March 1, 2023

Sinus Navigation System

Similar to the way Global Positioning Systems (GPS) have revolutionized how we find our way in cars, sinus navigation systems have transformed the way surgeons perform endoscopic sinus surgery.

A GPS uses satellite navigation devices to find your car’s location and display it on a local map. It can then calculate your shortest, fastest route to get where you need to go. Now imagine a similar process that allows surgeons to better pinpoint where structures are in the interior of your nose.

Your sinuses are air-filled cavities in your skull that link your nasal passages via small channels. The channels allow air to flow into your sinuses and mucus to drain from your sinuses into your nose. You have 8 pairs of sinus cavities in your head. The largest cavities are above and below your eyes and smaller pairs are between your eyes and in the middle of your head along your skull base.

A sinus navigation system is essentially a GPS for your nose. Before performing endoscopic sinus surgery, your physician will order images of your sinus cavity. During the surgery, they can calibrate the images to pre-set reference points in your anatomy. This helps track the position of the surgical instruments inside your nasal cavity and pinpoint locations of specific sinuses or other structures within your nose. This technology was originally developed for neurosurgeons but was soon after adapted for endoscopic sinus surgery.

What is Endoscopic Sinus Surgery?

Although the first recorded use of endoscopy to visualize a nasal passage was in Berlin, Germany in 1901, Dr. David William Kennedy, a professor at the Johns Hopkins School of Medicine, was the first American surgeon to perform the procedure.

During minimally invasive endoscopic sinus surgery, your doctor goes through your nostrils to remove blockages or treat other sinus problems without cutting your skin. A nasal endoscope includes a rigid, thin tube with fiber optic cables. It connects to a video camera and light and projects images onto a screen. This allows the surgeon to see into the very small cavities of your nose. Because endoscopic sinus surgery doesn’t involve cutting, it doesn’t leave scars.

Doctors use nasal endoscopy to diagnose a variety of problems, including:

Chronic sinusitis that isn’t responding to medication - Sinusitis is caused when your sinuses become blocked and filled with fluid. When your symptoms persist for more than three months, it is diagnosed as chronic sinusitis.
Nasal polyps - Nasal polyps are noncancerous growths on the lining of your nasal passages or sinuses caused by chronic inflammation from conditions such as asthma, recurring infection, allergies, drug sensitivity, or certain immune disorders.
Nasal obstruction or blockage - This occurs when your nasal passages are blocked, or you have difficulty breathing through your nose. It can be caused by nasal polyps or nasal tumors. Nasal obstruction also occurs if your adenoids (lymph tissue in your upper airway between your nose and the back of your throat) are swollen, or if the turbinates, (small structures in your nose that clean and humidify the air) become enlarged.

The goal of endoscopic sinus surgery is to open your sinus passages to:

Reduce the number and severity of your sinus infections
Improve symptoms of sinusitis such as a stuffy nose, facial pain and pressure, headaches, sore throat, or an achy jaw
Help mucus drain from your sinuses
Improve airflow through your nose
Improve your sense of smell
Help you reach your sinus cavities so you can rinse or clean them or deliver medication

If complex sinus anatomy or a previous surgery has you looking for a precise option, chat with us to find a sinus surgeon near you who uses image-guided navigation systems for safer, more accurate procedures.

Sinus navigation systems aren’t used during every endoscopic sinus procedure. In fact, if it is not necessary, a sinus navigation system won’t provide value for you or your surgeon. It will increase both the duration and expense of your endoscopic sinus surgery.

Sinus navigation systems are most useful for your doctor in cases where traditional surgery might be difficult, such as:

If you’ve had previous sinus surgeries
If you have complicated or unusual sinus anatomy
If you have benign tumors
If the bones between your sinuses and brain or eye are thinning

Three brands manufacture sinus navigation systems: Medtronic, Stryker, and Acclarent. Each of these devices is effective for sinus procedures. Surgeons usually choose based on their preferences or how compatible each device is with their existing equipment.

Acclarent’s TruDi Navigation system includes a software package with TruSeg and TruPath. TruSeg allows surgeons to apply automatic segmentation to a patient’s anatomical structures based on the preoperative CT scan, so they can more precisely label the eyes, brain, and other structures. These serve as beacons to alert a surgeon if a navigated instrument is coming close to the structure during an ENT procedure. TruPath calculates and shows the shortest path that won’t cross bone.

The Stryker ENT Navigation system uses Scopis software, which allows surgeons to analyze and identify sinus cells and complex patient anatomy and plan natural drainage pathways through a patient’s sinus cavities. During surgery, they can overlay the planned pathways in real time onto the endoscopic image for augmented reality technology.

The Medtronic StealthStation ENT Navigation System includes electromagnetic technology tracking and optical capabilities. It can be integrated with microscopes and ultrasound and offers additional instruments to use with it.

What Are the Benefits of Image-Based Sinus Surgery?

Surgeons must avoid eyes, nerves, major blood vessels, bones and the brain during endoscopic sinus surgery. Sinus navigation systems make it easier for physicians to position their instruments and make extremely precise movements during this procedure. It is most useful for doctors when they operate on patients who have had previous sinus surgery or have unusual anatomy.

For patients who need it, a sinus navigation system may mean:

Less post-surgery discomfort
Less blood loss during surgery
Fewer complication risks

Endoscopic Sinus Surgery Recovery

Traditional endoscopic sinus surgery involves removal of mucosa from your nose during the procedure to unblock the nose. With traditional endoscopic sinus surgery, most patients can return to work or school in one week and resume their regular routine in three weeks. Immediately after your surgery, you may experience:

Swelling and soreness - Your nose, upper lip, or cheeks may be swollen, and your nose may feel sore or bleed.
Congestion - Several days after the operation, you could feel congested as though you have a bad head cold.
Numbness - Any numbness in the tip of your nose, upper lip, or gums will usually go away after a few weeks or a few months.
Impaired sense of smell - This can last for about one to two months.
Fatigue - It is not unusual to feel tired for about one week after surgery.

To relieve your discomfort and keep your sinuses clear, your doctor may recommend:

An over-the-counter nasal saline spray - This can be used every two to three hours after surgery, so your nose doesn’t feel as sore.
Sinus irrigation - Your doctor will ask you to start this the day after surgery. You will usually be asked to irrigate at least twice a day to help clean out the debris in your sinuses.
Acetaminophen - You should avoid aspirin or any NSAIDs.

Your doctor will schedule post-operative appointments to see how you heal and clean any fluid from your nose and sinuses.

If your doctor uses navigation in conjunction with balloon sinuplasty technology you will have a quicker recovery and less down time. Ask your doctor what type of technique you require and reasonable expectations on recovery as it varies with each patient.

What to Avoid After Endoscopic Sinus Surgery

Following your doctor’s orders after endoscopic sinus surgery will help you heal as quickly as possible. Here are things they will ask you to avoid and for how long:

Swimming - this time frame varies but it can be up to six weeks
Sawdust, chemicals, and excessive dust - ask your doctor - up to four weeks depending on the extent of the procedure that was performed
Strenuous exercise - If you have balloon sinuplasty activity can return to normal the next day at the earliest. Most doctors will recommend longer restrictions for traditional sinus procedures, sometime up to one week and then ease back into these activities over two to three weeks
Heavy lifting and straining - time varies but restrictions can be up to 10 days
Blowing your nose - One to two days for balloon sinuplasty and up to 10 days for traditional sinus procedures
Aspirin or NSAIDs - before your surgery (at a duration recommended by your doctor) and for two weeks after depending on the recommendations of your doctor
Steroid nasal sprays - Some doctors start these immediately, others will have you stop these for two weeks or more

Navigating Endoscopic Sinus Surgery

Has your doctor recommended endoscopic sinus surgery? Speak with them to learn more about the procedure and ask if a sinus navigation system is right for you.

Sinus Navigation System