Clinical Services Stanley Ear Nose Throat & Sinus Centre

  • Endoscopic Sinus Surgery

    Professor Merserkinger - father of Endoscopic Sinus Surgery with Dr Stanley in Graz, Austria 1991.
    Hands-on Laboratory Endoscopic Sinus Surgery Course, Graz, Austria
    • Endoscopic Sinus Surgery – a form of minimally invasive transnasal surgery to drain and re-inventilate the paranasal sinuses.
    • Dr Stanley underwent an intensive hands-on instructional course / Laboratory Training by founders of Endoscopic Sinus Surgery, Prof. Merserklinger and Prof. Heinz Stamberger at Graz Austria in 1991.
    • Dr Stanley developed a keen interest in Endoscopic Sinus Surgery including the treatment of skull lesions as in advanced endoscopic sinus surgery.
    • Several thousands of Endoscopic Sinus procedures have been performed to date and has been extended for anterior and central skull base lesions.
  • Outpatient Endoscopy - Flexible
    Diagnostic Rigid Nasoendoscopy
    • Endoscopic Sinus Surgery is only offered after failure of maximal medical therapy for chronic sinusitis.
    • A conservative approach is done on children in addition to an adenoidectomy when indicated.
    • Paediatric Endoscopic Sinus Surgery is a last resort for children suffering from Sinusitis after failure of medical therapy.
    • If performed, a mini-FESS (Functional Endoscopic Sinus Surgery) technique is performed to promote ventilation and drainage of the osteo-meteal complex.
  • Thorough evaluation of CT Scans are essential
    • Final evaluation after failure of maximal medicinal treatment with CT Scans of the sinuses being examined. The extent of surgery and inherent variations of anatomy are assessed pre-operatively. Risks are minimised by proper evaluation of the CT Scans pre-operatively to identify danger areas in the patients anatomy.
  • Endoscopic Sinus Surgery
    Blocked Osteo-Meatal Complex Before Surgical Treatment of Chronic Sinusitis
    • A mini FESS procedure with middle meatal antrostomies to drain and ventilate the maxillary sinuses is the minimum procedure required. This is usually performed in children and occasionally in adults.
  • Endoscopic Drainage of Ethmoidal Mucocele

    Before operation
    Scan before operation Mucocele in Ethmoid
    • An ethmoidal mucocele (collection of thick fluid in a sinus cavity) causing exophthalmos (bulging of the eyeball).
  • Endoscophic Drainage of Ethmoidal Mucocele during and end of operation
    Endoscophic Drainage of Ethmoidal Mucocele during and end of operation
    • Intra-operative endoscopic drainage of the ethmoidal mucocele.
    • Cavity left alone to heal with good drainage and ventilation.
  • CT Scan after operation
    • Post operative CT Scan of the drained ethmoidal mucocele showing a well ventilated ethmoid cavity.
  • Endoscopic Sinus Surgery

    Post-operative FESS cavity on CT Scan
    Endoscopic View of Ethmoidal Cavity after FESS operation
    • These are post-operative endoscopic views of the ethmoidal cavity and post operative CT Scan of a clear completely healed ethmoid cavity.
  • Balloon Sinuplasty

    Frontal Sinusitis

    Frontal Cell causing Frontal Sinusitis – Suitable for Balloon Sinuplasty
    Frontal Sinusutus – Suitable for Balloon Sinusplasty from Obstructing Frontal Cell
    • Chronic frontal sinusitis is traditionally cleared by FESS.
    • But in this illustration, a frontal cell is obstructing the drainage and this can be widened by a balloon sinuplasty procedure.
    • High frontal cells in the frontal sinuses are difficult to reach by traditional FESS techniques and balloon sinuplasty is the only minimally invasive technique available.
  • Endoscopic Transnasal Central Skull Base Legions

    Pituitary tumour eroding the sphenoid sinus
    • Advanced Endoscopic Sinus Surgery can be performed for anterior and central skull lesions. The most common of which are pituary tumours.
    • MRI showing pituitary tumour eroding into the sphenoid sinus.
    • Tumors of the pituitary gland are routinely approached transnasally with an endoscopic technique as shown below.
  • Intra-operative Transphenoidal view of tumor
    Post-operative view in the clinic 1 week after surgery
    • A panoramic view of the surgical field is obtained.
    • Post-operative tumor surveillance is possible in the clinic.
  • New Instrumentation in Endoscopic Sinus Surgery

    Tru Cutting Instruments

    Grasping Forcepes
    Through Cutting Forcepes
    • The initial instruments were grasping forceps, where tissue is avulsed in a non-precise manner initially.
    • Unnecessary collateral tissue drainage was inevitable.
    • This then advanced to Tru-Cut forceps where the amount of mucosa and tissue was precise, with minimal collateral trauma to the surrounding area.
  • Mechanical Shaver

    • Tru-Cut forceps evolved with the use of a mechanical micro-debrider which cuts and sucks the diseased mucosa at the same time.
    • The removal of mucosa and bone is less traumatic, precise with less bleeding and minimal collateral tissue damage.
  • Tri-Cut Blades
    Frontal Recess Instrument – Micro Debride
    • Surgical operating time is also lessened.
    • This technique is good for nasal polyps and edematous mucosa.
    • Micro-debriders are routinely used in FESS surgery today.
  • Surgical Navigation (Image Guidance System)

    Fusion ENT Navigation System with EM Tracking Blade
    • Endoscopic Navigation System for complex revision operations near the skull base. A navigation system with real time identification of location of instruments near the skull base.
    • A real-time surgical navigation device is available attached to an EM tracking blade for image guidance. This is surgical real time GPS.
    • May be necessary in complex revision endoscopic sinus surgery especially with skull base lesions.

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