Nasal sinuses are hollow, air containing cavities in the skull behind the forehead and cheeks of the face. There are four pairs of sinuses and these are referred to as the paranasal sinuses. Sinusitis occurs when one or more sinuses become infected causing inflammation of the membranes that line the sinus cavity. Sinusitis is a common problem affecting millions of people around the world.
Chronic sinusitis are cases which last more than 12 weeks and can continue for months or even years. Functional Endoscopic Sinus Surgery or FESS is minimally invasive corrective surgery for chronic sinusitis. Computer assisted endoscopic sinus surgery, also referred to as image-guided surgery (IGS), may be used to perform your sinus surgery.
When medicine fails, surgery may be the only alternative for treating chronic sinusitis. The goal of surgery is to improve sinus drainage and reduce blockage of the nasal passages.
The surgery is usually done through the nose, the surgeon:
Functional Endoscopic Sinus Surgery (FESS)is performed through the nose using an endoscope, a long, thin, tube which has a light and a video camera on the end. Images from the endoscope are magnified and projected on a TV screen enabling your surgeon to visualize internal structures in great detail.
FESS is performed under sterile conditions in the operating room with the patient under general anesthesia or local anesthesia with sedation. This operation is usually performed as outpatient surgery enabling the patient to go home the same day.
Depending on your particular situation, your surgeon may perform additional procedures to offer you the best possible outcome for your situation.
These may include the following:
- Septoplasty: This is corrective surgery for a deviated nasal septum. The septum is the bony cartilage which divides the nose into two chambers. A deviated septum can interfere with breathing and predispose to sinus infections.
- Ethmoidectomy: This is surgery to remove diseased tissue and bony partitions in the ethmoid sinuses.
- Inferior Turbinoplasty: This surgery involves revision to the inferior choncha or turbinate bone. The turbinates are responsible for warming, humidifying, and filtering inspired air and can cause blockage of the nasal passages
Image guided surgery systems(IGS) enables the surgeon to perform a more thorough and precise surgery and has significantly improved the safety and effectiveness of the procedure.
In computer assisted surgery, special instruments are used that are connected to a computer system where they are tracked according to the patients' anatomy based on pre-operative CT scans. Using tiny bone cutting instruments and debriders, your surgeon will enlarge the sinus openings and remove any abnormalities blocking the sinuses such as polyps.
If septoplasty is indicated for a deviated septum, an incision is made to the nasal septum inside the nose through one of the nostrils. The mucous membrane is lifted away from the septum. The nasal septum is then reshaped into proper position straightening the septum.
Occasionally severely deviated portions of the septum are completely removed or repaired and replaced inside the nose. Mucous membranes are then returned to their normal position covering the nasal septum.
For an ethmoidectomy procedure, your surgeon will advance the endoscope into the ethmoid sinuses. Special instruments are used to remove diseased tissue and bony partitions to improve airway flow and decrease inflammation.
If the inferior turbinates are large and swollen your surgeon will perform an inferior turbinoplasty. Your surgeon will make an incision in the mucosal lining of the inferior turbinate. The underlying turbinate bone is carefully removed as well as any diseased tissue.
Dissolvable sutures, splints and/or packing are placed inside the nose to minimize postoperative bleeding and a small gauze dressing is taped under the nose.
Following the surgery, your surgeon will give you guidelines to follow depending on the type of surgery performed.
As with any major surgery there are potential risks involved. It is important that you are informed of these risks before the surgery takes place. These include:
Possible complications following sinus surgery can include the following:
Endoscopic Sinus Surgery offers many benefits over the older surgery techniques of “open surgery” where an outside incision was required.
Advantages of endoscopic surgery include: