What is endoscopic sinus surgery?
Endoscopic sinus surgery describes the use of endoscopes (telescopes) to operate inside the nose to enlarge the natural opening of the sinuses into the nasal cavity to allow ventilation and drainage of the sinuses. Traditionally sinus surgery has in the past often involved external excisions on the face and below the upper lip but this is only very rarely required nowadays. Sinus surgery usually takes about 1 - 1 1/2 hours to perform, involves an overnight stay in hospital and a week to 10 days off work. In most cases patients experience minimal postoperative discomfort, usually requiring panadol only and often no pain relief on the day following surgery. They are able to resume light duties within 2-3 days and return to normal activities within a week or so.
Because of the close proximity of the sinuses to other important structures such as the eye and the brain, there are small but significant potential risks associated with surgery, which include injury to the bone of the eye socket and leak of cerebrospinal fluid (brain fluid) from the roof of the sinus if the bone of the roof of the nasal sinuses is breached. Fortunately these complications are very rare and in most cases do not result in any significant permanent problem.
Endoscopic sinus surgery is often performed for patients who have a history of frequent episodes of sinusitis which have required repeated courses of antibiotics (or in the treatment of nasal polyps in selected patients). Typical symptoms include facial pain, nasal obstruction, purulent nasal discharge, postnasal drip and loss of sense of smell.
After care following surgery is an important part of the success of endoscopic sinus surgery. Typically patients return to the rooms a fortnight after surgery for removal of crusting and old blood clot from the nose using suction and local anaesthetic sprayed into the nose. A check is also made for adhesions which can form in the early postoperative period. Patients may be prescribed antibiotics and advised to use saline sprays in the initial postoperative period. Often three or four visits are required to check the interior of the nose while the sinuses heal and revert to a healthy state. In most cases the benefits of endoscopic sinus surgery (prevention of recurrent acute attacks of sinusitis or resolution of the symptoms of chronic sinusitis) are sustained for a lifetime, although some conditions, in particular nasal polyps, may have a tendency to recur after a few years.
There are a number of risks associated with the procedure and these are set out below.
Persistence of symptoms after surgery
Although every attempt is made to reduce/eradicate symptoms to the satisfaction of the patient this is not always achieved. Postnasal drip is not a symptom that is always easy to eradicate but patients troubled by blockage and pain can expect up to a 90% chance of significant improvement.
The inside of the nose is a very confined space and no matter how careful the surgeon is, minor scars though not outwardly obvious, are a common complication. Such scars may necessitate a minor revision operation if they cause any significant sinus blockage.
Swelling and bruising
This is not especially common after surgery but occasionally blood can seep through a defect in the eye socket giving rise to a very mild black eye which usually resolves within a week. In very rare instances (less than one chance in a thousand) a blood vessel in the eye can rupture. This does place the site at risk, although no permanent harm is usually incurred provided the surgeon drains the eye without delay.
Some minor bleeding always occurs over the first eight hours following surgery. A blood stained discharge is present for up to 2 weeks. If heavy bleeding does occur a nasal pack may need to be inserted, however nasal packing is not usually necessary in this kind of surgery. In the unusual event of a postoperative bleed a further anaesthetic or other additional measures may be required.
As the sinuses lie in close proximity to the eye, permanent damage with loss of vision could occur although the risk of this must be very remote indeed! Especially as the position of the eyes relative to the sinuses is carefully noted by the surgeon using a CT scan. Consequently your operation cannot be carried out without the CT scan being available.
CSF (cerebrospinal fluid) is the cushioning fluid which surrounds the brain. Very rarely during the course of the operation (less than a 1% chance) the thin roof of the nose may be breached resulting in a small leak of csf. Persistent leaks carry a risk of meningitis and so any leak that fails to seal itself after about a week would require a second operation to graft the leak.
Numbness due to nerve damage is almost unheard of with this kind of surgery.
Blockage and crusting
This is usual after sinus surgery and may last some weeks. The postoperative medication and douching should help. I will also will wish to clean the inside of your nose periodically in the consulting rooms. These visits are very important so that full healing of the internal wounds can occur without complication.
In most cases a satisfactory result is produced and revision surgery is not required. However up to 1 in 10 patients may require what is usually a minor revision procedure to promote the best healing of internal wounds. Patients with severe polyp disease will often require further surgery at a later date while those with mild disease will often achieve a cure first time round.
This procedure is performed under a general anaesthetic.
If there are any postoperative problems patients should contact me at the rooms, 03 356 0274, my residence 03 355 7996 or my mobile phone 0274 815 843.
Read the Endoscopic Sinus Surgery Advice Sheet
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