Sarah Goodwin

Kathi Ovnic
Holly Korschun
June 1, 1998

A computer-assisted technology for complicated sinus surgery cases is giving surgeons much more confidence in the safety and effectiveness of what can sometimes be a dangerous procedure.

"Sinus surgery is one of the most dangerous things we do," according to Emory otolaryngologist (ENT specialist) Todd Kingdom, M.D., "and it becomes even more dangerous in revision cases where a patient has already had multiple surgeries." Although the normal anatomy of the sinuses is well known, that anatomy varies from patient to patient and is distorted in revision cases. The biggest risk of sinus surgery is injury to the brain or eye.

"Image-guided sinus surgery helps us identify where those structures are and perform a more complete removal of diseased tissue while increasing safety," says Dr. Kingdom.

The new procedure, also called stealth technology, combines computer technology with sophisticated imaging techniques, and is the newest development in the field. Using a navigational system developed by Sofamor Danek, Inc., Emory ENT surgeons Kingdom, William Grist, M.D., and John DelGaudio, M.D., place a hand-held probe in the patient's nose while correlating their position with a special CT scan of the patient's sinuses visible on a computer screen. The new system allows surgeons to safely look for trouble spots, navigate around them and avoid them.

The sinuses are the eight air-filled cavities close to your nose and eyes that drain mucous into the nasal passages. When infected, they become blocked and filled with fluid, causing pressure around the face and eyes, headache, nasal discharge, a chronic cold and sometimes fever. Sinus infections result from allergies that produce mucous and block the tiny passages that drain the sinuses. Viral infections also can infect the cells lining the nasal passages, causing them to swell and produce mucus. Chronic allergies that lead to repeated episodes of swelling and mucus production can cause permanent thickening of the lining of the sinuses and the formation of polyps. Any kind of blockage can lead to further difficulties with drainage and more susceptibility to infection.

Although nearly 50 million Americans suffer from occasional or frequent sinus infections, most find relief in nasal decongestants, hot compresses, non-prescription pain relievers or antibiotics. In some people, though, chronic sinus infections do not respond to these common remedies and may require sinus surgery to allow drainage and healing. Using the state-of-the-art technique, surgeons work through the nose with endoscopes (small lighted telescopes) and remove the obstructive tissue. Straightforward first-time sinus surgery in the hands of a well-trained surgeon typically does not require stealth technology, Dr. Kingdom points out.

Revision cases, however, where patients have had previous, often multiple, sinus surgeries, present the greatest challenge to surgeons, Dr. Kingdom says. "Although nothing replaces anatomic knowledge of the surgeon, the stealth system is an adjunct that helps localize exactly where the growth is, the extent of it, how much needs to be removed, and how close we are to structures like the eye or the brain. This technology also is useful for benign and cancerous tumors of the sinus cavity or tumors in the skull-based area."

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