Did You Know?
o MORE THAN 70% OF THE NORMAL NOSE IS NOT SEEN WITH THE NAKED EYE - NOT EVEN WITH A STRONG LIGHT?
o A DEVIATED NASAL SEPTUM (D.N.S.) EXISTS IN MORE THAN 98% OF THE NORMAL POPULATION . IT MAY THEREFORE BE CONSIDERED A NORMAL ANATOMIC VARIANT & NOT A PATHOLOGY?
o IN CASES OF CHRONIC SINUSITIS, THE ANTERIOR ETHMOID GROUP IS MOST OFTEN THE ROOT CAUSE OF DISEASE AND NOT THE MAXILLARY SINUSES AS IS WIDELY BELIEVED?
o HEADACHES OF NASAL ORIGIN NEED NOT MANIFEST ONLY AS A FRONTAL HEADACHE - IT MAY BE REFERED TO ANY PART OF THE HEAD OR FACE?
o NASAL ENDOSCOPY HAS CAUSED A GREAT REVOLUTION IN THE FIELD OF NASAL DIAGNOSIS AND TREATMENT?
If there has been recently, in the field of Rhinology, a new diagnostic or therapeutic tool that has caused a revolution and a radical differentiation of specialists into the old school and the more logical new school, it is definitely nasal endoscopy.
Nasal diagnostics and treatment has always been hampered by an inadequate view into the nose. A large part of the nose is invisible to the naked eye. Paradoxically, it is this part of the nose that is usually the seat of the really chronic, serious and significant nasal disease.
One therefore had to fall back on X-rays for diagnosis of nasal and sinus disease which had unreliability as it's hallmark.(In fact, a study conducted, put the figure for inaccuracy of X-ray P.N.S. diagnosis at 63%). Nasal disease was therefore either missed or improperly diagnosed. Deviated nasal septums were often blamed for nasal complaints for which a cause was not found; and a host of unnecessary nasal surgery advised . A high recurrence rate after nasal surgery was thus common.
It is precisely this setback that has been overcome with the advent of nasal endoscopy. The greatly improved visibility offered by this technique makes early and precise diagnosis of nasal disease.
The anterior ethmoid group of sinuses being anatomically the most underaerated, SINUS DISEASE OFTEN ORIGINATES IN THE ANTERIOR ETHMOIDS. Gravitation of the discharge from here often leads to a secondary involvement of the maxillary sinuses. In cases of sinusitis therefore, the approach is not to indiscriminately puncture the nose but to attempt to identify the cause of this underaeration of the sinuses by nasal endoscopy and to rectify the cause -- where again a nasal endoscope is invaluable.Operative endosopy aims at restoration of this aeration pathway which paves the way for regeneration of the sinus mucosa. Scraping out of the sinus mucosa is therefore 'out' and a more functional approach 'in'. Hence the term FUNCTIONAL ENDOSCOPIC SINUS SURGERY (F.E.S.S.) Again the principle in F.E.S.S. is to treat all the sinuses as one group and deal with all of them in one sitting.
INDICATIONS OF NASAL ENDOSCOPY:
Diagnosis and help plan treat evaluation of headaches:
Headaches often originate in the nose. Interestingly, they need not always be referred to the frontal region. Endocopy is of immense value by virtue of being able to identify early sinus disease and identifying nerve pressure points in the nose.
Nasal endoscopy in chronic ear disease:
Serous otitis media or Middle ear effusions have their origin in a disordered eustachian tube function. Nasal endoscopy would pin-point it's cause; whether it be a simple sinusitis or a major nasopharyngeal carcinoma.
Nasal endoscopy in epistaxis:
When epistaxis is chronic and seemingly from deep inside the nose, endoscopy would identify the bleeding point and allow a precise cauterisation.
Nasal endoscopy in polpoidal sinus disease:
Early and accurate diagnosis is possible in nasal polyposis with this technique.
In the treatment of ethmoidal polypi, it is a great boon. Recurrence rates after conventional polypectomy which were nearing 100% have been drastically reduced (about 20% recurrence) with F.E.S.S.(Functional Endoscopic Sinus Surgery). The external scars of an external ethmoidectomy are also totally avoided
In the treatment of Antro-choanal polypi too, a Caldwel-Luc operation can be avoided and a recurrence rate of less than 5% can be achieved with an endoscopic procedure.
Nasal endoscopy in Chronic infective sinusitis:
In chronic infective sinusitis, F.E.S.S. offers a far superior cure rate than an Antral Puncture or Caldwel-Luc procedure.
Nasal endoscopy for biopsy of nasopharyngeal masses:
Effective visualisation, a precisely guided biopsy and avoidance of the need for general anaesthesia are the distinct advantages offered by this technique.
Nasal endoscopy before any septum surgery is advised:
Septum surgery is often advised due to a lack of a good view into the nose. Given the fact that air can pass through a curved passage, the logic for septum surgery is fast disappearing. In fact, the incidence of septum surgery has drastically reduced by atleast 80% in centres where the endoscopy logic has been accepted. A peep into the nose with an endoscope can identify the real cause of the nasal symptoms making septum surgery redundant.
Nasal endoscopy for a scar-less D.C.R.(Dachryo-cysto-rhinostomy):
Another great advance of F.E.S.S. has been it's application for performing a D.C.R. making it a scar-less surgery
Advantages of FESS
1. Simple local anaesthesia procedure.
2. Diagnostic endoscopy is an O.P.D. pro cedure. F.E.S.S:- 1-2days stay.
3. No external scars of surgery.
4. Greatly improved results .
COMPLICATIONS OF F.E.S.S.
1. Recurrence though rare
2. Epistaxis
3. Injury to the surrounding strucrures
4. OPTIC NERVE, ORBIT ; C.S.F. LEAKS.
o MORE THAN 70% OF THE NORMAL NOSE IS NOT SEEN WITH THE NAKED EYE - NOT EVEN WITH A STRONG LIGHT?
o A DEVIATED NASAL SEPTUM (D.N.S.) EXISTS IN MORE THAN 98% OF THE NORMAL POPULATION . IT MAY THEREFORE BE CONSIDERED A NORMAL ANATOMIC VARIANT & NOT A PATHOLOGY?
o IN CASES OF CHRONIC SINUSITIS, THE ANTERIOR ETHMOID GROUP IS MOST OFTEN THE ROOT CAUSE OF DISEASE AND NOT THE MAXILLARY SINUSES AS IS WIDELY BELIEVED?
o HEADACHES OF NASAL ORIGIN NEED NOT MANIFEST ONLY AS A FRONTAL HEADACHE - IT MAY BE REFERED TO ANY PART OF THE HEAD OR FACE?
o NASAL ENDOSCOPY HAS CAUSED A GREAT REVOLUTION IN THE FIELD OF NASAL DIAGNOSIS AND TREATMENT?
If there has been recently, in the field of Rhinology, a new diagnostic or therapeutic tool that has caused a revolution and a radical differentiation of specialists into the old school and the more logical new school, it is definitely nasal endoscopy.
Nasal diagnostics and treatment has always been hampered by an inadequate view into the nose. A large part of the nose is invisible to the naked eye. Paradoxically, it is this part of the nose that is usually the seat of the really chronic, serious and significant nasal disease.
One therefore had to fall back on X-rays for diagnosis of nasal and sinus disease which had unreliability as it's hallmark.(In fact, a study conducted, put the figure for inaccuracy of X-ray P.N.S. diagnosis at 63%). Nasal disease was therefore either missed or improperly diagnosed. Deviated nasal septums were often blamed for nasal complaints for which a cause was not found; and a host of unnecessary nasal surgery advised . A high recurrence rate after nasal surgery was thus common.
It is precisely this setback that has been overcome with the advent of nasal endoscopy. The greatly improved visibility offered by this technique makes early and precise diagnosis of nasal disease.
The anterior ethmoid group of sinuses being anatomically the most underaerated, SINUS DISEASE OFTEN ORIGINATES IN THE ANTERIOR ETHMOIDS. Gravitation of the discharge from here often leads to a secondary involvement of the maxillary sinuses. In cases of sinusitis therefore, the approach is not to indiscriminately puncture the nose but to attempt to identify the cause of this underaeration of the sinuses by nasal endoscopy and to rectify the cause -- where again a nasal endoscope is invaluable.Operative endosopy aims at restoration of this aeration pathway which paves the way for regeneration of the sinus mucosa. Scraping out of the sinus mucosa is therefore 'out' and a more functional approach 'in'. Hence the term FUNCTIONAL ENDOSCOPIC SINUS SURGERY (F.E.S.S.) Again the principle in F.E.S.S. is to treat all the sinuses as one group and deal with all of them in one sitting.
INDICATIONS OF NASAL ENDOSCOPY:
Diagnosis and help plan treat evaluation of headaches:
Headaches often originate in the nose. Interestingly, they need not always be referred to the frontal region. Endocopy is of immense value by virtue of being able to identify early sinus disease and identifying nerve pressure points in the nose.
Nasal endoscopy in chronic ear disease:
Serous otitis media or Middle ear effusions have their origin in a disordered eustachian tube function. Nasal endoscopy would pin-point it's cause; whether it be a simple sinusitis or a major nasopharyngeal carcinoma.
Nasal endoscopy in epistaxis:
When epistaxis is chronic and seemingly from deep inside the nose, endoscopy would identify the bleeding point and allow a precise cauterisation.
Nasal endoscopy in polpoidal sinus disease:
Early and accurate diagnosis is possible in nasal polyposis with this technique.
In the treatment of ethmoidal polypi, it is a great boon. Recurrence rates after conventional polypectomy which were nearing 100% have been drastically reduced (about 20% recurrence) with F.E.S.S.(Functional Endoscopic Sinus Surgery). The external scars of an external ethmoidectomy are also totally avoided
In the treatment of Antro-choanal polypi too, a Caldwel-Luc operation can be avoided and a recurrence rate of less than 5% can be achieved with an endoscopic procedure.
Nasal endoscopy in Chronic infective sinusitis:
In chronic infective sinusitis, F.E.S.S. offers a far superior cure rate than an Antral Puncture or Caldwel-Luc procedure.
Nasal endoscopy for biopsy of nasopharyngeal masses:
Effective visualisation, a precisely guided biopsy and avoidance of the need for general anaesthesia are the distinct advantages offered by this technique.
Nasal endoscopy before any septum surgery is advised:
Septum surgery is often advised due to a lack of a good view into the nose. Given the fact that air can pass through a curved passage, the logic for septum surgery is fast disappearing. In fact, the incidence of septum surgery has drastically reduced by atleast 80% in centres where the endoscopy logic has been accepted. A peep into the nose with an endoscope can identify the real cause of the nasal symptoms making septum surgery redundant.
Nasal endoscopy for a scar-less D.C.R.(Dachryo-cysto-rhinostomy):
Another great advance of F.E.S.S. has been it's application for performing a D.C.R. making it a scar-less surgery
Advantages of FESS
1. Simple local anaesthesia procedure.
2. Diagnostic endoscopy is an O.P.D. pro cedure. F.E.S.S:- 1-2days stay.
3. No external scars of surgery.
4. Greatly improved results .
COMPLICATIONS OF F.E.S.S.
1. Recurrence though rare
2. Epistaxis
3. Injury to the surrounding strucrures
4. OPTIC NERVE, ORBIT ; C.S.F. LEAKS.
