As our understanding of the sinuses has improved, we have come to understand that sinuses have an intricate design and an amazing ability to regulate and drain themselves. Any surgical treatment should take this important fact into account and aim to improve this function. The Targeted Endoscopic Sinus Surgery™ (TESS) technique has been developed by Dr. Larian as a minimally invasive method of treating the problematic areas of the sinuses where there is blockage, with minimal effects on the surrounding tissue, while capitalizing on the inherent ability of the sinuses to drain themselves. During the procedure, a thin, flexible instrument known as an endoscope is inserted into the nose (Fig. 4 & 5).

A wide variety of problems can be treated by this method, including chronic sinusitis, fungal sinusitis, nasal polyps, etc (Fig 6A & 6B).

Image-Guided Sinus Surgery

TESS combined with image-guided sinus surgery is another revolutionary treatment option for those with chronic sinusitis or who have polyps or frontal sinus disease. This advanced procedure works like a GPS system, using a sophisticated three-dimensional mapping system that uses real-time data and CT scans for accurate navigation of the sinus anatomy without damaging nearby tissues. This enhanced level of precision is important in avoiding complications since the sinuses lie close to the eyes, brain, and other vital organs and arteries.

Balloon Sinuplasty™

Targeted endoscopic sinus surgery is also combined with state-of-the-art Balloon Sinuplasty™ to help improve the quality of life for sinusitis sufferers. During this minimally-invasive procedure, a flexible balloon catheter is inserted through the nose and into the targeted sinus. The balloon is then inflated in the blocked sinus passageway to open them up. This helps to widen the walls of the passageways, resulting in restored drainage and other functions of the sinuses (Fig. 9).

Fig. 9

Each sinus is treated individually based on its particular problem. Narrow Boney opening maybe treated with balloon sinuplasty (Figure. Balloon Sinuplasty). Obstruction by polyps is removed and relieved by the micro-debrider. At all times, the technique is used that has not only the lowest risk, but causes the least amount of trauma and preserves the maximum natural functioning of the sinuses. In doing so, healing and recovery is much faster and simpler. Due to the minimal amount of trauma bleeding is much less and in a great number of cases no packing is used.

What to Expect After Targeted Endoscopic Sinus Surgery™

After sinus surgery, minor bleeding and some discomfort are common. These symptoms can persist for the first week. Weekly office visits may be necessary for the first three weeks after surgery to endoscopically visualize the sinuses, remove any secretions/crusting to assure appropriate healing. Dr. Larian may also recommend that antibiotics be used, as well as a steroid nasal spray to reduce inflammation. Moisture is an important element of surgical recovery and we typically recommend that our patients undertake a number of steps to ensure their environment contains a sufficient amount of moisture, by using humidifiers and performing salt-water rinses several times a day.

Risks Associated with Targeted Endoscopic Sinus Surgery™

All surgery carries some form of risk. This risk is minimized, although not completely eliminated, when receiving treatment from an experienced surgeon. Endoscopic techniques, such as the one performed by Dr. Larian, have an excellent track record when it comes to safety. That said, minor complications could include scar tissue attaching to nearby tissue and bruising or swelling around the eyes. Major complications, although rare, can include injury to the eye area, heavy bleeding, and brain injury. In the hands of an experienced surgeon, and with the help of image-guidance systems, the inherent risks associated with sinus surgery can be minimized.