ENDOSCOPIC SINUS SURGERY

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.

Before surgery your ENT doctor will obtain a CT scan of your sinuses. He will typically review the results of the scan with you and show you which of the sinuses are involved. There are 4 sets of sinuses in our heads. The maxillary lie in the cheek under our eyes, The Ethmoids lie along the inner aspect of our eyeball near the nose and extend backwards into the skull the Frontals lie above our eyes in our forehead. There is a forth set, the Sphenoids which lie directly in the back of our eyes deep in our skull.. Most commonly it is the ethmoid and the maxillary sinuses that are affected but the others can be as well.

Functional endoscopic sinus surgery (FESS) was developed in the 1950 with the introduction of the endoscope but has only been revolutionized in the past few decades. In the past, the surgical strategy was to remove all sinus mucosa from the major sinuses. The use of an endoscope has allowed us to remove only the infected tissue rather than the whole sinus mucosa. This has led to decreased recovery time and fewer complications compared to the older methods.

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.

The advantage of the procedure is that the surgery is less extensive, there is often less removal of normal tissues, and can frequently be performed on an outpatient basis. After the operation, the patient will sometimes have nasal packing. Ten days after the procedure, nasal irrigation may be recommended to prevent crusting.

Image guided surgery: The sinuses are physically close to the brain, the eye, and major arteries, always areas of concern when a fiber optic tube is inserted into the sinus region. The growing use of a new technology, image guided endoscopic surgery, is alleviating that concern. This type of surgery may be recommended for severe forms of chronic sinusitis, in cases when previous sinus surgery has altered anatomical landmarks, or where a patient's sinus anatomy is very unusual, making typical surgery difficult.