CENTRE FOR MICRO-ENDOSCOPIC ENT SURGERY CLINIC OF ATHENS bio_admin
CENTRE FOR MICRO-ENDOSCOPIC ENT SURGERY
Scientific Manager: Efthymios Christopoulos, ENT surgeon
In the last years, endoscopic surgery has become the state-of-the-art modality to manage most conditions that fall under ENT medicine.
Using mostly this technique, sinus and nose conditions can be treated. The sinuses are facial cavities that are located around the nose. They are divided into groups according to location: frontal, ethmoid and sphenoid. They contain air and communicate with the nose through small openings, from where the physiological or pathological fluids they produce are released.
Endoscopic surgery of the sinuses is termed Functional Endoscopic Sinus Surgery and is performed through the nose without external incisions using thin, inflexible endoscopes and a high-resolution camera. At the same time, Surgical Navigation-Computer Assisted Surgery technology is utilised; in this way, we can visualise the thin end of the special tools in real time during surgery by using the pre-operative CT scan of the patient performed at 3 levels, thus increasing safety and efficacy of the procedure.
Endoscopic surgery tools are highly specialised, including Microdebrider or Shaver, which facilitate a bloodless and faster removal of tissue than lasers, preventing damage caused by heat.
The following conditions are treated by endoscopic surgery:
The well-known nose polyps that block the nose and cause difficulty in breathing. We now know that these polyps are formed usually in the sinuses thereby blocking the nose. If they are locally removed from the nose the can form back quickly. Proper management consists in the complete and radical resection of these polyps from their origin, which we identify by nose endoscopy and 3-level special CT scan. Together with the nose, sinuses with polyps are thoroughly cleaned up, and by expanding their physiological openings they come into better contact with the nose so as to be functional after the surgery and fully checked at the outpatients department.
Nowadays the term that is used internationally is chronic sinusitis and depending on the sinus group affected we divide this condition into the less known ethmoiditis, sphenoiditis and frontal sinusitis. Chronic sinusitis, when not treated with medicines, needs endoscopic surgery, which gives us the change to clean up with accuracy all affected sinuses and make them communicate with the nose without unobstructedly. In this way, the patients is relieved from the symptoms and new inflammation is prevented.
If the inflammation is limited, we make use of minimally-invasive sinus technique (MIST), maintaining the sinus mucosa. However, if the inflammation is extensive, a larger scale and more radical endoscopic surgery is required.
They are usually removed using MIST, easily and effectively.
Benign nose and sinus tumors
The modern way to remove these tumors is by endoscopic surgery. When performed by experienced hands, results can be as good as open surgery, but avoiding external incisions and scarring.
In the same way, the endophytic or reversed papilloma and the small malignant tumors of the nose and the sinuses can be removed. Moreover, we can perform post-operative assessment in the outpatients department in case of relapse.
Eye socket infection
This inflammatory condition is caused in the eye socket mainly following an acute sinusitis. Its symptoms are very severe and necessitate emergency surgery, because there is risk of eyesight loss. It can be successfully performed endoscopically yielding impressive results.
Empyema of the frontal sinus
It can occur after an acute inflammation of the frontal sinus, when its physiological opening has been blocked. It required immediate endoscopic drainage, because inflammation can reach the eye socket thereby putting eyesight in danger or it can reach the meninges and the brain thereby causing meningitis or brain abscess.
Blocked tear duct
Excess tears are collected in the lacrimal sac that is located in the lacrimal bone on the lateral wall of the nose. From there, tears are released into the nose cavity through the lacrimal duct. Inflammation in this region leads to a blocked tear duct resulting in constant tearing that is very annoying for the patient. In these cases, endoscopic dacryocystorhinostomy (DCR) is needed, which consists in the removal of bone and extensive drainage and restructuring of the lacrimal sac region, thus ensuring flow of tears into the nose cavity.
Endoscopic surgery also contributes decisively in:
The success of nasal septum surgery
Removal of adenoids
Treatment of choanal atresia
Nasal concha surgery – conchoplasty
The nasal concha is a normal anatomical part of the nose interior. In pathological situations, it can overgrow and create difficulty when breathing from the nose, which can be treated effectively using surgery that is called conchoplasty. This consists in the controlled reduction of the nasal conchae to the desirable size that then remains constant throughout the patient’s life. Only through endoscopic surgery can the nasal conchae be fully controlled especially in their posterior region thus accomplishing an excellent result.
Apart from the above conditions, endoscopic surgery takes important part in the management of ear and throat conditions, in which cases advanced micro-surgery using state-of-the-art surgical microscopes and lasers when needed plays a dominant role.
Micro-surgical operations include:
Nowadays a stapedotomy is almost always performed consisting in replacement of the stapes bone using a special piston with a width of 0.4 – 0.6 cm. This is a very specialised microsurgical operation, which needs absolute accuracy and special skills by the surgeon. It is performed using the high magnification afforded by the microscope. We need very special tools, surgical high-accuracy devices and lasers. The successful outcome of this operation is almost always certain and hearing is restored to normal levels.
Some times, after an inflammation, injury or from birth, the ear drum may be missing or be perforated. With tympanoplasty the ear drum is repaired and hearing improves.
Surgery of chronic otitis and cholesteatoma
When the ear releases pus due to chronic otitis or cholesteatoma the patient surely needs an operation to clean up the ear and restore its function: this is performed by tympanoplasty.
Vocal fold microsurgery
This is state-of-art surgery of the larynx and in particular of the vocal folds. This is performed using a special micro-surgical technique in the mouth and when needed laser is also used.
In this way we can treat:
Nodules, polyps, cysts
Polypoid degeneration (Reinke’s oedema)
Papillomas, granulomas, haemangiomas
Precancerous lesions, leukoplakia
Small tumors in the throat
Unilateral and bilateral paralysis of the vocal folds
By vocal fold microsurgery we can repair with the utmost accuracy any condition while maintaining the fragile anatomical features of the vocal folds thus ensuring the best results for voice and speech.
In order to achieve the ideal result we apply the principles of microsurgery and use a special device for the identification, monitoring and protection of the facial nerve. The aesthetic post-operative outcome is excellent and is ensured by restoring the region by plastic surgery.
In our centre apart from the conditions that need microsurgery or endoscopic surgery the following procedures are also performed:
The Athens Bioclinic responding to patients’ needs of high-quality services has created a special Centre for micro-endoscopic ENT surgery, which is equipped and organised at very high standards. The extensive and long experience of surgeons using this equipment as well as the solidly-trained nursing staff are the best guarantee of excellent treatment outcomes following the latest international specifications.