The most common reasons for sinus surgery are chronic infections or sinus obstructions such as those caused by nasal polyps. The surgery itself usually takes about one to two hours and is performed as an outpatient procedure. It is usually done under general anesthesia, but it can be done under local anesthesia with sedation depending on your circumstances.
Sinus surgery is usually done as an outpatient procedure and is safe, effective, and well-tolerated.
There are low risks of sinus surgery, particularly today with the introduction of newer techniques such as balloon sinuplasty and computer image guidance.
Postoperative care involves using nasal saline, and antibiotics, visiting the surgeon for office debridement or cleaning of the nose and limiting strenuous activities.
Most patients opt for sinus surgery as either an addition to the overall care of their symptoms or because medical management is not sufficient.
It is one of the most surgical procedures performed today. There are more than 250,000 sinus operations performed annually in the United States. It is considered highly effective and safe with few risks.
Most patients have mild to moderate pain afterward, depending on the amount of work done inside the nose and sinuses. Some patients require simultaneous straightening of the mid-portion of the nose called the septum (deviated septum repair) and reduction of the lining of the nose (inferior turbinates).
Today, most sinus surgery is performed using an endoscope or an instrument with a bright light and a camera. Some doctors use highly sophisticated computer image guidance along with the patient’s CT scans to have the best possible results.
Am I making the right decision to have sinus surgery in the first place?
The decision to undergo surgery is carefully made between you and your doctor. Most patients who suffer from chronic sinusitis decide to have sinus surgery because the surgery will provide additional benefits over medical treatment alone.
Some patients have little or no choice but to have sinus surgery to improve their medical condition. These are the minority.
The absolute indications for sinus surgery include:
- Orbital or intracranial infection.
- Invasive fungal infection.
- Cerebral spinal fluid leak.
It’s a good chance you aren’t in any of the above categories, but if you or a loved one is, then surgery is usually something that cannot be avoided.
There is great variation among patients and doctors on whether to do sinus surgery. It is important to understand that sinus surgery alone is seldom enough to solve all of your nasal and sinus problems.
Sinus surgery should be viewed as one of the tools to help people with overall nasal and sinus symptoms. Many will still need occasional medications, allergy treatments, treatment of an underlying condition such as an autoimmune disease, or even repeat surgery in some cases.
Is sinus surgery more common now?
Sinus surgery numbers continue to increase because of better technology, better surgical instrumentation and techniques, and continually improving results.
A relatively new procedure called balloon dilation sinuplasty was introduced in 2006.
Here, a sinus balloon is threaded through natural sinus openings using a guide wire. The balloon dilates the sinus opening so there is the preservation of the bone and surrounding tissue.
Another new development in the 1990s was the use of image guidance. This is when the doctor uses the patient’s CT scans and special computer technology and surgical instrumentation to guide the surgical resection with amazing precision.
What can I expect on the day of surgery and afterward?
Nasal and sinus surgeries have undergone a tremendous transformation since becoming more mainstream in the 1970s by famous ENT doctor Walter Messerklinger. Most of the initial surgeries were done by time-honored and reliable external approaches.
While external approaches or making an outside skin of the face are rarely done today, they do still play a role in very select patients in certain circumstances, including intractable or difficult-to-manage conditions such as nosebleeds or tumors.
Most ENT doctors are trained in both the old external surgical approaches and the new internal ones using lighted endoscopes through the nose. Chances are, your procedure will not involve any skin incisions on your face and will be performed all through your nose.
Here are some of the components done during surgery.
Nasal packing, splints, or spacers
With the newest surgical techniques and use of absorbable materials, most ENT surgeons have abandoned the use of materials such as nasal packing that has to be removed unless there is more bleeding encountered during the surgery than is typical. Even then, most surgeons can remove any nasal packing before the patient is discharged home.
Some ENT surgeons use a combination of antibiotic ointment or gel material instead of using gauze or sponge packing, which has to be removed. Consult with your ENT surgeon regarding their use of these types of materials.
Occasionally, an ENT surgeon will use a spacer to keep the new openings of your sinuses that were created during the surgery. The spacer should be removed later during recovery in the doctor’s office, and it can be absorbable or non-absorbable.
Saline nasal spray and irrigation
All post-operative patients are instructed to use copious amounts of nasal saline either by spraying or some type of gentle irrigation.
The nasal saline will dissolve both any absorbable ointments or gels left inside the nose and promote healing.
Antibiotics and/or corticosteroids
Most surgeons will administer both antibiotics and corticosteroids through your IV during the surgery.
Postoperative oral antibiotics are usually taken as prescribed beginning the day after surgery, but some surgeons do not think it is necessary in many cases.
Office visits for nasal debridement
An essential part of nasal and sinus surgery is debridement. This means that the surgeon will place the medication in your nose in the office and use either suction or surgical instruments such as forceps to debride or remove any debris, packing, or scabbing from the nose.
This is usually not a painful procedure.
Debridement is necessary for post-operative recovery and proper healing to prevent unnecessary scarring or other potential issues.
Diet and activity
Most patients resume a normal diet either after the surgery the same day or by the following day.
All patients are advised to limit strenuous activity for at least one to two weeks after surgery. This includes bending over, straining, or lifting heavy objects to prevent the risk of bleeding.
Full healing within the nose and sinuses may take four to six weeks or more.
Sinus surgery is one of the most popular surgical procedures performed today and is considered highly effective and safe with few risks.
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