Nasal & Sinus Surgery

Sinus Disease

Experts estimate that 37 million people are afflicted with sinusitis each year, making it one of the most common health conditions in America.

The lining of the upper respiratory system is mucosa.  This mucosal membrane filters out foreign debris and germs that we breath in the air.  Dysfunction in the mucosa that lines the nose and sinuses will predispose an individual to infection.  Allergies, viral infections, chemical irritants, or certain congenital conditions can lead to failure of the mucosa to protect the upper respiratory system from infection.

Acute bacterial sinusitis is an infection of the sinus cavities caused by bacteria.  It usually is preceded by a cold, allergy attack, or irritation by environmental pollutants.  Bacterial sinusitis requires a physician’s diagnosis and treatment with an antibiotic to cure the infection and prevent future complications.

Normally, mucus collecting in the sinuses drains into the nasal passages.  When you have a cold or allergy attack, your sinuses become inflamed and are unable to drain.  This can lead to congestion and infection.  The sinus infection is likely bacterial if it persists for 10 days or longer, or if the symptoms worsen after an initial improvement.

When you have frequent sinusitis, or the infection lasts three months or more, it could be chronic sinusitis.  Symptoms of chronic sinusitis may be less severe than those of acute; however, untreated chronic sinusitis can cause damage to the sinuses that sometimes requires surgery to repair.

There are four sinuses that drain into each side of the nose.  These sinuses are called the Frontal (forehead), Maxillary (cheek), Ethmoid (between the eyes), and Sphenoid (back of the nose).  Each sinus must maintain a continuous exchange of air (ventilation), as well as a clearance of the continuous production of mucous (drainage).  Obstruction of the outflow tract of the sinuses can lead to infection.  This obstruction could be the result of swelling from a viral upper respiratory infection (“cold”), swelling from allergies, nasal polyps, deviation of the nasal septum, or failure of the sinus outflow tract to develop properly.

Most people develop chronic sinus problems from a combination of dysfunction of the lining of the nose and sinuses, as well as some obstruction of the outflow tract of the sinus.  Decongestants, antihistamines, steroid nose sprays, and allergy shots are attempts to help the lining of the upper respiratory system protect itself.  Obstruction of the sinuses may occur temporarily with some upper respiratory infections from swelling.  When this swelling does not resolve as the infection clears, or if there is an underlying obstruction of the sinus, an operation to drain the sinus and restore normal ventilation may be necessary.

Endoscopic Sinus Surgery

Endoscopic sinus surgery involves the insertion of the endoscope, a very thin fiber-optic tube, into the nose for a direct visual examination of the openings into the sinuses.  Abnormal and obstructive tissues are then removed.  In the majority of cases, the surgical procedure is performed entirely through the nostrils, leaving no external scars.  There is little swelling and only mild discomfort.  The advantage of the procedure is that the surgery is less extensive, there is often less removal of normal tissues, and can frequently be performed on an outpatient basis.

Image Guided Surgery

Image guided endoscopic surgery may be recommended for severe forms of chronic sinusitis, in cases when previous sinus surgery has altered anatomical landmarks, or where a patient’s sinus anatomy is very unusual, making typical surgery difficult.

Image guidance is a near-three-dimensional mapping system that combines computed tomography (CT) scans and real-time information about the exact position of surgical instruments using infrared signals.  In this way, surgeons can navigate their surgical instruments through complex sinus passages and provide surgical relief more precisely.

Caldwell Luc Operation

Another option is the Caldwell-Luc operation, which relieves 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.

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