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Endoscopic Sinus Surgery

The sinuses are air-filled holes in the skull. They are connected to the nose and can get infected leading to drainage, pain, etc. This may be caused by allergies, polyps, abnormal shape or swelling inside the nose. Medical therapies, such as antibiotics, steroids, nasal sprays and decongestants will often cure bouts of sinusitis. Sinus surgery is advocated in those patients who fail to improve after medicines. There are circumstances when immediate sinus surgery is warranted. Tumors of the sinuses, whether benign or malignant, often require surgical removal. Surgery may be the only option for some patients whose sinus condition aggravates other medical problems such as asthma. Cancer or immune patients may require drainage for culture or for treatment of a fungal infection. In the past, surgeries requiring an incision under the lip (Caldwell-Luc) or face (external method) were used to drain sinus cavities. Most procedures are now performed using endoscopies technology (small cameras through the nose), eliminating the need for external incisions. Some situations permit use of new balloon dilation procedures (Balloon Sinuplasty) which minimize discomfort, increase safety and allow for faster return to normal activities.

Small rods of light with a camera (endoscope) are used to operate through your nostrils into the sinuses. This does not involve any cuts on your face, but may be combined with other external approaches, which may involve cuts. This surgery is usually done under general anesthesia for your comfort. A CT scan will serve as a road map for your surgeon Endoscopies sinus surgery has ushered in a new philosophy allowing the surgeon to target the natural opening from the nose into the sinus. Obstruction here can lead to subsequent infection of the maxillary, frontal and sphenoid sinuses. Accordingly, endoscopies sinus surgery removes or dilates thickened and diseased tissue blocking the opening. Most of the healthy tissue in the sinuses is undisturbed allowing for faster and better overall recovery. Endoscopic surgery can also be utilized for removal of polyps, nasal masses and sometimes straightening the septum to improve nasal airflow.

The ear, nose, and throat specialist will prescribe many medications (antibiotics, decongestants, nasal steroid sprays, antihistamines) and procedures (flushing) for treating acute sinusitis. There are occasions when physician and patient find that the infections are recurrent and/or non-responsive to the medication. When this occurs, surgery to enlarge the openings that drain the sinuses is an option.

A careful diagnostic workup is necessary to identify the underlying cause of acute or chronic sinusitis, which is often found where the maxillary and frontal sinuses connect with the nose. This may necessitate a sinus computed tomography (CT) scan, nasal endoscopy with culture, smell testing, and selected blood tests to determine the optimal strategy.

Sinus Surgical Options Include:

Functional endoscopies sinus surgery (FESS): Developed in the 1980s, the nasal endoscope has revolutionized sinusitis surgery. In the past, the surgical strategy was to remove all diseased lining from the major sinuses. The use of an endoscope is linked to the theory that the best way to obtain normal healthy sinuses is to open the natural pathways to the sinuses. Once an improved drainage system is achieved, the diseased sinus mucous has an opportunity to return to normal.

 

Balloon Sinuplasty: Beginning in 2007 sophisticated catheter-based tools modeled after the balloons and stents used to treat heart disease have revolutionized the treatment of mild to moderate sinus disease. These tools are used along with endoscopic technology to create a more functional sinus opening in a way that is more gentle and comfortable for the patient.

Possible Complications

Sinus Surgery is done commonly and is generally safe with infrequent complications. When complications do occur, they may include:

• Bleeding
• Injury to neighboring structures including eyes or brain
• Change in sense of smell and/or taste
• Failure to control sinus infection making further medical or surgical therapy necessary.

Catheter-based (Balloon Sinuplasty) techniques have even further reduced the incidence of these rare events.

Download Pre-Op FESS Surgery Instructions

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