Endoscopic sinus surgery

Specialty of Otolaryngology / ENT

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What is endoscopic sinus surgery?      

Sinus surgery was typically performed in the past using external incisions, which caused discomfort and a significant amount of pain to the patient. Nowadays, however, endoscopic sinus surgery tends to be the standard surgery performed for conditions such as chronic sinusitis. In endoscopic surgery, a small telescope with a camera on the end is inserted up the nose to view the area to be operated on. This surgery is used to treat injuries or abnormalities that alter normal nose function or surrounding structures. Surgery is done under general anaesthetic.   

Why would you do it?

This surgery is done when there is chronic nasal and sinus inflammation, especially in chronic sinusitis, nasal polyps, or acute recurrent sinusitis that has not responded well to medical treatment. The treatment aims to restore normal nasal sinus function through a minimally invasive surgical procedure. This surgery is also used for septoplasty, turbinate surgery, closure of cerebrospinal fluid fistulas, and orbital decompression among others.        

What does it involve?    

A nasal decongestant should be used before dissecting the nose. A thin optic fibre is inserted in the nasal fossa to be able to view the sinus openings. With the right tools, the abnormal or obstructive tissue is resected. After surgery any bleeding points will be checked on, and in some cases nasal packing will be done to prevent haemorrhages, or silicone sheets will be placed to prevent the walls sticking to each other and forming anomalous scars.     

Surgery tends to last between 1 and 3 hours depending on the complexity of the case. The nasal cavities are blocked with coagulant foam and special sponges that dissolve, or plugs that can be taken out easily.  

How to prepare for it

Before surgery a sinus CT scan will be done to be able to plan the best form of treatment. Preoperative tests will also be carried out, as the surgery is done under general anaesthetic. The patient is normally in for a short stay surgery, they are only there one night. The patient should fast for 6 to 8 hours before the procedure.   

Post-operative care

The nose is usually blocked, so the patient can’t breathe through it. Bleeding may occur, so a gauze is placed under the nose, although it’s not always needed. For the first 3-4 days, the patient is advised not to; smoke, drink alcohol, or physically exert themselves. Patients are also told to rest at home, avoid blowing their nose, and sit in a position that reduces blood flow to the head, head congestion, and bleeding. Patients should follow a soft food diet and drink plenty of fluids for throat dryness due to nasal packing.

It is not a painful procedure, but it can cause discomfort. Anti-inflammatory medication is generally prescribed. Antibiotics may also be prescribed to prevent an infection of the retained mucus.   

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