Sinus surgery has evolved over the last several years into a minimally invasive, outpatient procedure performed endoscopically without any external incisions. The advent of minimal to no packing in functional endoscopic sinus surgery (FESS) has led to much faster recovery times. When packing is used, gentle, dissolvable forms are available that resorb with nasal rinsing.
The technique of sinus surgery has also changed from more aggressive tissue removal, to mucosal preservation techniques that focus on finding the natural openings to the sinus cavities and widening them in a controlled manner.
Commonly used instruments include seekers and forceps, which gently find and help remove diseased tissues. Powered instrumentation called microdebriders are used cautiously to help clear nasal polyps and bony fragments that have been dissected. Image guided sinus surgery (IGSS) is a new modality that uses a CT scan or MRI to help confirm anatomic landmarks intraoperatively. IGSS can be helpful in difficult and revision sinus cases in which normal anatomic landmarks are distorted.
Potential complications of endoscopic sinus surgery: Minor complications:
Minor complications include bleeding, pain, infection, and nasal congestion. While significant bleeding requiring a trip to the operating room for control is extremely rare, mild bleeding is a normal aspect of the post-operative course and usually resolves within 24 hours. Other minor complications are commonly and effectively treated with analgesics, antibiotics, and steroids. Scar tissue formation is a troublesome complication that can occur in the post-operative course. This can cause the newly-created sinus openings to close down and cause recurrent sinus infections. Consistent office management can help limit scar tissue formation.
Major complications:
Major complications involve the brain and the eye. Cerebrospinal fluid (CSF) leak can occur when the skull base is violated. They can usually be repaired endoscopically using native tissue grafts and tissue sealants. Eye complications include injury to the extra-ocular muscles, nasolacrimal duct, and bleeding into the orbit. These rare complications may require the help of an opthalmologist to correct.
Endoscopic sinus surgery plays a critical role in the management of patients with sinus disease. When medical management fails to control sinus conditions, FESS is a useful modality with a high success rate and patient tolerance.
During your visit to SINOVA for a nasal or sinus issue, the practitioner may wish to perform an endoscopic examination of the nasal passageways. The nasal endoscope is a thin, rod-like camera that helps to magnify the lining of the nose. It is used to:
After we have obtained verbal permission from you, we spray a topical anesthestic spray that will numb (Lidocaine) and decongest (Afrin) your nasal passages. Unfortunetly, the spray tastes quite bitter and you may swallow some of it, thus making the throat feel numb. The good news is that it only lasts about 15 - 20 minutes. The endoscope is then passed into the nose and each passageway is carefully examined. The vast majority of patients tolerate the procedure very well. For more information on nasal endoscopy, refer to:
http://www.american-rhinologic.org/patientinfo.introendoscopy.phtml
Nasal polyps are benign lesions that occur within the lining of the nasal and sinus cavities. They are the end result of inflammatory processes that present as translucent grape-like structures.
Symptoms include nasal congestion, difficulty or inability to smell, and occasionally, bleeding. Nasal polyps can block the natural openings of the sinuses and cause sinusitis.
We do not completely understand how and why nasal polyps form. Multiple theories exist, including allergy and blood vessel permeability, but studies have not shown a single one to be definitive. Nasal polyps are associated with a number of conditions such as asthma, cystic fibrosis, and allergic fungal sinusitis.
Treatment of nasal polyps involves both medical and surgical therapy. Saline irrigations, nasal steroids, oral steroids, antibiotics, topical steroid irrigations, mucolytics, and leukotriene modifiers are some of the medications used to manage nasal polyps. Functional endoscopic sinus surgery is the mainstay of surgical management.
The nasal septum is the partition that divides one side of the nose from the other. It is rarely perfectly straight--it is slightly crooked in over 80% of people. When the septum is so crooked or deviated that it blocks the nasal passage, then a surgical operation called a septoplasty may restore clear breathing. Please check the link below for more information.
http://www.american-rhinologic.org/patientinfo.septoplasty.phtml
Sinus Anatomy (Check Sinusitis page for video)
The main structures of the nasal passages are the sinuses, the septum, and the turbinates.
The sinuses are hollow, air-filled cavities that are located within the bones that comprise the skull. There are four paired structures consisting of:
It is unclear as to the definitive function of the sinuses but they may play a role in voice resonance, humification of inspired air, and as a shock absorber for the head. All of the sinuses have openings that communicate with the nasal passageways. The sinuses have a mucosal lining that produces mucus and contain cilia, which are tiny, microscopic hair-like structures that play an important role in clearing the mucus. Cilia beat in conjuction to sweep the mucus, which traps bacteria and allergens, into the nasal passageways and into the throat. Studies have shown that cilia function best in a warm, moist environment.
The turbinates are tubular structures that are bony outgrowths covered with a thick mucosal lining. This lining contains a rich blood supply, which allows the turbinates to perform the important function of warmth and humification of inspired air as it proceeds into the lungs. A secondary function is to trap bacteria and allergens as they initially enter the body. This exposure to allergens can often cause swelling of the turbinates (turbinate hypertrophy), which is a frequent cause of nasal congestion.
The nasal septum is the wall that separates the right and left nasal passageways. The septum is comprised of mostly cartilage in the front of the nose, and bone in the back. It is lined by a mucosal lining on both sides, which contains its blood supply. Septal deviation is a common finding in which a part of the septum bends toward either the left or right. At times, the deviation can cause nasal obstruction, headaches, and even sinusitis by blocking the openings.
Sinusitis is defined as inflammation of the sinuses caused by a number of etiologies including bacteria, viruses, fungi, pollutants, nasal polyps, anatomic abnormalities, and allergies among other agents.
The above agents cause swelling of the sinonasal lining. The sinuses produce roughly 1 liter of mucus daily that is cleared by the cilia. When the lining is swollen, the cilia do not function properly and the mucus becomes stagnant. This eventually leads to blockage of the openings of the sinuses and a vicious cylce begins leading to bacterial colonization of the mucus and thus, sinusitis.
Symptoms of sinusitis can be divided into major and minor symptoms. The diagnosis of sinusitis requires at least 2 major or 1 major and 2 minor symptoms.
Acute: Symptoms that last up to 4 weeks with complete resolution
Subacute: Symptoms that last between 4 and 12 weeks with complete resolution
Recurrent Acute: 4 or more episodes per year with resolution of symptoms between episodes
Chronic: Symptoms occuring for 12 or more weeks