Endoscopic sinus surgery This procedure is used to treat chronic sinusitis and remove benign nasal polyps. It is also performed with the aim of expanding the nasal drainage pathways of the sinuses and to improve ventilation. Learn more about this procedure in Turkey, and how to prepare for it.
Why is sinus surgery performed?
Chronic sinus infections are usually treated with medication rather than surgery.
However, sinus surgery may be necessary when these infections are frequent or persistent.
Therefore, sinus surgery is most commonly used to treat chronic sinus infections, but it may be necessary for other sinus problems.
Endoscopic sinus surgery involves widening the openings between the sinuses and inside the nose to improve sinus ventilation and help mucus escape into the nose.
It also enables the removal of sinus tissue, bone, or polyps.
Endoscopic sinus surgery is a newer technique that reduces postoperative bleeding, is less invasive than traditional sinus surgery, and requires less recovery time.
What are the types of sinus surgery?
- Functional Endoscopic Sinus Surgery (FESS): This is the most common type of sinus surgery. It can be performed on an outpatient basis. This is done using a special scope that is inserted into the nose through the nostril (a telescope) to see the inside of the nose and the entrances to the sinuses.
Then other tools are used through the same nostril to perform the operation.
- Image-guided sinus surgery: In this procedure, sinus surgery is often performed with an image-guided system that uses computerized tomography (CT) scans to help the surgeon identify anatomical structures and remove as little nasal tissue as possible. This system helps the ENT doctor know when to approach the edge of the sinuses and thus ensures the integrity of the sinuses.
What is fess endoscopic sinus surgery?
Functional endoscopic sinus surgery (fess) differs from traditional sinus surgery, by using an endoscope inserted into the nose to view the nasal cavity and paranasal sinuses. This eliminates the need for the external incision used in traditional sinus surgery.
Where the nasal endoscope allows a better visualization of the diseased structures and helps the surgeon to remove them.
This endoscope, along with detailed X-ray studies, may reveal a previously unobvious problem.
Another difference is that endoscopic functional sinus surgery focuses on treating the underlying cause of the problem.
The ethmoid areas are opened, allowing the maxillary, frontal, and sphenoid sinuses to be seen.
The sinuses can then be viewed directly, and diseased or obstructed tissue removed if necessary.
Therefore, removal of normal tissue is often less, and endoscopic sinus surgery can often be performed on an outpatient basis.
When is endoscopic sinus surgery fess used?
Endoscopic functional sinus surgery is generally performed for people with chronic sinusitis that does not respond to medical treatment.
The diagnosis of chronic sinusitis should be based on an evaluation by an otolaryngologist, as other problems can cause symptoms similar to those of chronic sinusitis.
The majority of people with sinusitis do not need surgery.
Symptoms of sinusitis can be treated medically with antibiotics and other medications, and allergy treatment. Therefore, the type of drug treatment used depends on the evaluation of the otolaryngologist.
However, surgical intervention is sometimes required as a sinus treatment. This may be because the infection has not been adequately treated with antibiotics or other medications.
Or that symptoms keep coming back when antibiotics are stopped, or for other reasons.
You should discuss the need for sinus surgery with your doctor. The decision to have sinus surgery depends on your health history and physical examination.
At the initial consultation, it is important to bring your records from your doctor including your health history and sinus treatment used up to this time. If a CT or MRI scan is available, it should also be brought to your first hospital visit. A CT scan is also required to accurately assess the affected areas. If you did not do this before your visit, you will need to do so at a later date.
An otolaryngologist suggests starting with drug therapies, to see how you respond to maximum drug therapy before deciding on a surgical procedure.
If endoscopic sinus surgery is an option for you, your consent will be obtained and an appointment will be arranged for the procedure.
How do I prepare for endoscopic sinus surgery?
- Before having endoscopic sinus surgery, you will need to have some blood tests and possibly other studies such as an ECG and chest x-ray, ordered if your age or medical history indicates the need.
- Sometimes starting oral decongestants (or increasing the dose if you are already taking them) and/or antibiotics in the period before endoscopic sinus surgery. Take these medications as directed by your doctor. If you have a significant increase in sinusitis in the week(s) before surgery, let your doctor know. Because you may need to postpone sinus surgery.
- Do not take aspirin or salicylate painkillers for at least 10 days prior to endoscopic sinus surgery. Aspirin, even in small amounts, can significantly increase bleeding during and after endoscopic sinus surgery.
- Do not take non-steroidal anti-inflammatory drugs (ibuprofen, Advil, Motrin, Aleve) for at least five days before endoscopic sinus surgery. These medications will also increase bleeding, although their effect on the blood is shorter.
- Do not smoke for at least three weeks before endoscopic sinus surgery. Because smoking not only aggravates sinus symptoms, but smoking in the weeks before or after the operation leads to hypertrophic scars, and may lead to the failure of the operation.
- Do not eat or drink anything after midnight the night before endoscopic sinus surgery.
You should get a nasal spray from a pharmacy, and spray it into your nose 1-2 hours before endoscopic sinus surgery.
What will happen during the functional endoscopic sinus surgery in Turkey?
Endoscopic sinus surgery is performed under general or local anesthesia, under the supervision of a specialist doctor.
If you choose to have endoscopic sinus surgery under local anesthesia, you will be given medications to make you sleepy and relax, and you will be provided with some music with a headset. You will usually hear some rattling sounds when removing the bones which may sound loud to you.
You may also feel some mucus or blood in the back of your throat that you must swallow. You will be able to talk to your doctor during the endoscopic sinus surgery, so let us know if anything is bothering you. If the patient feels uncomfortable during the operation, he will be given general anesthesia. In some cases it may be necessary to repair the nasal septum (patina) during endoscopic sinus surgery.
What are the risks of endoscopic sinus surgery?
Complications of functional endoscopic sinus surgery are not common, but your otolaryngologist and anesthesiologist will talk about them with you. So be sure to ask any questions you have. Complications may include:
Bleeding after surgical treatment
Although the risk of bleeding appears to be reduced with the endoscopic sinus surgery technique, sometimes severe bleeding may require termination of the procedure and placement of nasal tampons. Bleeding after endoscopic sinus surgery may require nasal packing and hospitalization. However, a blood transfusion is rarely necessary.
In the rare cases when a blood transfusion is necessary, there is a risk of an adverse reaction or transmission of an infection with the blood.
cerebrospinal fluid (CSF) leak
All operations performed on the ethmoid sinuses carry the rare chance of causing a leak of cerebrospinal fluid (the fluid that surrounds the brain).
The risk of cerebrospinal fluid leakage is generally higher when ethmoid sinus surgery is performed through the nose rather than through an external incision.
However, because the endoscope used allows for better vision, the risk of these complications is likely to decrease.
If this rare complication occurs, it creates a potential pathway for infection, which can lead to meningitis (inflammation of the brain). A cerebrospinal fluid leak may prolong your stay in the hospital and may require more surgery to repair.
Although extremely rare, there have been reports of vision loss after endoscopic sinus surgery. In addition, temporary or prolonged double vision has been reported after endoscopic sinus treatment in some patients.
General anesthesia risks
Because endoscopic sinus surgery is usually performed under local anesthesia, adverse reactions are uncommon. But if general anesthesia is required, you'll run into occasional, and potentially serious, risks. You can discuss adverse reactions to general anesthesia with a specialist.
Risks of reconstruction (correction) of the nasal septum
During the veneer repair, the patient may suffer from numbness in the front teeth, bleeding and inflammation in the nasal septum or perforation in it. And the perforation of the nasal septum may cause difficulty in breathing. Since the cartilage in the septum contains a “memory,” it may move after the reconstruction process and result in a recurrent deviation. There is also a small risk of a change in the shape of the nose.
Decreased sense of smell after endoscopic sinus surgery
Permanent loss or decreased sense of smell can occur after endoscopic sinus surgery. However, it has actually decreased in a number of patients before surgery, and usually improves with surgical intervention.
Endoscopic sinus surgery can result in chronic sinusitis not improving, and the patient may feel numbness or discomfort in the upper front teeth for a period of time. Temporary swelling, bruising or numbness of the lip may occur, as well as swelling or bruising around the eye. It is common for any slight changes in the voice.
What after endoscopic sinus surgery?
Some bloody secretions may occur in the nose for about two weeks after the operation, this is normal and gets better slowly. The patient should not blow their nose for at least four to seven days after endoscopic sinus surgery.
As normal sinus drainage returns, you may secrete some thick, bloody mucus. This is also normal.
Revision visits are usually arranged at about 1-6 days after endoscopic sinus surgery to clean the scales of the nose, and remove any inflammation or scar tissue under local anesthesia. Although the chances of complications from these procedures are rare, the potential risks are the same as with the surgery itself.
Careful post-operative care is essential to the success of this surgery. You will be provided with a brochure on post-operative care instructions. It is very important that you follow these instructions, as well as any additional instructions we give you, to promote healing and reduce the chance of complications.
The patient should be able to return to his daily routine several days after the sinus operation.
He may have a crusting or stuffy nose for several weeks after the operation. In the first few days, he may need to change the gauze placed under the nose.
Among the recommendations are sleeping with the head elevated and drinking plenty of fluids. If necessary, he may prescribe pain medication or antibiotics. The patient will also be asked to schedule follow-up visits with an otolaryngologist to ensure that the sinuses are healing properly, and to clean out any excess blood or mucus.
It is important that the patient not blow their nose when recovering from sinus surgery. This can cause excessive bleeding.
Will endoscopic sinus surgery treat sinus diseases?
As with all sinus surgeries, the disease may not be cured by the operation, or the disease may recur at a later time. If this happens, subsequent surgical treatment may be needed. Be aware that some medications must be continued after surgical treatment, especially if allergies or polyps play a role in the sinus disease. This is necessary to prevent recurrence of the disease. In general, the majority of patients had significant improvement with the combination of surgery and continuous drug therapy. We will certainly work with you to achieve this goal.
Recovery from endoscopic sinus surgery:
Endoscopic sinus surgery is an effective treatment for those with sinus problems, but it is only performed for patients who have not responded to medication.
Some people notice immediate improvement in their symptoms after endoscopic sinus surgery, while for others it may take a few weeks or months. Some patients may require continued care even after recovering from endoscopic sinus surgery.
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