Endoscopic Sinus Surgery

EXPLANATION:

Using telescopes to perform carefully controlled surgery inside the nose and sinuses. Frequently, this is combined with a septoplasty (straightening the partition inside the nose).

BACKGROUND

Most patients with recurrent sinus infections and/or nasal polyps can be managed medically. Antibiotics, antihistamines, decongestants, prescriptions, nasal sprays, steroids, and allergy shots will be sufficient therapy in most situations. However, for those patients who have recurrent infections despite aggressive medical therapy, poor tolerance of medical therapy, or infections, which may be threatening surroundings structures, it becomes necessary to consider sinus surgery.

Functional endoscopic sinus surgery (FESS) is a procedure, which has been used since the early 1980's to help to restore normal sinus function. These procedures are designed to enlarge the openings into the sinuses to allow them to function again normally. The sinuses are air-containing spaces in the face and head, which are lined by tissue, which is very similar to the tissue inside your nose. Repeated infections and/or nasal polyps can block the openings into these structures and create a situation for repeated infections. Using telescopes connected to a TV camera and special instruments, we work through the natural openings of the nose to enlarge sinuses and remove chronically infected tissues. This procedure does not alter the external appearance of the nose. It typically does not cause bruising or swelling of the eyes. The goal of the surgery is to allow the sinuses to heal themselves by enlarging their openings. This does not mean that you will never have another sinus infection, but you should have less frequent infections, which are easier to treat.

As noted above, the benefit of the surgery is fewer less severe sinus infections. As with any surgical procedure, there are risks. The sinuses are located very close to the eyes and brain. Complications in these areas are very rare. The sinuses underneath the eyes are also very close to the tubes that drain tears from the eyes and the nose. Again, a complication in this area is very rare.

PROCEDURE

You may be asked to take a steroid by mouth for approximately one week prior to surgery. This minimizes tissue swelling and bleeding at the time of surgery and makes the procedure simpler. You must also avoid any medications which would interfere with the normal clotting of blood; aspirin and aspirin containing substances such as Goody's powders, blood thinners and high does of medications such as ibuprofen (Motrin). On the morning of surgery you will be asked to not eat or drink after midnight. We would ask that you bring Afrin decongestant nasal spray to the hospital with you for use prior to surgery.

The procedure usually requires 1 - 1 1/2 hours. This will vary depending on the amount of work required. In addition to the sinus surgery, it may be necessary to straighten the septum, the partition between the two sides of the nose. The reason for straightening the septum would be to improve breathing or to allow access into the sinuses between the eyes. This will be discussed with you prior to your surgery.

You will be asleep through the entire operation and will be very carefully monitored. When you awaken in the Recovery Room, you will probably have packing in your nose, which may be removed in the Recovery Room so that you will go home without any packing. However, it is sometimes necessary to keep packing in place for 1-2 days. You will not be allowed to leave the hospital until the nursing staff and physician are satisfied that it is safe for you to leave.

PRE-OPERATIVE INSTRUCTIONS:

Nothing to eat or drink after midnight on the evening before surgery. You may brush your teeth and rinse out your mouth. Necessary medication, such as heart or high blood pressure medication, may be taken under the direction of your surgeon or anesthesiologist.

Purchase a small bottle of Afrin nasal spray from the drug store. Before leaving home on the morning of surgery, use two sprays on each side of the nose. Bring the bottle with you to the hospital.

There will not be any permanent change in the external appearance of your nose. Depending on the extent of your surgery. There may be some temporary swelling or bruising.