Endoscopic Sinus Surgery- Primary and Revision

Sinus surgery involves the use of small endoscopes and micro-instruments to enlarge the natural openings of the sinuses. Enlarging these openings makes it easier for the sinuses to drain, even when swollen from inflammation. Sinus surgery is also used to remove nasal polyps, nasal masses, fungal debris, and straighten the septum. Most importantly, the goal of sinus surgery is to allow topical medication to reach the mucosa(lining) inside the sinuses. If we are able to treat this mucosa directly– topical medications can provide more safe and reliable long-term therapy than oral medications.

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Sinus surgery FAQs

Do these sprays and irrigations really get into the sinuses?

Not entirely. Without previous surgery, much of the topical therapy that is used inside the nose can only reach the nasal cavity and possibly the area called the middle meatus where the sinuses drain. This can help decrease swelling of the mucosa around the drainage pathways, but little actually gets into the sinuses themselves.

How long does sinus surgery take?

The operative time can vary between 1 hour and 4 hours depending on what needs to be done.

What are the risks of sinus surgery?

The risks of sinus surgery include but are not limited to scarring, bleeding, infection, injury to the eye, injury to the brain with leakage of cerebrospinal fluid, and the risk of general anesthesia. The risk of scarring is greatly reduced by frequent nasal cleaning and irrigation after surgery. The risks of injury to the eye and injury to the brain are extremely low- less than 0.5% in experienced hands – and have become even less encountered with the use of image guidance.

What is image guidance?

An Image guidance machine allows the surgeon to use a patient’s CT scan and various measured points along the patient’s face to create a navigable 3D map of the sinuses. It allows the surgeon to confirm anatomical landmarks and determine if cells are full opened and if we are getting close to the eye or skull base. It is not officially the standard of care, but is quickly becoming more heavily used because it allows the surgeon to be more efficient and safe.

What happens after sinus surgery?

After surgery, there are often blood crusts, clots, and debris which must be removed from the operated sinuses in order to prevent scarring and promote proper wound healing. In order to ensure a good long term outcome, the operated patient should continue to irrigate with saline several times a day as recommended by the surgeon.

Typical post-operative visits are one week after surgery, then two weeks after surgery, then one month after surgery. Depending on how the body is healing, visits will either continue on this pace or become more spaced out. Medications will also be added and removed as the body is healing.

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