Functional endoscopic sinus surgery (FESS) with navigation system in childhood – our experience. Presentation of clinical cases

Abstract

Introduction: Functional endoscopic sinus surgery (FESS) is the gold minimally invasive standard in diagnosing and surgically treating many diseases of the nose and paranasal cavities. An advantage of FESS is the possibility of application in all age groups. Materials and methods: We observed pediatric patients attended the Otorhinolaryngology Clinic in the University Hospital “Dr. Georgi Stranski” – Pleven in 2021. FESS surgery was performed in the “Integrated interdisciplinary operating unit with navigation and telesurgery systems” at the Center of competence on personalised medicine, 3D and telemedicine, robotic and minimally invasive surgery „Leonardo da Vinci” in Medical University – Pleven. Clinical cases: Case 1: A 7-year-old male patient with orbital complication of rhinosinusitis, with left orbital preseptal cellulitis, without ophthalmoplegia or loss of vision, + ptosis of the eyelid and data on pansinuitis from CT images. Performed FESS found lysis of lamina papyracea with involvement of anterior and posterior ethmoidal cells. Postoperative treatment was done with Ceftriaxone 1g/12h i.v. for 7 days, nasal glucocorticoids and antihistamines. Case 2: A 17-year-old female patient with suggested primary ciliary dyskinesia with a recurrent rhinosinusitis, persistent nasal obstruction, and thick viscous secretions that did not respond to conservative treatment. Sweat test for cystic fibrosis (-). FESS reshaping of the natural openings of the maxillary sinuses and anterior ethmoidectomy were performed bilaterally. Conclusion: FESS is a minimally invasive method, which is suitable for application in pediatric patients. When applied by trained professionals, FESS with an integrated navigation system is optimal for the diagnosis and surgical treatment of chronic and acute rhinosinusitis in children.