PET-CT SCAN
August 24, 2023
PET-CT SCAN: WHAT YOU NEED TO KNOW A PET-CT scan is a medical imaging test that combines two technologies, Positron Emission Tomography (PET) and Computed
Nasal Procedures
Nasal Problems Consultations
Nasal Procedures
Nasal obstruction can interfere with nasal breathing during the day and night, and it can play a major role in snoring and obstructive sleep apnea. Relief of nasal obstruction can improve snoring and obstructive sleep apnea by itself and can also improve the ability of some patients to tolerate positive airway pressure therapy for obstructive sleep apnea.
What treatments can improve nasal obstruction?
Treatment options include medications such as nasal saline, topical corticosteroid and antihistamine sprays, and oral medications such as antihistamines or decongestants. Non-surgical treatments can include external nasal dilators like the Breathe Right® strip for selected patients.
If these are not successful by themselves, surgery can improve the nasal airway either alone or in combination with these other options. The most common nasal procedures include turbinate surgery, septoplasty, sinus surgery, and rhinoplasty and nasal valve surgery.
Can nasal surgery, by itself, cure snoring or sleep apnea?
Treatment of nasal obstruction often forms part of an overall treatment plan for snoring and obstructive sleep apnea. However, in some cases nasal surgery may be treatment for snoring and sleep apnea as it might allow a better tolerance of the CPAP, improve its adherence and in many cases reduce the number of hypopneas and apneas
The external nose (the part you can see easily on the outside) can also play an important role in nasal obstruction. The nostrils and area directly above them form what is called the nasal valve This area is somewhat prone to collapse but can be particularly narrowed or easily collapsible due to a number of reasons, including congenital (at birth) factors or previous trauma or surgery. Rhinoplasty and nasal valve surgery are commonly used to treat nasal obstruction that originates at the external nose.
Rhinoplasty procedures are highly individualized, so your doctor should discuss the nature of the procedure as well as the risks and postoperative instructions.
Rhinoplasty and Nasal valve surgery
Nasal valve surgery is designed to stabilize or support the side walls of the nose. This holds the nasal valve more open during breathing. Nasal valve surgery can be performed by itself or in conjunction with other nasal procedures. There are two approaches to nasal valve surgery:
- Cartilage pieces placed in the sides of the nose. This can be the cartilage removed during septoplasty (when performed at the same time as septoplasty) or additional cartilage that can be taken from one of the ear cartilages
How is nasal valve surgery using cartilage performed?
For placement of cartilage in the sides of the nose, a pocket is created on each sidewall of the nose through an incision inside the nose. On each affected side, a piece of cartilage designed to support the sidewall of the nose is placed into the pocket to support an area of narrowing or collapse. The incisions are then closed with stitches.
In addition to the potential for bruising and a minor risk of infection, the major risk associated with the procedure is a slightly wider or fuller appearance to the middle portion of the nose. Although the general appearance of the nose is primarily related to the nasal tip and the shadows at the tip (not affected by this procedure), there will a change in appearance. Because the cartilage graft is typically only 2-3 mm thick, this change in appearance may or may not be noticed by others.
Septoplasty
The nasal septum separates one side of the nose from the other. It is composed of bone, cartilage, and the overlying soft tissues such as the lining of the nose. Septal deviation (positioning of the septum towards one side of the nose or the other) or septal spurs (thickening or bowing where the septum’s cartilage and bone meet or at an area where trauma to the nose has fractured the cartilage or bone) can produce blockage of one or both nasal passageways. Septoplasty is a procedure to treat a deviated septum and improve nasal breathing.
How does a septoplasty improve breathing through the nose?
Septoplasty attempts to straighten the septum and restore its position to the midline to open the nasal airway.
Septoplasty is performed by raising the lining off both sides of the nasal septum through an incision inside the nose. At the end of the procedure, the lining of each side is replaced against the septum, and stitches may be placed to help the nasal lining heal back in its original position against the septum. Nasal splints may be placed in the nose as another measure to help with healing.
Sinus Surgery
Sinus surgery can be an important part of treatment for repeated or chronic sinus infections (sinusitis) as well as trouble breathing through the nose. Sinuses are effectively spaces in the head. They serve many purposes, but nobody is sure exactly why we have them. There are four pairs of sinuses. The picture below shows the maxillary sinuses behind your cheekbones, the frontal sinuses in your forehead, and the ethmoid sinuses that form a honeycomb-type structure in the area between your eyes.
In addition, there are sphenoid sinuses towards the back of your nose, almost between your ears. Sinuses are connected to your nose through narrow passageways, and the lining (mucosa) of the sinuses and these passageways is very similar to the lining of the nose. The mucus made by the lining of the sinuses normally drains into the nose. However, when the lining of your nose is swollen, including swelling related to allergies or colds, these passageways can close off, trapping mucus inside your sinuses and leaving it open to infection with the bacteria (and possibly fungus) in our noses.
Short-term sinus infections (acute sinusitis) are common, as they can be caused by colds or viruses. Typically, they respond well to combinations of nasal sprays and, possibly, antibiotics. Sinus surgery is reserved for those who have many short-term infections or have infections that last a long-time (chronic sinusitis), without good control with medications alone.
What is sinus surgery?
Sinus surgery is generally performed using small telescopes to look into the nose through the nostrils, and it may be combined with other nasal procedures such as septoplasty. Sinus surgery involves removal of small pieces of bone and lining (as well as any abnormalities like polyps) to widen the passageways connecting the sinuses to the nose.
By widening these passageways, the goal of sinus surgery is to reduce the number and severity of sinus infections while also making them easier to treat. The sinuses are next to important structures like the eyes and brain, so sinus surgery will involve obtaining a CT scan of the sinuses beforehand to help in making decisions about the extent of sinus surgery and to minimize risks to these important structures.
Turbinate surgery
There are three pairs of turbinates that originate on the lateral walls of the nasal cavity inside the nose. When the inferior turbinates (the lowest pair) are enlarged due to a condition such as environmental allergies, they are a common cause of nasal obstruction. Reducing the size of the inferior turbinates improves nasal blockage because this creates more space for breathing through the nose.
Inferior turbinate reduction surgery can be accomplished with a variety of techniques; the most used are submucous resection and radiofrequency reduction. When done in the operating room, these reduction procedures can be combined with a procedure called outfracture, in which the inferior turbinates are moved towards the side of the nose (opening up the space for breathing a little more) by breaking the thin bone that is inside the turbinate itself.
What are different types of turbinate reduction procedures?
Submucous resection of the inferior turbinates is performed in the operating room under general anesthesia. It is usually performed in combination with other procedures. It involves make a small cut in the lining of the inferior turbinates and lifting the lining off the thin bone that forms the structural support of the inferior turbinate. By removing part of this bone and allowing the healing process to shrink the lining of the turbinate, the nasal passage increases in size.
Radiofrequency inferior turbinate reduction is typically performed in the office without general anesthesia or sedation. A specially designed probe with a needle at the end is placed into the turbinate, and radiofrequency energy is delivered to heat the tissues beneath the surface in a controlled way. By heating the tissues, damage is created, and the healing process reduces the size of the inferior turbinates. The entire procedure typically takes approximately 10 minutes, although more time is required to numb the area with local anesthesia. The procedures typically have little to no pain during the healing period, and the risks are relatively low. Often a single treatment session is effective, but many patients do require more than one session.
Nasal Procedures
Nasal blockage can impair nasal breathing both during the day and at night, and it can contribute to snoring and obstructive sleep apnea. Nasal obstruction relief can improve snoring and obstructive sleep apnea on its own, and it can also enhance some patients’ capacity to tolerate positive airway pressure treatment for obstructive sleep apnea.
What treatments can improve nasal obstruction?
Medication alternatives include nasal saline, topical corticosteroid and antihistamine sprays, and oral drugs such antihistamines or decongestants. External nasal dilators, such as the Breath Right® strip, can be used as non-surgical therapy for some individuals. If they do not work, surgery, either alone or in conjunction with the other alternatives, can enhance the nasal airway. Turbinate surgery, septoplasty, sinus surgery, rhinoplasty, and nasal valve surgery are the most frequent nasal treatments.
Can nasal surgery, by itself, cure snoring or sleep apnea?
Nasal obstruction therapy is frequently used as part of an overall treatment strategy for snoring and obstructive sleep apnea. However, nose surgery may be used to cure snoring and sleep apnea in some circumstances because it may enhance CPAP tolerance, adherence, and, in many cases, reduce the number of hypopneas and apneas.
The external nose can also contribute to nasal blockage. The nasal valve is formed by the nostrils and the region just above them. This region is prone to collapse, although it might be very restricted or readily collapsible for a variety of causes, including congenital (at birth) characteristics or recent trauma or surgery. Rhinoplasty and nasal valve surgery are standard treatments for nasal blockage caused by the external nose.
Rhinoplasty operations are very personalized; therefore, your doctor should go through the procedure’s nature, dangers, and postoperative recommendations with you.
Rhinoplasty and Nasal valve surgery
Nasal valve surgery is intended to stabilize or maintain the nasal side walls. This keeps the nasal valve open when breathing. Nose valve surgery can be done alone or in combination with other nasal surgeries. Nasal valve surgery can be done in two ways:
- Cartilage pieces inserted into the nose's sides This might be the cartilage removed during septoplasty (when performed concurrently) or extra cartilage taken from one of the ear cartilages.
How is nasal valve surgery using cartilage performed?
A pocket is formed on each sidewall of the nose by an incision within the nose for the implantation of cartilage in the sidewalls of the nose. A piece of cartilage designed to support the sidewall of the nose is put into the pocket on each afflicted side to support a region of narrowing or collapse. Stitches are used to seal the incisions.
Aside from the possibility of bruising and a tiny risk of infection, the main danger of the surgery is a slightly larger or fuller look to the center region of the nose. Although the general look of the nose is mostly determined by the nasal tip and shadows at the tip (which are unaffected by this surgery). There will be a visual update. Because the cartilage graft is often just 2-3 mm thick, people may or may not notice the difference in appearance.
Septoplasty
The nasal septum is the membrane that divides one side of the nose from the other. It is made up of bone, cartilage, and soft tissues that cover it, such as the nasal lining. Septal deviation (shifting the septum to one side of the nose or the other) or septal spurs (thickening or bowing where the septum’s cartilage and bone meet or where trauma to the nose has cracked the cartilage or bone) can cause obstruction of one or both nasal airways. Septoplasty is a surgical technique that is used to correct a deviated septum and enhance nasal airflow.
How can a septoplasty enhance nasal breathing?
Septoplasty seeks to straighten the septum and return it to its midline position in order to open the nasal airway. Septoplasty is a procedure that involves lifting the lining from both sides of the nasal septum through an incision within the nose. At the completion of the treatment, the nasal lining on either side is reinstalled against the septum, and sutures may be used to aid in the healing of the nasal lining back into its original position against the septum. Nasal splints may be inserted in the nose as an additional treatment to aid in healing.
Sinus surgery
Sinus surgery can be an important aspect of treating sinus infections (sinusitis) and difficulty breathing through the nose. Sinuses are essentially empty regions in the skull. They fulfill a variety of functions, but no one knows why humans have them. There are four sinus pairings. The maxillary sinuses are located behind your cheekbones, the frontal sinuses are located in your forehead, and the ethmoid sinuses are located between your eyes and create a honeycomb-like structure. There are also sphenoid sinuses towards the back of your nose, practically between your ears. Sinuses are linked to the nose by tiny passages, and the lining (mucosa) of the sinuses and passageways is remarkably similar to the lining of the nose.
Normally, mucus produced by the sinus lining drains into the nose. When the lining of your nose becomes inflamed, such as from allergies or colds, these airways can block, trapping mucus inside your sinuses and leaving you vulnerable to infection from the bacteria (and probably fungus) in our nostrils.
Acute sinusitis (short-term sinus infection) is frequent and can be caused by colds or viruses. They usually react nicely to a mix of nasal sprays and antibiotics. Sinus surgery is intended for those who have a lot of short-term infections or long-term infections (chronic sinusitis) that aren’t under control with drugs alone.
What is Sinus Surgery?
Sinus surgery is often performed through the nostrils with tiny telescopes, and it may be coupled with other nasal surgeries such as septoplasty. Small sections of bone and lining (as well as any abnormalities such as polyps) are removed during sinus surgery to enlarge the airways connecting the sinuses to the nose. Sinus surgery aims to lessen the number and severity of sinus infections while also making them simpler to cure by expanding these channels. Because the sinuses are close to vital systems such as the eyes and brain, sinus surgery will include a CT scan of the sinuses to aid in decision-making regarding the scope of sinus surgery and to reduce risks to these vital structures.
Turbinate Surgery
Inside the nose, three pairs of turbinate emerge from the lateral walls of the nasal cavity. When the inferior turbinate (the bottom pair) become swollen as a result of a disorder such environmental allergies, they are a common cause of nasal blockage. Reduced size of the inferior turbinates’ relieves nasal obstruction by creating greater room for breathing via the nose. Submucous resection and radiofrequency reduction are the most often utilized procedures for inferior turbinate reduction surgery. These reduction methods, when performed in the operating room, might be coupled with a process known as out fracture., in which the inferior turbinates are shifted to the side of the nose (creating extra breathing space) by shattering the thin bone inside the turbinate itself.
TWhat are different types of turbinate reduction procedures?
Under general anesthesia, submucous excision of the inferior turbinates is done in the operating room. It is frequently done in conjunction with another operation. It entails making a tiny slit in the lining of the inferior turbinates and pulling the lining away from the thin bone that serves as the inferior turbinate’s structural support. By removing a portion of this bone and enabling the healing process to reduce the turbinate lining, the nasal canal expands.
In most cases, radiofrequency inferior turbinate reduction is done in the office without the need of general anesthesia or sedation. A specifically developed probe with a needle at the end is inserted into the turbinate, and radiofrequency energy is supplied in a regulated manner to heat the tissues under the surface. Heat causes tissue injury, and the healing process diminishes the size of the inferior turbinates. The complete treatment usually takes around 10 minutes, however numbing the region with local anaesthetic takes longer. The operations are normally painless during the recovery time, and the dangers are minimal. A single therapy session is often sufficient, but many people require more than one.
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