sinus surgery

Miss Sarah Little talks to The Revu about her involvement in the Intensive 3-Day Sinus and Bone Grafting course with hands-on cadaver surgery to be held in Manchester on 9th – 11th November 2017 and how this experience relates to her day-to-day practice.

How did you get involved in the Sinus and Bone Grafting course?

I’m an Ear Nose and Throat surgeon specialising in nose and facial disorders and I’ve been in practice for over 15 years. In recent years, I’ve developed a special interest in the management of sinus disorders and specifically sinus problems related to dental issues. A local colleague, Dr Koray Feran, started the course with Professor Cemal Ucer and as we had worked together on patients in the past, he asked me if I might like to get involved, which I was delighted to do.

During the course, you and Mr Abbad Toma discuss the anatomy in relation to para-nasal sinuses and sinus pathology from an ENT perspective. Why is this so beneficial to delegates?

When undertaking implant dentistry, it’s easy to become focused around the maxilla alveolus and dental arches, but beyond that there is a world of anatomy that can become impacted by implants that have been inappropriately or incorrectly placed. Mr Toma and I deliver a concise understanding of the anatomy and physiology of the sinuses from the top down, which delegates find very helpful. We try to condense this into the first day of the course from didactic lectures and discussions, and reinforce it on day two when we move into the cadaver and dissection lab and demonstrate the anatomy on the cadavers.

How in-depth is the information given to delegates?

Thanks to a limit of just 16 delegates, we can tailor the course to their needs. We generally start with the basics of pure anatomy and simple physiology and then work through that in a more detailed way, giving a practical application to the students’ learning. Typically, we’ll be working at a fairly high level of understanding by the end of the course, particularly of the pathological processes of the sinuses and how we can manage them from an ENT perspective if problems should occur.

In terms of the practical day, having someone of your expertise and skill level on hand must be an eye-opener for delegates.

Day two is my favourite day of the course. It’s the opportunity to really get hands-on with the delegates, using the cadavers to show the anatomy in a practical and 3-dimensional way, which you just can’t re-create in a classroom setting. We use endoscopes to look in through the natural openings of the sinuses and it’s fascinating to watch what’s going on within the maxillary sinus when the implants are being placed; it’s a view you would never experience in real life.

Does each delegate get a cadaver head to work on?

The delegates are split into pairs, so they have one cadaver between two. This is beneficial as delegates can take it in turns to help each other and talk things through as different surgical situations arise.

The course looks at CT scanning and what to look for in a CT scan. Can you expand on this?

CT scanning and discussion of the imaging is a crucial part of the course. Most implant patients will undergo some form of imaging and it’s really useful for delegates to get an in-depth understanding of the optimal mode of imaging, most likely using a cone-beam CT scanner. We look at how to review a scan, what to look for in terms of anatomy, normal anatomy variants and pathology, then move on to how to make an independent assessment of them. Delegates quickly learn to read CT scans accurately for themselves, which is a vital step towards becoming a successful implant surgeon.

Do you usually work in a multidisciplinary way with dental care professionals?

Yes, I do. Working with other surgeons, and implant surgeons in particular, is a really interesting and rewarding part of my practice and I get involved in different stages of patient care. Sometimes when patients come along for their first assessment at the treatment planning stage, it might be highlighted that they have a sinus or nose problem and it’s useful for us to provide input at that point before any dental work is undertaken. On other occasions we get involved if there are unexpected issues that arise either during treatment planning or after implants have been placed. It can be as simple as reviewing the imaging or perhaps doing an endoscopy to assess any abnormal sinus anatomy or infections or nasal polyps.

This collaborative way of working is very important to me. In my opinion, the days of people working in isolation as single-handed practitioners is no longer the optimal way to look after patients. The course also allows participants to build networks that can be really useful for patient discussions and collaborations.

Can you tell me more about your day-to-day practice?

My practice centres around the nose and facial issues, and sinus operations form a large part of my surgical work. We conduct operations on patients with chronic sinus disease, which may be related to chronic sinusitis or dental pathology, plus more advanced work on patients with skull-based or other complex sino-nasal problems.

It’s been interesting watching how dental implant provision has evolved in recent years. There’s been an obvious expansion in the number and types of procedures being performed, but, along with this, has come a rise in the number of complications. We are using our experience of understanding the technicality of implants so we know best how to manage patients should things not work out ideally.

Do you have any final words about the Sinus and Bone Grafting course and the work that you do?

I’ve been involved with this course for a couple of years now and I find it incredibly rewarding in terms of building relationships with dental surgeons, both locally and nationally. In return, I think the dental surgeons themselves have found that understanding how working with an ENT surgeon can help their practice is extremely useful. When I first started doing this course, I didn’t realise that I would get as much out of it as I have. It has really helped in my understanding of dental implantology and how to manage implant patients properly. Having an ENT surgeon involved really aids in a 360-degree understanding of the maxillary sinus and the feedback we have had from delegates has been excellent.

Miss Sarah Little

Miss Sarah Little is a Consultant ENT Surgeon at St George’s NHS Trust with dual subspeciality interests in Rhinology & Facial Plastic Surgery and Anterior Skull Base Surgery. She is also an Honorary Senior Lecturer at St George’s University of London Medical School.

Sarah Little qualified from the University of Aberdeen in 1999. She completed Higher Surgical Training in the East of Scotland, joining the ENT consultant Specialist Register in 2010.  Her training included a year as a research Fellow in Surgical Oncology at Memorial Sloan Kettering Cancer Centre in New York and a further Fellowship year in anterior skull base surgery at Columbia University College of Surgeons and Physicians in New York. This was followed by a Fellowship in Facial Plastic Surgery at St George’s Hospital. She also gained higher training in the management of paediatric ENT disorders at Rady Children’s Hospital, San Diego, California.

Her practice includes medical and surgical treatment of chronic rhinosinusitis, including balloon sinuplasty and rhinoplasty and facial plastic surgery.

For more information or to book your place on the next Intensive 3-Day Sinus and Bone Grafting course with hands-on cadaver surgery, visit
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