laryngology-head and neck surgery at the University of Maryland
School of Medicine. "I would think that it's being used by many sur-
geons a majority of the time," he says. "It is not the standard of care
yet, but it is widely used."
The latest systems help doctors navigate through the sinuses using a
3D map that is created by using CT scans of the patient. By viewing 3-
dimensional images of the sinuses during surgery, the computer imag-
ing can give surgeons better visibility in guiding the surgical instru-
ments around vital structures such as the optic nerve and skull base.
These images help surgeons avoid orbital and skull base injuries, and
are especially helpful when working on patients with altered anatomy
from severe polyps or prior procedures, says Dr. Wolf. "Navigation
can help reinforce where you are in the sinus cavity and reduce the
risk of complications," he says.
The latest ENT navigation systems also promise to be smaller, more
portable and more accurate than previous models. Mani H. Zadeh,
MD, FACS, an ENT surgeon with his own practice in Los Angeles,
Calif., notes that though the technology has been around for roughly
15 years, it has "changed quite a bit" over the last 5 years.
"They have become more accurate, with an intraoperative accu-
racy of less than 1mm, and they're often easier to set up," he says.
"They've become more affordable as well."
Dr. Zadeh notes that image-guided surgery can benefit both the
novice and the expert ENT surgeon. It all depends on the surgeon's
skill and experience level, from those who specialize in sinus sur-
gery and are performing revision or complex procedures to those
who might not do a lot of sinus cases.
"While this technology is not meant to replace knowledge of anato-
my or surgical skill," says Dr. Zadeh, "it can be used to get a second-
ary assurance that the surgeon is doing a complete surgery and also
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