Minimally Invasive Image Guided Sinus Surgery

Dr. Cohen is founder and innovator of MIGSS™, which is a less invasive and more painless variation of endoscopic sinus surgery (aka ESS or FESS). In this outpatient surgical procedure there are no cuts made on the face and the entire procedure is performed with the aid of endoscopes and various specific instruments to target problem areas within an individual’s nose and sinuses. The goal of this procedure is to simply target diseased areas within one’s nose and sinuses and allow proper ventilation of an individual’s sinus cavities without disturbing any of the remaining normal tissues. As such the most common area targeted in this procedure is the “middle meatus / osteomeatal complex” region within each side of the nose. (Figures 1+2) This region is the common drainage pathway for the frontal, ethmoid and maxillary sinuses and also is the key area where disease causes recurrent sinus infections, sinus headaches, changes in one’s sense of smell and is also the area where sinonasal polyps commonly originate from. To perform this unique procedure a special dedicated preoperative planning CT is performed that acts as a roadmap during surgery; it confirms problematic areas that require attention and also functions to keep the surgeons away from danger areas such as the eyes and bottom of the brain. (Figure 3) If preoperatively Dr. Cohen also notices that part of the problem is a deviated septum or enlarged turbinates causing nasal obstruction, then a septoplasty and submucous resection of the inferior turbinates is also performed at the same time. Patients often are amazed how little pain and discomfort there is following the procedure and how much their nasal congestion and sinus headaches improve following the procedure. Most patients also report significant decrease in the number and severity of sinus infections for many years following this simple outpatient procedure. It is very common for patients who have undergone sinus surgery by other surgeons in the past to comment to Dr. Cohen that this was an entirely different experience for them as they had no significant postoperative pain or bleeding following surgery. Some patients even say that they never once required narcotic pain medications following surgery.

Figure 1

Figure 2

Figure 3