Nasal and sinus diseases
Balloon sinuplasty
Ballon sinuplasty is a new technology that has become available to deal with certain sinus conditions. It utilizes balloon dilation similar to angioplasty for blocked blood vessels. Not all patients are candidates for this technology. Dr. Kerner assisted in the development of fiberoptic technology allowing balloon sinuplasty to be performed without the need for intraoperative xrays or fluoroscopy.
To determine whether you are candidate for this technology a comprehensive examination, including nasal endoscopy and CT scanning have to be performed. If you are deemed a candidate, this can be performed in the office under local anesthesia with minimal discomfort. To see if you are a candidate for this cutting edge technology, contact us at (818) 349-0600.
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Minimal incision comprehensive sinus surgery ™(MICSS)
Surgical treatment of sinus conditions underwent a revolutionary change in the late 1980’s and early 1990’s. This had to do with the introduction of rigid telescopes which provided better visualization, and recognition of more rational anatomic approaches to surgery. This surgery was termed functional endoscopic sinus surgery (FESS). The goal of surgery is to reestablish normal drainage pathways by removing diseased tissues causing blockage. There were significant advantages of this approach over prior surgical approaches which used incisions directly on the face or under the gums. Early surgery was fraught was with significant pain and discomfort, nasal packing, and bleeding. The surgical techniques have evolved to minimal incision comprehensive sinus surgery, a technique described by Dr. Kerner. This entails delivering a targeted, endoscopic anatomic approach to the surgery with focused surgical treatment of only those anatomic areas affected by disease.
In addition, the use of image-guidance technology and powered instrumentation also allows more comprehensive surgery with minimal discomfort. Dr. Kerner was instrumental in advancing this technology while the medical director for the largest laser rental company which provided image-guided systems to hospitals. He also was responsible for training over 500 surgeons in its use in the late 1990’s. Since the introduction of this technology has resulted in safer, more comprehensive surgical treatment. The complication rate of this procedure in our group is less than 0.001%.
Nasal endoscope
Normal anatomic view of the nose with an endoscope
This gives us the ability to culture drainage and make a precise diagnosis, identify anatomic abnormalities such as septal deviations, nasal polyps or mucosal abnormalities and plan further diagnostic studies.
The shiny growth in the nose is a nasal polyp
The next diagnostic study is a high resolution computed tomography scan or CT scan.
This helps us identify anatomic abnormalities that are not readily visible with nasal endoscopes .Utilizing a combination of the patient’s history, physical examination with the nasal endoscope in the office, and a CT scan using the latest 64 slice scanner technology, a concise treatment plan is individualized for each patient.
Abnormal CT with fungal disease filling the right side of the sinus
Before any patient is offered surgery, they are treated aggressively with antibiotics and other medications. Patients must also undergo office endoscopy to evaluate the nasal and sinus anatomy. We also obtain CT scans to fully delineate the anatomy prior to any surgery.
Our group pioneered the use of no packing surgery—we typically use dissolving medications to prevent adhesions(scar formation) after MICSS. Our postoperative routine is simple as well. Patients are instructed to begin nasal and sinus irrigations on the first day after surgery and continue for at least 3-6 months. We see our surgical patients on a cycle that includes two weeks post-surgery, then 6 weeks, 3 months, and 6 and 12 month follow-up. A nasal endoscopy is performed at these visits to facilitate cleaning of the nasal and sinus cavities, and then examination to ensure proper healing. Most patients have significant relief by two weeks after surgery.
For our national and international patients that fly in for surgery you can expect to remain in the area for 10 days. At that time we will perform the first examination and cleaning allowing you to fly after that point. Contact our staff if you have any further questions. We will also go over that in detail at the time of consultation and preoperative visit.
Revision sinus surgery
The doctors at Calwest have extensive experience dealing with difficult or revision sinus surgery. We get patient referrals nationally and internationally for treating patients that have had prior surgery.
Computer-aided image guided sinus surgery
There are a number of image-guided surgical systems available for surgery. Dr. Kerner was associated with the early development of these technologies while training at UCLA. He was the first to use the Instatrak® in southern California. To utilize this technology, the patient undergoes a CT scan which is then brought to the operating room where it is used with a computer guidance system similar to global positioning satellite technology.
Nasal reconstruction including septoplasty
The septum is the structure that separates the left and right nasal cavities. It can be thought of as a wall with wallpaper. The wall is the cartilage and bone, and the wallpaper is the lining on both sides of the septum. Many conditions can affect the septum including trauma, tumors, and bleeding. The most common resulting condition is termed a “deviated septum.” No matter the underlying cause, this can result in obstruction, nasal congestion, bleeding, recurrent sinus infections, headaches, facial pain, and noisy breathing.
The diagnosis is made by examination in the office and correction of septal deformities can be performed with sinus surgery or cosmetic nasal surgery (rhinoplasty) if necessary or desired.
Septoplasty, or correction of septal deformities, is performed entirely through the nostrils through a minimal incision made at the front of the septum. We typically utilize the endoscope to assist with the procedur. Occasionally we have to place a splint in the nose after surgery that is usually removed between the third and fifth day after surgery. No gauze packing is utilized. Again this is individualized depending on the type of deformity—all of which is determined at the time of consultation. Patients who have undergone this surgery have highly satisfactory results.
Please call (818) 349-0600 for a consultation.
Turbinate Surgery
Enlargement of the inferior turbinates is caused by primarily by allergies. When the tissues swell they block the nasal airway. We aggressively treat this with medications, however, if patients fail medical treatment, surgical treatment is possible. Multiple techniques are available to treat the turbinates in a safe, and effective manner. Dr. Kerner utilizes state-of-the-art radiofrequency technology that shrinks the turbinates using a small probe directed into the turbinates. This procedure can be performed in the office under local anesthesia. This technology preserves the underlying tissues resulting in less bleeding, discomfort, and faster healing with a very low complication rate.
Repair of septal perforations
Septal perforation is a condition that involves a hole within the nasal septum, the wall of cartilage and bone that separates the two nostrils. The septum supports the nose, regulates air flow, and is covered by the mucous membranes of the nose.
Septal perforations result from previous nasal surgery, trauma to the nose, cocaine use, various cancers, nose picking, and rare infectious diseases such as syphilis, leishmaniasis, and tuberculosis.
This condition often causes troubling symptoms such as bleeding, whistling through the nose, and obstruction. The perforations can bleed from localized infection and trauma which leads to crusting and discomfort. Some patients may not experience any symptoms from this condition. Uuntreated perforations may affect the structure of the nose and lead to deformities such as collapse or saddle nose deformities.
Treatment for septal perforation depends on the size and severity of the hole. Small perforations can often be treated conservatively with saline irrigations and application of antibiotic ointment. Large perforations require surgical repair to relieve symptoms and restore the structure and function of the septum. There are several different surgical options available for septal perforation repair. Our surgeons will complete the evaluation with nasal endoscopy, CT scanning and then tailor the surgery to the patient’s specific findings.
This procedure is performed under general anesthesia and can often utilize minimally invasive techniques to reduce the trauma and recovery times associated with surgery. At the time of surgery our surgeons may use either grafts or flaps from the surrounding tissues to bring healthy tissue to the area of the perforation.
Dr. Kerner has extensive experience with surgically repairing large perforations. The surgery is customized to the specific defect. After this surgery patients will have a splint for five to seven days. After removal, patients will need to rinse their nose frequently with Neil-Med sinus rinse throughout the healing process. Patients can return to work shortly after surgery, but must avoid blowing their nose, bending forward and strenuous exercise for up to 14 days. Complete healing may take up to 6-8 weeks.
Nasal and Upper Airway Allergies
Many people who suffer from chronic sinusitis also have nasal allergies or allergic rhinitis. Millions of people suffer from nasal allergies which results in a runny or congested nose, watery eyes, headaches, sneezing, and rashes. Since our practice focuses on providing the highest level of surgical care, we refer our patients for allergy testing to a number of highly skilled board certified allergists that work closely with our practice. Patients receive top notch care with both blood and skin testing, medical therapy, and desensitization with allergy shots if necessary.