RHINOLOGY AND FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS)

Rhinology is that aspect of Otorhinolaryngology that deals with diseases of the nose and sinuses. The most common condition affecting the nose is chronic sinusitis, which refers to chronic infection and inflammation of the sinuses. Approximately 15% of the North American population suffers from sinusitis, which presents with headaches, facial pain, pressure, loss of smell and taste, nasal congestion, obstruction and postnasal drainage. In most instances chronic sinusitis occurs as a result of blocked sinus drainage pathways usually secondary to a viral cold, or sometimes allergies. When the narrow sinus drainage pathways obstruct, the sinuses, which continue to make mucous, get infected with bacteria from the nose resulting in a bacterial sinus infection. If this is not dealt with quickly, the lining of the sinuses get inflamed and further obstruct the drainage pathways, resulting in a chronic sinus infection. Polyps usually occur as a result of the chronic infection and add to the sinus and nasal obstruction.

Endoscopic sinus surgery was introduced in the early and mid 1980's to North America by Dr. Heinz Stammberger, a student of Dr. Messerklinger in Graz, Austria. Dr. Messerklinger was the first to use endoscopes, thin pencil-like rods with fiber optic light pathways, to provide superior views of the sinus drainage pathways. Such unparalleled visualization allowed sinus surgeons to accurately open natural drainage pathways of the sinuses without destroying critical mucous membrane lining, or creating "windows" in the sinuses where they didn't belong. Hence the term "functional endoscopic sinus surgery". Recent technologic advancements have allowed sinus surgeons to use computers to guide exactly where their instruments are located within the sinuses, in real time, during surgery. Such technology (Computer Assisted Sinus Surgery - CASS) has allowed sinus surgeons to forge into previously unchartered territory, such as the removal of skull base tumors and repair of brain fluid (CSF) leaks without making skin incisions, and with significantly reduced morbidity and shorter hospital stay for the patients. St. Paul's Sinus Center was the first to obtain a computer-guided system in Western Canada and the second in Canada. Vancouver now has three image-guided systems in operation at different facilities.
(Upper image: Sphenoid Sinus during surgery to remove fungal ball.)