Minimally invasive treatments of sinus and nasal problems

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.

Indications

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.

Procedure

The surgery is usually done through the nose, the surgeon:

  • Enlarges the natural opening of the sinuses
  • Removes any polyps
  • Corrects significant anatomic deformities that contribute to the obstruction

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.

Post-Operative Care:

Following the surgery, your surgeon will give you guidelines to follow depending on the type of surgery performed.

  • Your nostrils will be packed with sterile cotton gauze and will usually be removed before being discharged to home or at your follow up appointment the next day. The gauze dressing under the nose will need to be changed when wet and may be kept in place for a few days.
  • You will be given pain medications to manage your pain. Do not use aspirin or ibuprofen products as these can cause bleeding to occur.
  • Take all medications given to you as prescribed. These may include antibiotics, decongestants, or steroids.
  • Do not drink alcohol while taking antibiotics and pain medications.
  • Get plenty of rest. You should avoid strenuous activity as well as bending and lifting for 1-2 weeks after surgery as this may cause bleeding.
  • Sleep with your head elevated on extra pillows.
  • Sneeze with your mouth open so as not to dislodge the nasal packing.
  • Do not smoke as smoking delays healing and increases your risk of developing complications.

Risks and Complications:

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:

  • Allergic reactions
  • Blood loss
  • Heart attacks, strokes, kidney failure, pneumonia, bladder infections
  • Infection or nerve damage

Possible complications following sinus surgery can include the following:

  • Bleeding
  • Infection
  • Numbness
  • Meningitis
  • Symptoms Recur

Advantages

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:

  • Minimal soft tissue trauma
  • Less pain
  • Faster healing time
  • Lower infection rate
  • Less scarring
  • Usually performed as outpatient day surgery