Sinus Surgery & You: Making the Right Choices
The First Decision: Am I Ready for Surgery? : Understanding Alternatives
The first step in consulting with your doctor about undergoing sinus surgery is the simple awareness that surgery is a big decision.
Doctors typically recommend that his or her patient exhaust all viable methods of treatment before turning to surgery. In general, once a patient is initially diagnosed with acute or chronic sinusitis, doctors will recommend conservative medical treatment. One option is a course, or several courses, of antibiotics, decongestants, antihistamines or other medications over a period of time. This is an attempt to treat the inflammation or bacterial and fungal infections to a point where the body is able to handle the infection on its own.
You should make several lifestyle changes to help alleviate your sinus issues. For example, quitting smoking and/or taking steps to avoid harmful pollutants, allergens and other bacteria in the home and outdoor environment may serve as an effective solution. Specifically, these steps act to preserve the health of the sinus and nasal cilia, which can reduce further instances of acute and/or chronic sinusitis.
Another alternative switches the focus in eliminating sinus complications from treatment to prevention. Sometimes, merely following a strict regime of nasal sprays containing steroids, in conjunction with saline sprays or other similar nasal washing products may be all that is needed to purge your sinus woes. While this appears to be a simple and basic approach, for many patients, it serves as an extremely effective & easy method for preventing the onset of sinus inflammation and blockages. Dr. Bennett reminds patients that it is important to be diligent and to remember to use the nasal sprays and saline rinses as your doctor recommends.
If these and other alternative treatment plans have failed and your doctor advocates for sinus surgery, this decision must be based on a variety of assessments relating to the following:
(1) Severity of symptoms
(2) Results of a CT scan and
(3) General physical condition*
*Children or adults over age 60 should take extra care in understanding the risks and complications involved in going forward with any form of sinus surgery
The Second Decision: Which Surgery is Right for Me?
If you have carefully considered your doctor’s input, and feel comfortable with the decision to move forward with surgery, the next decision is to determine which type of surgery will provide the most effective results based on your symptoms.
After groundbreaking strides in medical technology made in the last two decades, there have emerged three commonly used types of sinus surgery:
(1) Functional Endoscopic Sinus Surgery (FESS) – Full Article
(2) Balloon Sinuplasty Surgery – Full Article
(3) Traditional Sinus Surgery – Full Article
Each of the three procedures listed above accomplishes the same goal in different ways: flush out infected bacteria, clear blocked passages, and keep healthy tissue intact for normal functioning of your sinuses.
In arriving at the decision of which sinus surgery is right for you, Dr. Bennett urges patients to have an in-depth knowledge relating to the methods, risks, complications, and recovery expectation of all three procedures. This will allow you to not only make the most informed decision with your doctor, but also understand that your options are many and varied.
FACT SHEET: Option 1 – Functional Endoscopic Sinus Surgery
The most common procedure that maximizes results & minimizes risks
- The modern and most common surgical method for sufferers of chronic sinusitis
- Patients typically receive general anesthesia, but local anesthesia may be appropriate in some cases
- Two Step Process:
(1) A surgeon inserts an endoscope into the nasal cavity with a fiberoptic
lens to identify the specific obstruction
(2) A surgeon then uses several fine instruments to cut and remove the
infected tissue or bone and open passages
- Following surgery, the nose is covered in a sponge dressing to catch blood or drainage from the nose; aftercare will be important because the nose must be free of crust-build up. Cleaning the nose via a nasal rinse 2-3 times daily is imperative
- Patients typically experience full results after one or two months
- No external incisions are needed, all sutures are inside the nose
- Typically performed under in one to two hours, however some cases may take longer depending upon:
– The severity of the patient’s condition and amount of blockage
– The sinuses on which the surgeon is operating
- A very serious risk is blindness due to optic nerve damage, although the risk is extremely low; the most common major complication is cerebrospinal fluid leak. This risk is also low (0.2% of cases, nationally)
- Most commonly-reported results are an elimination of nasal obstruction and facial pain
FACT SHEET: Option 2 – Balloon Sinuplasty Surgery
Highlights: Safe, less-invasive, allows for a speedy recovery & long-lasting results
- A newer form of sinus surgery; less invasive than FESS and often performed by doctors in their office
- Sometimes referred to as Balloon sinus dilation (BSD)
- Symptoms triggering the need for a BSD procedure are identical to those experienced by patients undergoing a standard functional endoscopic sinus surgery (FESS)
- Limited to the frontal, sphenoid, and maxillary sinuses only; usually patients who consider this option have a limited to moderate amount of complications involving these sinuses.
- Patients with pansinus polyposis (polyps existing in all of the sinuses), severe fungal disease or connective tissue disease, or possible tumor(s) are advised not to undergo BSD as tissue is not removed by use of the balloon
- Patients may receive either general anesthesia or local anesthesia
- There is a low complication rate, but the procedure is not without risks, which include tissue and mucosal shock, or trauma, subsequent infection, or possible eye injury or blindness
- A return to work and normal activities is 2 days, on average, for those patients who select the in-office procedure
- Five-Step Process
(1) Insertion of a sinus guide catheter into one nostril under endoscopic
visualization to identify the blockage
(2) A guide-wire that is inserted into the catheter.
(3) Access to the blockage by using the guide-wire to insert a second
catheter, which contains a small, inflatable balloon.
(4) The surgeon gently inflates the balloon to “reshape” the nasal cavity and
Expand bone of the nasal passages, whereupon the balloon is then deflated.
Tissue is not removed
(5) An ‘irrigation catheter’ is inserted to flush out any residual, infected
mucus and induce draining
FACT SHEET: Option 3 – Traditional Sinus Surgery
A rarely used option of last resort for the chronic sufferer
- An option for patients who have experienced a failed FESS operation, or have severe complications of sinusitis, such as:
(1) A severe case of pus-filled sinuses
(2) A severe infection in the facial bones; or
(3) A severe brain abscess
- The most invasive surgery – the surgeon makes an incision in the mouth or facial skin to access the sinuses directly to scrape away the infected tissues, bacteria, or fungus
- After surgery, the nose is packed with gauze in order to prevent bleeding and absorb drainage.
- Aftercare includes changing the packing multiple times per day, and irrigating the sinuses daily to ensure moisture
- Infection may occur, so patients must be diligent in aftercare instructions, if infection occurs, it can be eliminated easily through the use of antibiotics
- FESS procedure and balloon sinuplasty surgery are less invasive with an overall faster recovery rate, however some patients do not qualify for these options
- Involves a higher incidence of more serious risks, such as: heavy bleeding form the nose, inflammation of the cranial membrane, partial loss of sight, death
- Success rates are above average, although the amount of people who elect for this form of surgery has decreased dramatically since the advent of FESS
Lesser-Known & Used Forms of Sinus Surgery
There are two, lesser-known type of sinus surgery that are available in the event that you seek further options in treating your sinus condition.
The first, image-guided surgery, takes advantage of the rising popularity in the use of a new 3-dimensional mapping system that can be described as combining together the basic sinus CAT scan and live, streaming information about the exact position of surgical instruments via infrared indicators.
Perhaps the most revolutionary aspect of this new type of sinus surgery is in the way that it heightens the accuracy in which surgeons may use their instruments when operating on the complex and intricate sinus passages. Interestingly enough, the mapping system used was taken from the missile guidance division of the United States armed forces.
This type of surgery is being increasingly used in the United States. Typically, 3-D image guidance is used for those who suffer from an uncommonly severe form of chronic sinusitis, have abnormal sinus structure, are undergoing revision sinus surgery, or have frontal or sphenoid sinusitis.
The Caldwell Luc procedure is a more specialized form of surgery that is not a representative treatment plan for the ordinary patient with a case of chronic sinusitis. Rather, it is a procedure performed once it is discovered that a patient has a malignancy exists in the sinus cavity.
This operation involves a focus on only one of the paranasal sinuses – the maxillary sinus, which is located in the cavity above the upper teeth and beneath the eye. A surgeon gains entrance to this sinus through the upper jaw, near the second molar tooth. From here, the surgeon creates an opening, thereby connecting the maxillary sinus with the nasal cavity, so as to remove blockages, clear tissue and induce drainage. As you may have guessed, this operation’s name is derived from two famous physicians who took critical steps towards its development: An American doctor by the name of George Caldwell and Henry Luc, a French laryngologist. Henry Luc and is most often performed when a malignancy is present in the sinus cavity.
Be Prepared for Your Office Visit. Prepare a List of Past
and Pre-Existing Health History Before Surgery
All three surgeries require a discussion about your past and pre-existing health conditions, as well as post-op instructions. Review the following checklist to anticipate the information you will need to give, and be provided with, leading up to, and on the day of surgery:
- Pre and post operative instructions
- Common risks, possible alternatives and patient expectations
- Collection of previous operative notes and records, including any CAT scans
- A complete medical history (for anesthesia purposes)
- Current or past nose injuries
- Current breathing difficulties
- Current Medicatations
- Medication allergies
Our staff takes care of the following as far as checking your healthcare benefit eligibility and letting you know so there are no surprises.
- Scheduling of the surgery & additional follow-up visits*
*Note: Typically, you will meet with your surgeon’s office manager and/or patient care coordinator to discuss these actions
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