Nasal Endoscopy Procedure Performed By Dr. Brian Weeks

Nurse:
Hi.

Michelle King Robson:
Hi, how are you?

Nurse:
Good, and you?

Michelle King Robson:
Good, thanks.

Nurse:
Good. Okay, so I’m going to start you off with putting some sprays. Dr. Weeks is going to put a scope in your nose. He is first going to start off by numbing your nose so that way we are just going to get you prepared when he comes in, okay?

Michelle King Robson:
Okay.

Nurse:
Yeah, you are not going to feel anything and it’s going to be pretty good.

Michelle King Robson:
Oh good, we like that.

Nurse:
So I am going to give you some tissue and then first spray is a nasal decongestant just to clear your nose. The second one is called Pontocaine, it’s going to numb you up a little bit. That way you won’t feel any discomfort when he goes there with the scope. So let’s see. Let’s start you off.

Michelle King Robson:
How long does the Pontocaine lasts?

Nurse:
It depends how much I spray. I try to spray just enough so that way it won’t be worn out right away and you will have time.

Michelle King Robson:
Enough time when he comes in, so it goes away pretty fast then?

Nurse:
Oh yeah, it does.

Michelle King Robson:
Okay, great.

Nurse:
This is your checkup, so it’s the same thing. So if you want to look up for me, I am going to spray once side, all you have to do is breathe in. Now we are going to spray you with the Pontocaine.

Michelle King Robson:
So this is the numbing?

Nurse:
Yeah, this is the numbing. This is the important one.

Michelle King Robson:
I like the first one.

Nurse:
Yeah, it clears it. OK, so breathe in. All right, so we’ll let it, that’s it and then the doctor will be coming in, in a few minutes and he will put the scope in and you will be set.

Dr. Brian Weeks:
Hello, I am Dr. Brian Weeks and I am here visiting with my patient Michelle. Michelle came to see me about eight months ago. At that time she had suffered an injury to her face.

She was having a procedure done and was having a local anesthetic placed, and apparently the needle had nicked a branch of her trigeminal nerve. And when I saw Michelle she was in tremendous pain.

She was having pain basically starting in her face and extending all across her face into her ear, up into her forehead and it was, I think, one of the more difficult situations you’ve ever dealt with.

At the time I evaluated her we performed a comprehensive head and neck examination and then we did a nasal endoscopic procedure where we actually looked inside the nose.

Michelle comes in today. She is feeling much better and we are going to do a follow up examination with nasal endoscopy just to make sure everything looks good and to confirm that she is completely healed and doing well.

Michelle King Robson:
Yes, and I loved the procedure so much. At the time it wasn’t so great because I was in so much pain but we needed to get to the root of the problem, so to speak, and you did.

But I thought the way the instrumentation that you use to identify the problem was so fascinating that I thought it would be great to actually show women what this procedure is like.

Dr. Brian Weeks:
Absolutely, and hopefully it keeps people from having fear about endoscopes and endoscopic procedures, and the truth of the matter is that when you are dealing with a problem that potentially involves the nose and the sinus or the face it really gives us tremendous information.

And so, as I told you at the time and as I am going to tell you today, it’s really the best way to assess the nose and try to come to the diagnosis that we need to come to.

Michelle King Robson:
Yeah it was great and it was so easy and painless and I think that’s one of the keys to this is that it is so easy and painless.

Dr. Brian Weeks:
Super. Now Michelle has already had some topical medications sprayed on her nose, and typically what we’ll do as you know is just decongest and then anesthetize the nose, and really that’s it.

There’s no intravenous medications, no pills needed, and so what we will do now is we are going to hook the camera up and move forward.

Michelle King Robson:
And I do have to tell you I feel a whole lot better. That was even the left side of my nose inside was completely numb for about four to five months, and it didn’t go down below my lower mouth area but just stayed to the left side underneath the eye, right above the brow and then just short over to the left ear.

Dr. Brian Weeks:
I’ll tell you, trigeminal nerve pain of any sort is probably one of the most debilitating pains that any of my patients deal with, and I was thinking earlier as I was preparing to meet with you, I have had a number of patients with this type of problem and really, really probably some of the most uncomfortable people I have ever dealt with in terms of their pain.

I think the important factors with any situations like this and obviously to the women that visit the site and are following along with your examination to understand that we don’t always know what causes it but it’s often an important indicator for different disease processes.

So in your situation it was rather clear why this developed, but for some women if they are having this type of pain, it’s really important to understand that this may be indicating a more serious medical problem.

It could be a sinus problem. It could be some sort of a growth involving the trigeminal nerve at a different location. It could also represent some sort of a severe dental problem like a dental infection. And then it could also be post traumatic in nature, and then patients do develop situations like this where it’s what we call idiopathic or we don’t know what causes it.

But I think the key is get to your doctor, let him know what you are dealing with and then we can talk about treatment modalities and what not. If I recall we utilized some oral medications for you that I think had some, a little bit of benefit initially. Really with you the key was just to tincture of time and that was waiting and allowing the nerve to sort of heal and regain its normal function.

Michelle King Robson:
And that was the hardest part was to just know that if it was nicked because you don’t really know whether it’s going to repair itself or not. The hope is, you know, fingers crossed that it does.

But it was the waiting, you know, every day I would check and I would feel because it is so uncomfortable to have that numbness like that and also to have that exposure was like having open root and now in the top six, six top left hand side of my mouth.

So that was, I had never experienced anything like that. Now I know we have talked about cancer patients who come in with that trigeminal nerve and it must be from having radiation, I guess.

Dr. Brian Weeks:
Different treatments.

Michelle King Robson:
Or different treatment modalities.

Dr. Brian Weeks:
Yeah, when we, like in radiation we are delivering energy around the nerve. If there’s a tumor involving that kind of part of the head and neck, the radiation can get to the nerve and cause damage. Unfortunately a lot of times in situations like that because of the amount of damage that occurs to nerve it doesn’t get better or it doesn’t complexly resolve.

I think the key is that it needs to be evaluated and we need to basically encourage patients to have that done, and with nerves typically we are often guessing, we are often hopeful, and depending on the cause of it we have a better sense of understanding if it’s likely to come back or not.

In your situation I would have been really surprised if it had not returned to normal, but as you remember I didn’t know how long it was going to take. I told you, Michelle, I am hoping it takes a week but it might take six months, it might take a year.

And that’s probably the hardest thing for a lot of patients to really struggle with is, am I going to have to deal with this for months or years, and they just have to, I mean it’s really, really can be charging.

But thankfully for you it got better and hopefully the people that are viewing understand that they are not alone. They are not without help and without hope, and that there’s a really good chance that these problems can be accurately diagnosed and attended to.

Michelle King Robson:
Exactly right, and that’s exactly why we are doing this, just for that very reason, so that women do understand that it does. You can have a good outcome. Even in my case where it wasn’t sure what the outcome was going to be, you know you always hold out hope and you go to the best person you can, like yourself, so that you can diagnose it and then decide what the treatment protocol is going to be.

Dr. Brian Weeks:
So basically what we have here is we have a flexible fiber optic laryngoscope and what that means in layman’s terms is this is a camera that’s made to look inside the nose and it looks at the upper airway, the voice box and the sinuses.

And basically what we are going to do with this is we are going to place this camera gently inside Michelle’s nose. We use a video monitor screen which we have on the back, which allows us to even get a better view.

But what we are going to do is we are going to look at the surface of Michelle’s nose. We are going to assess the stages of the mucosa and we are going to look for inflammation just like we did before.

Last time we evaluated Michelle with the scope the left side of her nasal cavity, her nose, was quite swollen and inflamed and was very illustrative or indicative of what we were seeing and what we were dealing with and that there was an acute inflammatory reaction going on, and in patients who have sinus problems it can be very telling as well.

So we are going to go ahead and what we do expect to see is a healthy nose. So we are going to go ahead and put the camera inside Michelle’s nose and we are going to just go in her left side today and I am gently just placing it just inside the tip of her nose.

And basically if you look at Michelle’s nose, what you are going to appreciate immediately is she has a very pink lining of the nose with a healthy mucus membrane and you can see there on the side of the screen is that pink healthy appearing tissue.

Now the nerve branches to the trigeminal nerve are going to lie in this entire surface of the nasal cavity. And when you see irregularities in this mucosa you can see evidence of infection or inflammation, and in a situation like this with Michelle we are not seeing any of that.

This is the structure that is basically shielding this cheek sinus where Michelle’s major pain was and again what we are seeing is a very healthy appearing sinus mucosa and nasal mucosa without evidence of infection or any sort of problem whatsoever.

And as we move further back in the nose we can look all the way back into the back part of her nose where her throat and her nose connect, and that tissue in the very back is where we hear about the adenoids in young people. Well that’s where the adenoids live, but in an adult we don’t expect to see adenoid tissue.

But again, in this situation, branches of the trigeminal nerve innervate or sends signals to all parts of the nasal cavity, and I am thankful to report in Michelle’s situation that her nasal membranes look incredibly healthy, incredibly clean and with no evidence of inflammation or infection.

So I am gently coming out of her nose now. The procedure is complete, and we have looked throughout the entire nasal cavity, and I am hoping that it wasn’t uncomfortable or really didn’t feel anything at all.

Michelle King Robson:
Didn’t feel a thing.

Dr. Brian Weeks:
So hopefully in this situation that we demonstrated to the viewers and also shown ourselves that we can get a tremendous amount of information with the camera. The endoscope really does help us, and again, it doesn’t replace any part of our workup or examination but it’s an integral part of really being able to assess the nose.

And I am happy to say that your nose looks beautiful. It’s completely healthy, I mean, the membranes are beautiful; they are not inflamed at all and it’s very, very significant and that it shows that the nose is really in a healthy non-inflamed state.

Michelle King Robson:
Oh good, now does this mean Dr. Weeks that I have to be careful about having any kind of dental block again in that area? Is it rare for that to happen?

Dr. Brian Weeks:
It really is rare. I would say to basically share with everyone who is watching this and who is worried about this that the likelihood of this type of injury is extremely low and for somebody to have this happen in the hands of an expert, like I know you were meeting with, it’s very rare. It’s very unexpected and so there is not an increased risk next time.

Thankfully the likelihood of you having it the second time would be, you’d have a better chance of winning the lottery. So for people that are watching it’s really not something to be worried about but if you do have a problem like that or, you know, god forbid, do experience something like that or somebody else does, then they need to know what to do and who to go to, to see.

But anyway, it’s wonderful to see you again and I am so pleased that you are doing well. Congratulations!

Michelle King Robson:
Thank you, thank you so much.

About Dr. Weeks, M.D.:
Dr. Brian Weeks specializes in diseases of the ear, nose, throat, as well as tumors of the head and neck region, including thyroid, parathyroid, and skull base tumors. He has advanced specialty training in endoscopic sinus surgery, and is a national/international leader in balloon sinuplasty surgery. Additionally, Dr. Weeks has expertise in minimally invasive surgeries of the head and neck, as well as head and neck reconstruction. His role in reconstruction of the head and neck includes management of skin cancers, facial defects and blemishes, and cosmetic imperfections. He also provides extensive knowledge in skin care, facial peels, and facial care products.

Tags:

• Ears, Nose & Throat
• Trigeminal Neuralgia