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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 methodic) 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 Simulcast) which minimizes discomfort and allows 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 stomata complex (OMC), an area in the anterior method sinus region. Obstruction of the OMC 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 OMC. Most of the healthy tissue in the sinuses is undisturbed allowing for faster and better overall recovery. Endoscopies 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 recommendation for sinus surgery in the early 20th century would easily alarm the patient. In that era, the surgeon would have to perform an invasive procedure, reaching the sinuses by entering through the cheek area, often resulting in scarring and possible disfigurement. Today, these concerns have been eradicated with the latest advances in medicine. A trained surgeon can now treat sinusitis with minimal discomfort, a brief convalescence, and few complications.

A clinical history of the patient will be created before any surgery is performed. A careful diagnostic workups is necessary to identify the underlying cause of acute or chronic sinusitis, which is often found in the anterior method area, where the maxillary and frontal sinuses connect with the nose. This may necessitate a sinus computed topography (CT) scan (without contrast), nasal physiology (chiromancer and nasal cytology), smell testing, and selected blood tests to determine an operative strategy. Note: Sinus X–rays have limited utility in the diagnosis of acute sinusitis and are of no value in the evaluation of chronic sinusitis.

Sinus Surgical Options Include:

Functional endoscopies sinus surgery (FESS): Developed in the 1950s, the nasal endoscope has revolutionized sinusitis surgery. In the past, the surgical strategy was to remove all sinus mucous 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.

FESS involves the insertion of the endoscope, a very thin fiber-optic tube, into the nose for a direct visual examination of the openings into the sinuses. With state of the art micro-telescopes and instruments, abnormal and obstructive tissues are then removed. In the majority of cases, the surgical procedure is performed entirely through the nostrils, leaving no external scars. There is little swelling and only mild discomfort.

Download Pre-Op FESS Surgery Instructions

Content is provided and licensed by the American Academy of Otolaryngology

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