Functional Endoscopic Sinus Surgery

Overview

The sinuses are air-filled holes in the skull. They are connected to the nose and can get infected leading to drainage, pain, etc. This may be caused by allergies, polyps, abnormal shape or swelling inside the nose.
Medical therapies, such as antibiotics, steroids, nasal sprays and decongestants, will often cure bouts of sinusitis. Sinus surgery is advocated in those patients who fail to improve after medicines.

There are circumstances when immediate sinus surgery is warranted. Tumors of the sinuses, whether benign or malignant, often require surgical removal. Surgery may be the only option for some patients whose sinus condition aggravates other medical problems such as asthma. Cancer or immunocompromised patients may require drainage for culture or for treatment of a fungal infection. In the past, surgeries requiring an incision under the lip (Caldwell-Luc) or face (external ethmoidectomy) were used to drain sinus cavities. Most procedures are now performed using endoscopic technology (small cameras through the nose), eliminating the need for external incisions.

Endoscopic Sinus Surgery

Small rods of light with a camera (endoscope) are used to operate through your nostrils into the sinuses. This does not involve any cuts on your face, but may be combined with other external approaches, which may involve cuts. This surgery is usually done under general anesthesia for your comfort. A CT scan will serve as a road map for your surgeon — please bring it with you to the clinic or operating room.

Endoscopic sinus surgery has ushered in a new philosophy allowing the surgeon to target the ostiomeatal complex (OMC), an area in the anterior ethmoid sinus region. Obstruction of the OMC can lead to subsequent infection of the maxillary, frontal and sphenoid sinuses. Accordingly, endoscopic sinus surgery removes thickened and diseased tissue blocking the OMC. Most of the healthy tissue in the sinuses is undisturbed allowing for faster and better overall recovery. Endoscopic surgery can also be utilized for removal of polyps, nasal masses and sometimes straightening the septum to improve nasal airflow.

POSSIBLE RISKS AND COMPLICATIONS RELATED TO FUNCTIONAL ENDOSCOPIC SINUS SURGERY

All surgical procedures have risks, benefits, alternatives and complications. The following possible risks and complications have been discussed with the patient regarding this surgical procedure to include:

1. Bleeding-Mild to moderate bleeding is expected up to 48 hours after surgery.
2. Infection
3. Injury to tear duct or sac resulting in tearing of the eyes. This may require further surgery
4. Need for frequent post-surgical visits for cleaning, to help prevent the disease from recurring.
5. May have an external scar if external approach is used.
6. Drainage of brain spinal fluid from the nose may occur. Further surgery may be needed.
7. Numbness of the teeth/cheek or near any external cuts.
8. Reactions to anesthesia.
9. Blindness or near vision changes. The patient should call the ENT clinic immediately if vision decreases.
10. Meningitis- (Brain infection)-Symptoms include: Stiff painful neck, increase in temperature and headache.
11. Voice change due to airflow changes between nose and mouth.
12. Change in sense of smell and/or taste.
13. Unexpected cardiac, pulmonary or kidney changes from anesthesia or medications given during surgery.
14. Need for future medical (like antibiotics) and surgical care.

INSTRUCTIONS FOLLOWING SINUS SURGERY

The procedure generally lasts from one to three hours. You can expect to go home after the procedure unless other medical conditions complicate recovery.

Your nose may or may not have packing in place after the procedure. This packing is often removed 3-5 days after surgery, at your next scheduled office visit. Full recovery may take several weeks. Dry blood, mucus and crusting in the nose will occur, and may result in symptoms like a severe cold or sinus infection. It is important to begin nasal irrigations with distilled water starting the day after surgery. You can use either Sinus Rinse by Neil Med or a baby bulb syringe. Fill this syringe with distilled water, and gently flush out each side of your nose twice a day starting the day after surgery. This will help clean the clots from your nose, and prevent scarring after surgery. Proper postoperative care is essential to prevent scar formation and allow normal healing. This requires regular visits back to your surgeon for endoscopic cleaning. Generally speaking, your first visit back is the most difficult, and you may need someone with you to drive home after the visit.

THINGS TO DO

- Take pain medicines as prescribed, including Tylenol:
- Take antibiotics, if prescribed:
- Call San Francisco Otolaryngology at 415-362-5443 to confirm your next postoperative appointment.

Your next appointment is:

- Start your nasal irrigations the day after surgery
- Sneeze or cough with your mouth open
- Eat a regular diet
- Take your pain medicines before your first post-operative visit

THINGS NOT TO DO

- Any heavy activity including lifting children and exercise for 1 week
- Blow your nose or pick at your nose
- Take aspirin or aspirin containing medicines, Advil, Motrin or any other NSAIDS
- Fly without your doctor’s clearance for 7-10 days after surgery

Call the ON Call Doctor Immediately if any of the following occur:

1. Change in vision
2. Increased swelling around the eyes
3. Neck stiffness or deep head pain
4. Continued Nausea or Vomiting
5. Bright red blood that lasts more than ten minutes or causes choking
6. Fever over 101 degrees

Functional Endoscopic Sinus Surgery Risk & Complications

 

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