Minimally invasive endonasal paranasal sinus and nasal surgery and digital volume tomography (DVT)

Modern endonasal and nasal sinus surgery is founded on the development of exact procedures, intensive specialised training and advanced education. The demand for the minimally invasive method already goes back 25 years. Scientific research and the improvement of operative techniques have paved the way for the development of methods that minimally traumatise the paranasal sinuses and entail virtually no complications. External skin incisions are thus not required. The intervention takes place through the nostrils. At the same time, modern x-ray diagnostics has made an essential contribution to diagnosis and strategic operation planning. The only very recently introduced technique of digital volume tomography permits the acquisition of images with significantly lower radiation exposure compared with conventional computed tomography and three-dimensional images of the skull. It enables the recognition of paranasal sinus disorders, the display of nerve structures, and simplifies operative management. These operative measures can be used for the therapy of inflammations of the paranasal sinuses in conjunction with nasal breathing problems, often associated with disturbances to the sense of smell, headache, increased secretion, asthmatic and allergic problems, loud snoring and sleep disturbances.

Goal: Restoring physiological nasal breathing and optimised aeration of the paranasal sinuses, with normalisation of nasal secretion and nasal mucous tissue.

Indications:

• nasal and paranasal sinus polyps
• cysts of the maxillary sinuses
• mucocele and pyocele formation (DVT images)
• meningeal fistulae of the base of the skull (3D paranasal sinus images of  chronic inflammations of the paranasal sinuses)
• thickening of the nasal concha
• arcuations of the nasal septum
• tumours of the paranasal sinuses, and
• lacrimal duct drainage impairments.

Technique: Microscopic, endoscopic procedure, laser and coblation technique

Hospital stay: Largely in-patient for 3-4 days, according to complexity also out-patient in the Anaesthesia Day Clinic: general anaesthesia

Dressing: 1-2 days light nasal tamponade

Pain: virtually none

after 2-7 days awareness: besides the classical nasal septum operation, all forms of revision operations of the nasal septum, with construction of the nasal columella, operation for the widening of the nasal valve or plastic defect closure with the formation of holes in the nasal septum, using the patient's own cartilage in order to obtain natural nasal breathing.