When less invasive, non-surgical approaches are unsuccessful in treating ear, nose, and throat disorders, having an experienced, well-educated surgeon to take the next steps in treating your problems is essential. Dr. Peter Killian at Treasure Valley Nasal & Sinus Center is the leading sinus surgeon in the state of Idaho for these procedures. As a fellowship-trained rhinologist, Dr. Killian expanded his skills after residency by completing an additional year of training in endoscopic sinus and skull base surgery giving him a unique combination of surgical training and experience in performing these surgeries.
When Do You Need Nasal and Sinus Surgery from an ENT Physician?
Because Dr. Killian specializes in complex nasal and sinus conditions, many patients come to our ENT clinic having exhausted their options with other healthcare providers. Whether you are just beginning to uncover your ENT diagnosis or you have tried other forms of treatment to no avail, Treasure Valley Nasal & Sinus Center is here to help you take the next step.
Surgery is often not the first step for most common ENT diseases; however, once other options have failed, surgery is a reasonable (and possibly essential) option to resolve lingering and disruptive symptoms. Modern surgical techniques such as functional endoscopic sinus surgery (FESS) have also drastically reduced invasiveness, complications, and recovery time resulting in better outcomes for our patients.
Types of Nasal, Sinus and Skull Base Surgery
Septoplasty
This is what we call a deviated nasal septum repair through surgery. This procedure is used when the nasal septum (a part of the facial skeleton made up of cartilage and bone) is crooked or malformed in a way that prevents clear breathing, sinus drainage, and may cause snoring and/or sleep apnea. While septoplasty may be a stand-alone procedure, it may also be included in a larger surgical correction to open the sinuses and nasal passages. This is also a specific surgery that uses endoscopic surgical techniques. Septoplasty is usually done under general anesthesia, meaning patients are asleep and pain-free during the procedure.
Nasal Turbinate Reduction Surgery
Turbinates are thin bony structures on the inside of the nose that are covered in soft tissue and mucosa. They help regulate the flow of air through the nose. The turbinate soft tissue, mucosa, and mucus blanket warms, humidifies, and filters the air that we breathe, conditioning it for our lungs.
When the inferior turbinates are inflamed or enlarged (called inferior turbinate hypertrophy), they can block the nasal passage, decreasing air flow and proper nasal and sinus drainage. If the nasal swelling is due to mucus membrane inflammation, non-surgical treatment is usually most helpful. However, when the narrow passageway is due to the bony and soft tissue structures being too large, surgery may be required to reduce the size and obstructive nature of the turbinate.
Nasal Polypectomy
Nasal polypectomy is the removal of nasal polyps. It is a common, minimally invasive treatment for nasal and sinonasal polyps if non-surgical approaches have failed. The size and depth of the polyps will determine the approach for removal. Some nasal polyps are near the opening of the nose and easy to reach. These can typically be visualized by the surgeon without an endoscope, and removal is quick and simple. If the polyps are further into the nasal cavity or into the sinuses, a more complete endoscopic sinus surgery may be needed for complete removal. The extent and location of the nasal polyps will also determine the type of anesthesia required, though local anesthesia is often an excellent choice for this procedure.
Functional Endoscopic Sinus Surgery (FESS)
Also abbreviated to just “endoscopic sinus surgery,” refers to a surgical technique rather than just a single treatment for a single condition. Conditions that can be treated with FESS include:
- Chronic Sinusitis (Rhinosinusitis)
- Nasal Polyps (Sinonasal Polyps)
- Sinonasal Tumors
- Other Forms of Nasal and Sinus Blockage and Congestion
FESS is a minimally invasive surgical procedure that uses a small camera mounted on a narrow tube (a nasal endoscope) inserted through the nostril into the nasal and sinus cavities. This allows sinus surgeons to visualize these small cavities and passageways without incisions on the face. Similarly small and narrow surgical tools can then be inserted through the nostril to remove obstructions and widen airways and sinus ostia, which improves breathing and nasal and sinus drainage. This procedure may be conducted under local or general anesthesia, depending on the condition being treated, the extent of the surgery, and the patient’s preference.
Image Guided Sinus Surgery
Also called computerized surgical navigation. Again, this is a surgical technique and not a procedure intended to treat one condition. Because of rapid improvements in the clarity and accessibility of medical imaging like MRI and CT scans (magnetic resonance imaging and computed tomography scans, respectively), sinus surgeons have developed techniques to get clear images of an operating site both before and during surgery. Along with endoscopic sinus surgery (see above), the guidance provided by this imaging reduces the invasiveness of a procedure, increases a surgeon’s accuracy, increases safety, and results in smoother, faster recovery for patients.
Image guided sinus surgery is essentially like having a GPS for your facial skeleton. The imaging allows ENT doctors to make a “map” and mark specific “landmarks” that are important in guiding them to the appropriate location on the day of surgery. Having thorough imaging performed before surgery helps ENT surgeons plan the procedure with much greater understanding and detail. Image guided surgery has the following steps:
- Imaging prior to surgery.
- During and soon after the imaging, and in consultation with a radiologist, the ENT physician uses a computer to carefully examine the images and digitally tag the landmarks that are important for surgery. This might include tumor margins (boundaries) or the location of a cerebrospinal fluid leak, for example.
- After documenting landmarks, the surgeon saves all the data, the imaging, and the “map”, to a computer or disk.
- The surgeon uploads the information from pre-surgery imaging to the imaging navigation system being used during the procedure.
- With a combination of the landmarks already identified and live imaging showing the location, direction, and movement of surgical tools, the surgeon completes the procedure.
The combination of past and present imaging gives surgeons greater accuracy, minimizing risk and again improving outcomes for patients.
Image guided sinus surgery can be especially helpful in:
- Cerebrospinal fluid (CSF) leak repair, many of those leaks have first been diagnosed with a CT scan to begin with.
- Performing revision sinus surgery when normal anatomic landmarks have been damaged, removed, scarred, and/or distorted due to severe sinusitis or injury which makes their cases more complex.
- Planning the removal of nasal or sinus tumors.
- Guiding surgeries affecting the anterior skull base, as it is one of the more difficult areas in which to operate endoscopically.
Nasal and Sinus Tumor Removal
Both malignant and benign nasal and sinus tumors can cause nasal obstruction and congestion. As one of the only fellowship trained sinus surgeons in the state of Idaho, Dr. Killian is uniquely qualified to diagnose and surgically remove nasal and sinus tumors. Pituitary and skull base tumors are removed in conjunction with neurosurgeons. These types of tumors are often able to be removed utilizing endoscopic surgical techniques that are less invasive, safer, allow for a quicker recovery and shorter hospital stay then traditional open techniques.
Cerebrospinal Fluid (CSF) Skull Base Leak Surgery
CSF leaks are rare, challenging to diagnose, and difficult to accurately localize. Cerebrospinal fluid protects and nourishes the brain and spinal cord and is vital to the proper function of the nervous system. When there is a hole or crack in the anterior skull base and the dura (outer covering of the brain) CSF may leak and require surgical repair if conservative measures fail. (See our page about CSF leaks for details about CSF leak symptoms. Also note that, since the meninges is involved, CSF leaks and corresponding repair may carry a risk of meningitis.)
When we think about the skull, and especially the skull base, a common assumption can be that it has nothing at all to do with the nose and sinuses. However, the anterior skull base, the portion of the skull base that is closest to the front of the facial skeleton, is very close to the sinuses and nasal cavity. The back of the frontal sinus and the upper border of the ethmoid and sphenoid sinuses comprise a large portion of the anterior skull base. This is why rhinologists are the ideal doctors to perform these repairs.
Once a leak is identified, a skull base surgeon uses endoscopic surgical techniques (see FESS above) to enter through the nose to gain access to the anterior skull base where the CSF leak can be clearly identified and repaired using a variety of techniques.
When such a complex operation is being performed in an incredibly sensitive part of the body, having a surgeon with experience in this exact procedure will give you the best possible outcome. Dr. Peter Killian at Treasure Valley Nasal & Sinus Center is one of the only fellowship-trained anterior skull base surgeon in the state of Idaho. He treats patients throughout the region–including patients from Oregon and surrounding regional states because his skill set is unique, and his education surpasses that of most ENT physicians.
No patient wants a doctor to utter the dreaded word “surgery”. Most people have a very reasonable unease regarding surgical procedures. However, if you’ve noticed your quality of life decreasing because of your moderate or severe sinusitis, nasal polyp symptoms, or CSF leak symptoms, modern surgical techniques in the hands of an extraordinarily capable and experienced surgeon like Dr. Peter Killian at Treasure Valley Nasal & Sinus Center can help you overcome that anxiety to pursue minimally invasive, effective treatments. Refining procedures, reducing post-operative pain, and decreasing recovery times for patients is the primary ENT goal for Peter Killian, MD.