Endoscopic sinus surgery is a surgical procedure that uses nasal endoscopes through the nostrils to avoid cutting the skin to remove blockages in the sinuses.
Types of Sinus Surgery
Balloon Sinuplasty sinus surgery procedure is performed by ENT doctors that opens sinus passages to relieve sinus pain and sinus pressure associated with chronic sinusitis.
Functional endoscopic sinus surgery (FESS)
Functional endoscopic sinus surgery (FESS) is the most common surgical method for treating chronic sinus conditions. The surgeon performs this surgery through the nostrils by using a magnifying endoscope (thin tube with camera and a lighted end). Traditional sinus surgery is performed through cuts in the mouth and face, so FESS presents a less risky method with decreased recovery time. Overall FESS is a less invasive and more exact method of opening the sinuses to increase the patient’s health and quality of life. There are three common FESS procedures including:
Located between the eyes and the bridge of the nose are the ethmoid sinuses. The ethmoid sinuses are crucial in treating most sinus conditions, because all other sinuses drain either next to or directly through them. If there is a blockage in the ethmoid sinuses, the infection can move to other sinuses. During an ethmoidectomy, a surgeon first looks into the ethmoid sinuses with an endoscope (thin tube with camera and light at the end), and then removes infected tissue and bone in the ethmoid sinuses that prohibits the natural drainage.
Located directly behind the cheekbones are the maxillary sinuses. This is the most usual site of sinus infection for adults. The maxillary sinuses empty into the nose approximately one-half inch below the corners of the eyes (osteomeatal complex). During maxillary antrostomy, the sinus opening is unblocked and usually the osteomeatal complex is cleared out at the same time. In rare cases, the surgeon may have to actually create a new drainage route between the maxillary sinus and the nose (a Caldwell-Luc procedure).
Powered Septoplasty with Turbinoplasty
The bony cartilage wall located between the two sides of the nose is the septum. The septum, which is supposed to be straight, functions to direct airflow and support the nose. Sometimes the septum becomes deviated or crooked due to injury or other factors, which can obstruct correct drainage and make it difficult to breathe through the nose. The turnibates are bony and delicate scroll-like structures in the nose. When the septum is crooked, one side of the nasal canal is larger than the other and the turnibates may become larger too, making the obstruction worse. During a septoplasty, the ENT surgeon straightens the septum in order to allow air to flow through the two sides of the nose evenly and normally. During a turbinoplasy, the ENT surgeon decreases the size of the turbinates to increase breathing and sinus drainage, while leaving enough turbinate tissue for normal function.
There are also many other types of sinus surgery that physicians perform. The ENT specialist (otolaryngologist) will suggest the type of sinus surgery that is most advantageous for each particular patient and their condition.
Risks and Complications of Sinus Surgery
As with any surgery, there are associated risks and complications including risk from anesthesia and potential infection. In particular, each type of sinus surgery presents a specific set of other risks including:
- Ethmoidectomy—Risks associated with this procedure include bleeding after the operation, cerebrospinal fluid leakage, and other intracranial damage to the brain, which might be hard to repair. There is also a risk of injury to the muscle that controls eye movement and the optic nerve. Very seldom, patients may lose some or all of their sense of smell.
- Maxillary antrostomy—Risks associated with this procedure include a rare chance of damage to the eye, tear ducts, surplus production of tears, and nosebleeds.
- Powered septoplasty with turbinoplasty—Risks associated with septoplasty include the removal of too much tissue and a collapsed septum, as well as a perforated septum (hole in septum) that can cause bleeding. Risks associated with turbinoplasty include removing too much tissue, which means the turbinates will be unable to humidify or warm air as it is breathed in. This can cause a persistently dry and crusty nose, which can be very uncomfortable. Other rare risks associated with turbinoplasty include chronic nasal inflammation, loss of sense of smell, and bleeding.
What to Expect Before Sinus Surgery
Usually, sinus surgery is an outpatient procedure, which means the patient will be able to return home the same day as the surgery. The patient should arrange for someone to drive them home from the hospital following surgery.
One to two weeks prior to surgery, patients should stop taking medications that thin the blood. The patient should also ask the physician if they should discontinue the use of any other medications. The patient will be given specific instructions on when to stop eating and drinking the night before the surgery. If the patient has any additional health problems or is taking prescription medications, the physician may order blood tests.
What to Expect After Sinus Surgery
The patient will be given exact instructions on how to care for themselves at home, which depends on the particular surgery performed and the original severity of sinus disease prior to surgery. The physician will usually prescribe pain medication following surgery.
In general, however, patients are typically instructed:
- Be in the care of another adult for at least the first day after surgery.
- Do not drive, sign any legal papers, or engage in any activities that require them to stay fully alert and awake for twenty-four hours.
- Usually a small volume of bloody drainage from the nose is normal but should be closely watched.
- Keep upper body elevated to help minimize swelling and pain.
- If experiencing any nausea or vomiting, eat and drink clear fluids.
- It may be necessary to only breathe out of the mouth if there is packing or splints in the nose.
Additionally, patients should call their physician if they experience:
- Uncontrollable pain or swelling.
- Extreme bleeding.
- Fever or chills.
- Green or Yellow drainage from the nose, especially if a foul odor exists.
- Inability to urinate by 8 to 12 hours after surgery.
Exact recovery time depends the patient, the extent of their sinus disease, and the particular surgery performed.
Outcomes of Sinus Surgery
After the nose and sinuses fully recover from sinus surgery, patients should be able to resume all normal activities. The patient’s sinus problems and symptoms should be much better, and the patient should experience a reduced amount of sinus infections in the future. Although most patients’ symptoms improve following sinus surgery, results are not guaranteed and sometimes, additional therapies are required to manage sinus problems after surgery.
Tips to Prevent Sinus Disease (Sinusitis)
To help prevent the development of sinusitis during an allergy attack or cold:
- Use an oral decongestant or nasal spray decongestant.
- Blow the nose carefully, blocking one nostril while blowing through the other.
- Keep from traveling by air if possible. If flying is necessary, use a nasal spray decongestant prior to take off.
- Drink ample amount of fluids to keep nasal discharge thin.
- Avoid contact with things that cause allergy attacks. Also, use over-the-counter or prescription antihistamines and/or prescription nasal spray to manage allergy attacks.