Functional endoscopic sinus surgery is a minimally invasive technique used to restore sinus ventilation and normal function. The most suitable candidates for this procedure have recurrent acute or chronic infective sinusitis, and an improvement in symptoms of over 90 percent may be expected following the procedure.
The sinuses are hollow areas in the skull occupying the space above, between, and below the eyes. They are connected to the nose and can get inflamed or infected leading to drainage, congestion, decreased sense of smell, fatigue and pain. The underlying cause of the inflammation may be air pollution, allergies, polyps, abnormal internal nasal and sinus anatomy, or swelling inside the nose.
Medicines, including nasal sprays, decongestants, antibiotics, antihistamines and steroids will often improve nasal and sinus symptoms. Sinus surgery is recommended only after appropriate medical therapy has failed to provide long term control of inflammation and relief from symptoms.
On rare occasions immediate sinus surgery is warranted. Sinus infections which have spread to or are threatening the brain or eye, trauma, and tumors of the nose or sinuses require surgical intervention without delay. Additionally, surgery may be the only option for some patients whose sinus condition aggravates other medical problems such as asthma. In children, any complication from untreated sinusitis is typically an indication for sinus surgery.
Historically, surgeries requiring an incision under the lip (Caldwell-Luc) or through the face (external ethmoidectomy) were used to access the sinus cavities. Today, technology allows sinus surgeries to be accomplished entirely through the nostrils.
This procedure is performed with the patient asleep (general anesthesia). A CT scan of the sinuses provides a road map for the surgery. Small endoscopes are gently inserted through the nostrils to illuminate and magnify the nasal and sinus cavities on a video monitor. The surgeon uses delicate, angled and curved instruments to open or dilate the sinus drainage pathways. Irreversibly diseased tissue and obstructing bone fragments can be carefully removed with the instruments under magnification. The most important principle in endoscopic sinus surgery is to preserve as much normal tissue as possible, allowing the sinuses to recover normal function.
If infected sinus cavities are encountered, they can be drained and washed out with sterile saltwater or antibiotic solution during the procedure. Polyps, malignant and benign tumors, fungus balls, and stagnant mucous buildups can also be removed.
Endoscopic surgery can also be utilized to correct a deviated septum, reduce enlarged turbinate tissue, remove overgrown
adenoid tissue, relieve compression of the optic nerve and eye, repair cerebrospinal fluid leaks, and reconstruct defects in the wall between the brain and sinuses.