Endoscopic Sinus Surgery

Most surgeries on the sinuses are conducted to relieve a chronic condition. In the past, operations on infected sinuses were conducted externally through incisions on the face. Incisions were made under the upper lip through the gum (the Caldwell-Luc operation) or an external ethmoidectomy, a removal of the sinuses between the eyes through an incision in the face. However, most surgical procedures for the sinuses are now carried out using endoscopic sinus surgery, which are performed through the nose.

The development of endoscopic sinus surgery (ESS) has ushered in a new philosophy allowing the surgeon to target the ostiomeatal complex (OMC), an area in the anterior ethmoid sinus region. Obstruction in the OMC can lead to subsequent infection of the maxillary, ethmoid, frontal, and sphenoid sinuses. Accordingly, endoscopic sinus surgery, a procedure through the nose, removes thickened and diseased tissue that blocks the OMC. Most of the healthy tissue in the sinuses is undisturbed, allowing rapid recovery.

Endoscopic surgery can also be utilized for removal of polyps and to straighten the septum, thus restoring a normal flow from the sinuses. Unlike other sinus surgical procedures, endoscopic sinus surgery has minimal and usually temporary effect on the patient's appearance, e.g. mild swelling.

What to expect with Endoscopic Sinus Surgery

The endoscopic procedure usually lasts from one to three hours and is performed using general anesthesia in children. Generally, the patient goes home after surgery unless other medical conditions complicate recovery.

Full recovery may take several weeks. Dry blood, mucus, and crusting in the nose may occur, presenting symptoms of a severe cold or sinus infection. Nasal irrigation or salt-water sprays and antibiotic lubricants may be recommended by the surgeon to facilitate normal sinus activity. Proper post-operative care is essential to prevent scar formation and allow normal healing. The surgeon performing the procedure will generally perform all required follow-up procedures.

Endoscopic Surgery for Sinustitis in Children

Surgery is considered for the small percentage of children with severe or persistent sinusitis symptoms despite medical therapy. Using an instrument called an endoscope, the ENT surgeon opens the natural drainage pathways of your child's sinuses and makes the narrow passages wider. This also allows for culturing so that antibiotics can be directed specifically against your child's sinus infection. Opening up the sinuses and allowing drainage and air to circulate usually results in a reduction in the number and severity of sinus infections.

Also, your doctor may advise removing adenoid tissue from behind the nose as part of the treatment for sinusitis. Although the adenoid tissue does not directly block the sinuses, infection of the adenoid tissue, called adenoiditis, or obstruction of the back of the nose can cause many of the symptoms that are similar to sinusitis, namely, runny nose, stuffy nose, post-nasal drip, bad breath, cough, and headache. (For further information, see Tonsillectomy and Adenoidectomy)

Other Useful Links:

Information on Sinus Infections

Surgical Treatment of Sinustitis, see http://www.emedicine.com/ent/topic340.htm  

Source: the American Academy of Otolaryngology- Head and Neck Surgery, Inc., 2001