Endoscopic Sinus Surgery
Most cases of sinusitis are resolved with medical therapy. Surgery is usually only recommended for those cases with recurrent or persistent problems despite proper medical treatment. Mucous produced within the sinus moves toward the natural opening of the sinus and is expelled into the nose.
Blockage of this opening by swelling from infection or by polyps results in stagnation of the mucous creating a culture media for growth of bacteria.
Benefits and Goals of Endoscopic Sinus Surgery
Endoscopic sinus surgery is used to relieve symptoms associated with nasal polyps (see nasal obstruction) and recurrent sinusitis.
This surgery is designed to restore and/or improve the functionality of the nasal sinuses.
- Restore the natural function of the sinuses
- Enlarge the natural opening of the nose, leaving it open and removing infected material, polyps or other disease which may be a contributing factor
Endoscopic Surgical Treatment
Functional endoscopic surgery (FESS) is performed under general anesthesia usually on an outpatient basis, with the patient being discharge on the same day.
FES is performed through the nose using endoscopes with visualization by high definition video monitoring. There are no incisions on the face nor inside the mouth. The surgery is directed at the involved sinuses as demonstrated by the pre-operative CT scan.
Many surgeries are performed under image guided technique which guides the surgeon by accurate localization of the instruments during the procedure as visualized on a computer, three dimensional image.
Any of the sinuses can be approached by this surgical technique, including the maxillary sinuses in the cheeks, the ethmoid sinuses between the eyes, the frontal sinuses in the forehead and the sphenoid sinuses centrally located behind the eyes. Polyps are removed, the septum may be straightened and the turbinates may be reduced in size using this technique.
Post Surgical Care
Care of the nose and sinus area after surgery involves flushing of the nose with saline by the patient and postoperative office visit within the first two weeks. Antibiotics and steroids may also be prescribed. The nose is cleaned of mucous and crusts during the office visit, and patients usually continue the saline irrigations for weeks to months.
Swelling or discoloration of the nose and face usually do not occur. Usually patients may return to regular activities within several days. Long term care of the sinus area may include intranasal sprays, allergy testing and treatment and discontinuance of abusive habits such as smoking.
In most cases good long term results are achieved, but recurrent disease may occur depending on history of polyps, allergy, smoking and immunologic problems.
The complication rate of endoscopic sinus surgery is very low because of more widespread subspeciality training of sinus surgeons and also more precise techniques of sinus instrumentation, thorough preoperative CT scan evaluation and also the use of image guided techniques during the performance of the surgery.