Sinus Surgery

What is a deviated nasal septum and what are enlarged turbinates? 

The nasal septum is the wall that divides the middle of your nose. A deviated septum is when the bone or cartilage that makes up the septum is crooked. This condition can make breathing difficult, cause snoring or sleep apnea and can lead to sinus infections. A deviated nasal septum may be from birth, from normal aging, or as a result of trauma. Diagnosis of a deviated nasal septum is based on a complete history and examination of the nose.

Turbinates are the large mucosal covered bony structures on either side of the nasal septum inside the nose. Enlarged turbinates, or turbinate hypertrophy, are caused by turbinate irritation or allergies and may grow to fill an area left by a deviated nasal septum. The swelling may be treated by nasal sprays or oral medication. Allergy testing may be needed to determine the triggers that contribute to the nasal congestion, so they can be avoided or treated.

When is deviated nasal septum or turbinate surgery indicated?

Straightening the deviated nasal septum is called septoplasty, submucosal septal resection, or septal reconstruction. Septoplasty may be indicated when medication and other treatments have failed. The purpose of the procedure is to allow easier breathing, decrease snoring, or improve sinus function. Dr. Bennett works through the nostrils to straighten the twisted cartilage and bone. The procedure takes about an hour at an ambulatory surgery center and general anesthesia is usually required. You generally go home about an hour after surgery. Dr. Bennett rarely finds it necessary to pack the nose.

Turbinate surgery, or turbinoplasty, may be necessary when medication and allergy avoidance do not improve breathing from turbinate hypertrophy. The turbinate size is reduced by repositioning the enlarged bone laterally and shrinking the mucosa. Breathing is usually better than before surgery at 1 week and can improve over the next year or more. Turbinoplasty and septoplasty can be combined with sinus surgery as well as with rhinoplasty (nasal reshaping surgery).

What are the sinuses and what is sinusitis?

Sinuses are spaces in the skull that are lined with tissue (mucosa) that warms, humidifies and purifies the air that we breathe. The sinuses constantly make fluid that purifies the nose and prevents infection. Small passages connect the sinuses (osteomeatal complexes) with the inside of the nose. There are four sinuses on each side including the maxillary sinuses in the cheeks, frontal sinuses in the forehead, ethmoid sinuses between the eyes, and sphenoid sinuses in the back of the nose.

When allergies, a deviated septum or “common cold” prevent the sinuses from draining normally, a sinus infection (sinusitis) can occur. Because the draining spaces inside the nose are millimeters or less, even a small amount of swelling can cause sinusitis. Repeated sinusitis episodes can cause thickening of the sinus bone and mucosa and can  cause  recurring  acute or chronic sinusitis. A “head cold” that lasts more than a few days may be undiagnosed sinusitis.

What are the signs and symptoms of sinusitis?

Thick drainage from the nose- Infected mucous is thicker and in larger amounts than normal, may be green or yellow, can be foul smelling, and can drain from the nose or be coughed up.

Headache or sinus pain- Pressure from blockage of the small sinus cavities can cause severe facial pain, headache, toothache and feeling of nasal congestion. When lying flat the congestion and pain are more extreme and can dramatically disrupt sleep. Changes in barometric pressure from flying or scuba diving should be avoided.

Repeated sinus infections- Tissue thickening inside the sinuses can narrow the passages and increase the risk of getting another infection. The bacteria inside the nose may become resistant to antibiotics making infections more difficult to treat.

Fatigue- Constantly fighting an infection drains normal energy and can interfere with the ability to get a good nights’ sleep.

Decreased sense of smell or taste- Swelling of the tissue of the nose and sinuses will block the nerves that control smell.

How is sinusitis treated?

History and examination inside the nose will determine if a sinus infection is present. Successful treatment of an acute sinus infection is often possible using an antibiotic directed toward the most likely causes of infection. Additional improvement may be obtained by a combination of anti-allergy medication, decongestants, nasal sprays, saline rinses and environmental controls. Failure of the infection to clear may require a longer course of antibiotics. Failure of antibiotics may require further testing including a sinus CT scan.

When is sinus surgery necessary?

When medical treatment has failed, sinus surgery can dramatically improve your quality of life and sense of well-being.  Endoscopic sinus surgery is a procedure used to remove blockages in the sinuses (the small passages needed for healthy sinus function).  Over the past decade, the advancement of endoscopic sinus surgery using minimally invasive microinstruments to restore the natural drainage of the sinuses, has resulted in more effective and better tolerated sinus surgery. Computed tomography (CT) scanning in the management of sinusitis has led to more precise localization of sinus problems. Dr. Bennett may also use 3-dimensional imaging during the procedure to provide an additional layer of safety and thoroughness. With Dr. Bennett’s advanced sinus techniques, placement of packing within the nose and the associated discomfort is rarely needed. This improves the overall experience and contributes to a more rapid recovery. Patients are typically back to normal activity in 7-10 days.

What is Functional Endoscopic Sinus Surgery (FESS)?

Functional endoscopic sinus surgery is an option for patients when other medical treatments have failed. The surgery addresses each individual sinus and removes the blockages to allow each sinus to be ventilated and drain through its natural opening. Polyps and scar tissue are removed along with thickened mucosa to improve sinus function. All procedures are performed though the nostrils. Straightening a deviated nasal septum (septoplasty) or reducing enlarged turbinates (turbinoplasty) at the same time may improve the results of sinus surgery. Insurance will cover the cost for sinus and breathing surgery.

How is the recovery from sinus surgery?

Patients will usually be comfortable enough to go home an hour or two after the procedure. Dr. Bennett does not usually place packing in the nose as this can cause discomfort. For the first few days a feeling of a “head-cold” is normal and this may resolve before the first office visit 1 week after the procedure. The nose is cleaned at the follow-up visit and most patients are able to go about their normal activities. An improvement in ease of breathing and a decrease or complete elimination in the frequency and severity of sinus infections is common.

Can sinus and breathing surgery be combined with rhinoplasty (nose job)?

Yes. Because the recovery periods are the same, no additional time is needed. A form-fitting splint is often placed over the nose for the first week. Insurance may help with sinus and breathing care as well as with traumatic nose injuries, but will never pay for cosmetic surgery.