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Author: admin, 01.12.2014
He serves on national committees (Young Physicians Committee, Speech and Swallowing Disorders Committee) through the American Association of Otolaryngology Head and Neck Surgery.
The skull base is the undersurface of the brain that is separated by bone between the facial structures of the ear, nose and throat. Our sinuses are spaces which contain air, and produce mucous to cleanse the nose and upper respiratory tract.
When mucous becomes trapped inside the sinus, it gets infected with the bacteria that normally live in the unsterile nose (and discolors to green from its normal clear, white or yellow hue). If medical therapy fails-meaning symptoms continue despite antibiotic treatments-and maintenance medications above are without benefit, a CT scan of the sinuses without contrast is obtained. As discussed above, one recent option to FESS is in-office balloon sinus dilation performed under local anesthesia.
Over 90% of the time, endoscopic sinus surgery is performed for benign chronic inflammatory disease like chronic sinusitis and nasal polyps. Most nasal and sinus tumors can be safely and completely removed endoscopically through the nose avoiding external incisions.
Transnasal endoscopic repair is the best method to close most cerebro-spinal fluid leaks, which present with CSF rhinorrhea (watery discharge from one side of the nose).
Patel is one of only a handful of double fellowship trained Board Certified Otolaryngologists in the United States.
Patel specializes in pediatric Otolaryngology and practices at our Tampa and Wesley Chapel locations.
Within that team, we further recognize a small subset of physicians who have additional expertise either through fellowship training or because a majority of their practice is spent performing advanced nasal, sinus and skull base surgery. Staffed by fellowship-trained ear, nose and throat doctors and other specialists in allergy and immunology, the Advanced Sinus and Skull base Center provides a comprehensive approach to managing nasal and sinus disorders.
Procedurally, a small rod with light and camera (endoscope) is passed into the nose to look inside the nasal and sinus passageways.
There are four sinuses located on each side of our face…specifically the cheek or maxillary, eye or ethmoid, forehead or frontal and the back of the nose sinuses called the sphenoid sinuses. Based on a patient’s history of chronic sinusitis, as well as an examination and CT scan evaluation, a recommendation for FESS is made.
While awake, under topical and local anesthesia, a balloon is passed into the natural opening of the three sinuses.
However, tumors or growths-benign and malignant-can be found inside the nasal and sinus cavities. Skull base tumors, especially pituitary tumors, which comprise 10% of all brain tumors, can be removed in this manner.
He performs surgery at Florida Hospital Tampa, All Children’s Specialty Care in New Port Richey, and New Tampa Surgery Center in Wesley Chapel.

Our physicians are dedicated to providing the highest level of care to patients with complex sinonasal disorders. However, based on very recent advances in medical therapy, another option besides FESS is may now be available to some patients.
Recent trauma, which has significantly changed the shape of the nose, may require a closed reduction (manipulation of the nasal bones) or a more formal operation six weeks later (open reduction).
Frequently, patients who undergo cosmetic rhinoplasty have medically necessary surgery performed simultaneously to correct a deviated nasal septum for breathing problems.
Some skull base tumors require the collaboration of co-surgeons from two different surgical services. We work closely with experienced specialists in allergy and immunology to resolve the most complex nasal and sinus conditions.
The physician(S) emphasize comprehensive strategies that combine both medical treatments and sinus and nasal surgery. The average human being produces about one to two liters of mucous a day, which is swallowed without interference with regular activities. Specifically, a sinus specialist may recommend opening your sinuses with an inflated balloon. A microfracture is made around the sinus opening of the maxillary, frontal and sphenoid sinuses keeping the sinus open. Frequently, a deviated nasal septum is repaired due to breathing problems at the same time. Partial coverage may apply, but out of pocket expenses will be applied for services considered cosmetic or medically not necessary.
The rhinologic endoscopic surgeon partners with a neurological surgeon colleague to remove brain tumors through the nose. However, when these openings are blocked due to a swelling from a cold, virus, allergy or polyp the sinuses retain the mucous. Antihistamines aid allergic symptoms of seasonal sniffling, postnasal drip, itchy eyes, nose and throat. This minimally invasive procedure can be performed right in the doctor’s office, under a local anesthesia. Functional Rhinoplasty, generally performed as the result of recent trauma, may be covered by insurance (if it is deemed medically necessary). Inverted papilloma usually grows on one side, tend to recur despite removal in at least 20% of cases and can undergo a malignant change 7-19 %. The most common procedure performed is removal of pituitary tumors from behind the sphenoid sinus. The procedure usually takes place at an outpatient facility either at the hospital, freestanding facility or doctor's office.

When these fail, a visit to a physician is required to determine if antibiotics are needed to treat a bacterial sinus infection. As a result, this option is both far less intrusive and provides the patient with a far quicker recovery.
The advantages of the balloon treatment include less bleeding (since there is no tissue removal), quick recovery (usually 24 hours) and less postoperative discomfort.
In boys, it is commonly performed after the ages of 15 to 16 years old, so most of their growing will have been completed. Most commonly coverage is the result of well-documented trauma (car accident, sports injury).
Other types of surgical cases involve repairing CSF leaks, removal of encephaloceles (brain tissue herniating through a crack in the skull base), craniopharyngiomas, chordomas, meningiomas and cervical spinal cord decompression.
Anesthesia is generally required-preferably general anesthesia or twilight sedation-and the recovery period is about one week; two weeks from heavy exercising. A topical steroid spray may be required if the condition is chronic or felt to be secondary to an allergic condition. It should be noted that patients with massive nasal polyps are not candidates for this in-office procedure since polyps need to be removed.
Patients who are not candidates for general anesthesia such as COPD, asthmatics, morbid obesity, sleep apnea, cardiac risk and patients who have not tolerated general anesthesia in the past, may benefit from this procedure.
At ENT & Allergy Associates, patients receive a thorough review of documents, photos are taken and the appropriate imaging (CT scans) tests are ordered and reviewed.
All of these procedures combine trans-nasal endoscopic skull base surgery with image-guided, computer-assisted surgery. Certain circumstances allow for local anesthesia only, should minimally invasive techniques be appropriate (see balloon office sinus dilation).
A severely deviated nasal septum may also be a relative contraindication to the transnasal balloon but these patients may benefit from the oral approach under the lip. Recuperation is usually about five to seven days but physical activities are off limits for at least two weeks.
This type of surgery has enabled quicker recovery, more complete tumor removal due to the optics of the scope being able to look around the corners. Malignant tumors are squamous cell carcinoma, nasopharyngeal carcinoma, adenocarcinoma, mucoepidermoid, adenoid cystic, melanoma, esthesioneuroblastoma, lymphoma, sarcoma and midline granuloma.
Typically, there are three to four episodes a year with interval free periods between episodes.

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