulted with conventional sinus surgery instruments.
  • Reduces unnecessary damage to the sinus tissues, resulting in less scarring and more rapid healing.
  • Allows timely and opportune removal of blood and tissue keeping the operation site clean so the surgeon can proceed safely and smoothly under conditions of good visibility.

Balloon Sinuplasty

For more information on Balloon Sinuplasty, please click here

Video Explanations

1. Understand why your nose & sinus is blocked

In this video, Dr Kevin Soh reveals the different causes for block nose. He illustrates with interesting graphics and videos. Understand deviated nasal septum, nasal polyps, enlarged adenoids.

2. How To Get Rid Of Fungus In Your Sinus

In this video, Dr Kevin Soh describes what is fungal sinusitis, and how it can cause nose polyps. Learn how he approaches the maxillary sinus.

3. How is Functional Endoscopic Sinus Surgery Performed?

In this video, Dr Kevin Soh explains endoscopic sinus surgery using an example from a real case. Understand the different stages of the operation as seen during live surgery.

4. How is Functional Endoscopic Sinus Surgery Performed

In this video, Dr Kevin Soh explains functional endoscopic sinus surgery (FESS). What do you do if you still have frontal and ethmoid sinusitis after having had previous endoscopic sinus surgery. How to open the frontal sinus and remove the ethmoid sinuses properly.

5. How is Functional Endoscopic Sinus Surgery Performed

In this video, Dr Kevin Soh describes a case of sinusitis after titanium dental implantation. Functional endoscopic sinus surgery (FESS) was performed.

6. Sinusitis, Mucocele, Cyst in the Ethmoid Sinus

In this video, Dr Kevin Soh explains how to remove a cyst in the sinus without injuring the eye/brain.

7. Image Guided Sinus Surgery, Computer Navigation, for Sinus Surgery

In this video, Dr Kevin explains how image guided sinus surgery works.

8. How To Read CT Sinus Scans Like An Expert

In this video, Dr Kevin Soh explains the nose and sinus anatomy using slices from a CT sinus scan. Learn sinus anatomy while listening to jazz music. The Mozart Effect at work!