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Endoscopic Sinus Surgery

Functional endoscopic sinus surgery is a minimally invasive technique used to restore sinus ventilation and normal function. The most suitable candidates for this procedure have recurrent acute or chronic infective sinusitis, and an improvement in symptoms of up to 90 percent may be expected following the procedure. With recent advances in technology including the nasal endoscope, this procedure is now incision less and can often be performed with minimal packing, pain and recovery. The most common indication for endoscopic sinus surgery is a chronic sinus infection refractory to medical management.

Background

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 sense of smell, fatigue and pain. The underlying cause of the inflammation may be air pollution, allergies, polyps, abnormal internal nasal and sinus anatomy, 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. In children, any complication from untreated sinusitis is typically an indication for sinus surgery.

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

The Procedure

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, relieve compression of the optic nerve and eye, repair cerebrospinal fluid leaks, and reconstruct defects in the wall between the brain and sinuses.

Download Sinus Surgery Information sheet

Post Operative Instructions

• Learn about image guided sinus surgery

Septoplasty

Septoplasty is a surgical correction of the wall that divides the two nostrils (nasal septum) performed to improve breathing, relieve nasal obstructions, remove benign or malignant tumors, or reconstruct the septum after previous surgery or trauma.

Description of Septoplasty

The nasal septum is the wall or partition that divides the nasal cavity. It is composed of both bone and cartilage, and covered with a mucous membrane. An injury or malformation of this septum can produce a deviated septum, resulting in a defect where one part of the nasal cavity is smaller than the other. This can obstruct airflow, cause contact nasal and sinus pain, and lead to frequent nosebleeds (epistaxis). Septal deviations are very common in the community, but when they start to cause symptoms people often seek medical advice.

Occasionally, the deviation may obstruct breathing, block the normal flow of mucus from the sinuses during a cold or nasal virus, or prevent proper drainage of the sinuses resulting in chronic or recurrent acute sinusitis. In some cases nasal surgery may be necessary to relieve the obstruction and reduce irritation or infection in the nose and sinuses.

Surgical correction of the nasal obstruction caused by a deformed or malpositioned septum is called septoplasty. Some degree of septal deviation is normal and varies among individuals, therefore septoplasty is only performed if the deviated septum is causing symptoms that are not controlled by medical treatment.