Sinus surgery has truly evolved in the last several years. This procedure was once performed through external incisions (incisions on the face and in the mouth), required extensive nasal packing, caused significant patient discomfort, and was often followed by a lengthy recovery. With recent advances in technology, including the nasal endoscope, this procedure is now commonly performed without incisions and entirely through the nose. The nasal endoscope is a small lighted metal telescope placed into the nostril, which allows the surgeon to visualize the nose and sinuses. In current practice, endoscopic sinus surgery usually requires minimal nasal packing and is associated with relatively mild pain and short recovery times.
What are the indications for sinus surgery?
The most common indication for endoscopic sinus surgery is “chronic rhinosinusitis”. Chronic rhinosinusitis is a term applied to various nasal processes which involve inflammation of the nose and sinuses that do not adequately improve with medical management.
Less common indications include (but are not limited to): recurrent infections (rather than chronic inflammation), complications of sinus infections, nasal polyps (See Figure, black arrows), mucoceles, chronic sinus headaches, impaired sense of smell, tumors of the nasal and sinus cavities, cerebrospinal fluid leaks, nasolacrimal duct obstruction, choanal atresia, and the need to decompress the orbit. Additionally, recent advances in endoscopic techniques allow your sinus surgeon to provide access to areas of the brain and pituitary gland for neurosurgeons, or to the orbits (eye sockets) for certain ophthalmology procedures.
How is endoscopic sinus surgery performed?
Endoscopic sinus surgery may be performed under local or general anesthesia. The procedure involves the use of a small telescope (nasal endoscope) that is inserted into the nasal cavity through the nostril to visualize your nose and sinuses. The goal of the surgery is to identify the narrow channels that connect the paranasal sinuses to the nasal cavity, enlarge these areas and improve the drainage from the sinuses into the nose.
Most people have four sinuses on each side of their face, for a total of eight sinuses. These are the maxillary, ethmoid, sphenoid and frontal sinuses. The maxillary sinuses are in your cheek, the ethmoids are between your eyes, the sphenoid sinuses are almost exactly in the center of your head, and the frontal sinuses are in your forehead. It is possible that you may not have all of these sinuses due to developmental differences from person to person, or they may have already been opened by previous procedures.
Sinusitis may affect some or all of your sinuses. Your symptoms, endoscopic exam, and CT scan will determine which sinuses need to be opened.
Sometimes sinus surgery may require simultaneous repair of the nasal septum, which divides the two sides of the nose, or the turbinates, which filter and humidify air inside of the nose.
What is the recovery after endoscopic sinus surgery?
The use of nasal packing will depend on the extent of surgery and the preference of your surgeon. The recovery period will also vary depending on the extent of surgery but postoperative discomfort, congestion, and drainage should significantly improve after the first few postoperative days, with mild symptoms sometimes lingering several weeks after the surgery.
What is “Sinuplasty” (or Balloon Sinuplasty)?
"Sinuplasty" refers to a procedure, or specifically a surgical device that was developed by a specific device manufacturer. This device is similar to balloon angioplasty, the technology that expands the vessels in someone’s heart. These balloons are advanced into the opening of a patient’s sinuses and are expanded to open the narrowed channels. Sinuplasty may also be used in conjunction with more traditional endoscopic sinus surgery techniques.
Like all medical advances, the information in the popular press may not reflect reality. Although useful, this new technology is not for everyone, and in many cases is not a substitute for standard techniques. However, in some people it is a technique that may decrease recovery time. Only with a thorough examination, in conjunction with a CT scan, can this be determined by your surgeon
What are the potential complications of sinus surgery?
Adverse events are rare but may include postoperative bleeding, orbital (visual or eye) complications, complications from the general anesthetic, cerebrospinal fluid leaks and intracranial complications such as meningitis. However, it is important to realize that chronic sinus infections are located directly beneath the skull base and adjacent to the eye and the failure to treat this problem without surgery may lead to dire consequences, such as involvement of the eye or brain.