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Endoscopic Sinus Surgery (Functional Endoscopic Sinus Surgery)

The sinuses are hollow areas in the skull occupying the space above, between and below the eyes. They are connected to the nose and can get inflamed or infected leading to drainage, congestion, decreased smell, fatigue and pain. The underlying cause of the inflammation may be air pollution, allergies, polyps, abnormal internal nasal and sinus anatomy, reactions viruses, fungus and bacteria or swelling inside the nose.

Medicines, including nasal sprays, decongestants, antibiotics, antihistamines and steroids will often improve nasal and sinus symptoms. Sinus surgery is recommended only after appropriate medical therapy has failed to provide long term control of inflammation and relief from symptoms.
On rare occasions immediate sinus surgery is warranted. Sinus infections which have spread to or are threatening the brain or eye, trauma and tumors of the nose or sinuses require surgical intervention without delay. Additionally, surgery may be the only option for some patients whose sinus condition aggravates other medical problems such as asthma. 

Historically, surgeries requiring an incision under the lip (Caldwell-Luc) or through the face (external ethmoidectomy) were used to access sinus cavities. Today, technology allows most sinus surgeries to be accomplished entirely through the nostrils, without facial and forehead incisions.

 Learn more about Endoscopic Sinus Surgery here at our Endoscopic Sinus Surgery Video Library

Endoscopic Sinus Surgery

This procedure is usually performed with the patient asleep (general anesthesia). A CT scan of the sinuses provides a road map for the surgery. Sometimes a computer is used in conjunction with the CT scan to act as a navigation system, a “GPS” for the nose, so to speak. Small telescopes are gently inserted through the nostrils to illuminate and magnify the nasal and sinus cavities on a video monitor. The surgeon uses delicate, angled and curved instruments to open or dilate the sinus drainage pathways. Irreversibly diseased tissue and obstructing bone fragments can be carefully removed with the instruments under magnification. The most important principle in endoscopic sinus surgery is to preserve as much normal tissue as possible, allowing the sinuses to recover normal function.

If infected sinus cavities are encountered, they can be drained and washed out with sterile saltwater or antibiotic solution during the procedure. Polyps, malignant and benign tumors, fungus balls and stagnant mucous buildups can also be removed. Rarely, tumors, trauma and unusual infections may require an incision somewhere on the face for additional access. These incisions can usually be hidden in the eyebrow, scalp, a forehead wrinkle or under the lip. 

Endoscopic surgery can also be utilized to correct a deviated septum, reduce enlarged turbinate tissue, remove overgrown adenoid tissue, open blocked tear ducts, relieve compression of the optic nerve and eye, remove some pituitary gland tumors, repair cerebrospinal fluid leaks and reconstruct defects in the wall between the brain and sinuses.

The procedure generally takes one to three hours and most patients go home the day of surgery. In the vast majority of procedures, nasal packing is not necessary . Mild nasal oozing is expected during the first 48 hours.

Patients begin rinsing the nose and sinuses with saline solution the day after surgery. Patients can eat a normal diet and are allowed to perform light activity including walking the day after surgery. A follow up visit one week after surgery allows for cleaning of the nasal and sinus cavities. Most patients return to normal activity, including exercise regimens, in 10 days.

Download Post Operative Sinus Surgery Instructions

Learn more about Endoscopic Sinus Surgery here at our Endoscopic Sinus Surgery Video Library

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