Endoscopic Sinus Surgery
Endoscopic Sinus Surgery
|Endoscopic Sinus Surgery|
Functional endoscopic sinus surgery (FESS) is the primary safe approach used currently for the surgical treatment of chronic sinusitis.
This procedure is a minimally invasive, safe and it can be performed entirely through the nostrils, leaving no external scars. There is little swelling and only mild discomfort. It can be combined with other nasal operations (septoplasty, turbinate radiofrequency etc.).
A recently developed alternative to functional endoscopic sinus surgery is balloon sinuplasty. This technique uses balloon catheters to dilate the maxillary, frontal, and sphenoid natural ostia without bone or soft-tissue removal. Reports show persistent patient symptom improvement and sinus ostia patency.
Indications for Endoscopic Sinus Surgery
|Indications for Endoscopic Sinus Surgery|
The most common indication for endoscopic sinus surgery is “chronic rhinosinusitis”.
The most common indications for endoscopic sinus surgery are as follows:
• Chronic sinusitis refractory to medical treatment
• Recurrent sinusitis
• Nasal polyposis
• Antrochoanal polyps
• Sinus mucoceles
• Excision of selected tumors
• Cerebrospinal fluid (CSF) leak closure
• Orbital decompression (eg, Graves ophthalmopathy)
• Optic nerve decompression
• Dacryocystorhinostomy (DCR)
• Choanal atresia repair
• Foreign body removal
• Epistaxis control
Contraindications for Endoscopic Sinus Surgery
|Contraindications for Endoscopic Sinus Surgery|
There are probably no absolute contraindications to endoscopic sinus surgery.
The most common relative contraindications for endoscopic sinus surgery are as follows:
• Absence of specific osteomeatal complex abnormalities.
• Oesteomyelitis involving the sinuses.
• Frontal sinus disease with stenosed internal ostium.
• Threatened intracranial and / or intracerebral complications.
• Inaccessible lateral frontal sinus disease.
Smoking is also consider as a relative contraindication to endoscopic sinus surgery.
Technique of Endoscopic Sinus Surgery
|Technique of Endoscopic Sinus Surgery|
Endoscopes with different diameters of 4mm (adult use) and 2.7mm (pediatric use) and with a variety of viewing angles (0 degrees to 30, 45, 70, 90, and 120 degrees) provide good illumination of the inside of the nasal cavity and sinuses. High definition cameras, monitors and different tiny articulating instruments aid in identifying and restoring the proper drainage and ventilation relationships between the nose and sinus cavities.
Paranasal Sinus CT scanning can also be used to identify the diseased areas, a process that is required for planning the surgical procedure.
Endoscopic Sinus Surgery - Maxillary Drainage Video
On the video above: Right maxillary sinus retention cysts discharging into the nasal cavity.
Inner wall of right maxillary sinus pushed toward the nasal cavity by retention cyst, endoscopic evacuation of cyst is showing on video.
Endoscopic Concha Bullosa Operation Video
Endoscopic Sinus Surgery - Injection of Local Anesthetic Video
Caldwell Luc Operation: An Alternative Method For Surgical Traetment of Chronic Maxillary Sinusitis
|Caldwell Luc Operation: An Alternative Method For Surgical Traetment of Chronic Maxillary Sinusitis|
Caldwell-Luc operation is defined before the endoscopic sinus surgery to relieve chronic sinusitis by improving the drainage of the maxillary sinus, one of the cavities beneath the eye. The maxillary sinus is entered through the upper jaw above one of the second molar teeth. A window is created to connect the maxillary sinus with the nose, thus improving drainage.
Risks and Complications of Endoscopic Sinus Surgery
|Risks and Complications of Endoscopic Sinus Surgery|
The risks and complications of endoscopic sinus surgery are as follows:
• Blindness : The most serious risk associated with FESS. It is resulting from damage to the optic nerve. The chances of this complication occurring, however, are extremely low.
• Cerebrospinal fluid leak: It represents the most common major complication of FESS. The leak is usually recognized at the time of surgery and can easily be repaired.
• Orbital hematoma
• Nasolacrimal duct stenosis
• Changes in your sense of smell and / or taste
Postoperative Patient Care for Endoscopic Sinus Surgery
|Postoperative Patient Care for Endoscopic Sinus Surgery|
For the post-operative first week patients should not blow his / her nose. For firts few days, minor nasal or post nasal bleeding are normal. A saline spray may be used several times per day to relieve nasal irritation. In addition, exercise or any other exertional activity for at least two weeks following surgery should not be performed. This includes no bending, lifting (more than about 10 lbs.), or straining.
The amount is post-operative pain usually less and disappears within a few days.
You should plan on taking at least one week off from work to recover from surgery.
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Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul
Appointment Phone: +90 212 561 00 52
Mobile phone: +90 533 6550199