Nasal congestion; Rhinosinusitis
Surgery can unblock the sinuses when drug therapy is not effective or if there are other complications, such as structural abnormalities or fungal sinusitis.
The simplest surgical approach is the insertion of a drainage tube into the sinuses followed by an infusion of sterile water to flush them out.
Functional endoscopic sinus surgery (FESS) is the standard procedure for most patients requiring surgical management of chronic sinusitis or polyposis. The procedure allows correction of obstructions, including any polyp and ventilation and drainage to aid healing.
Candidates for the Procedure.
Surgery may not be as effective for patients with the fungal infections or severe chronic sinusitis, although endoscopy is proving to be beneficial even for these conditions with the use of more powerful instruments.
Procedure. The surgery generally proceeds as follows:
Complications. Serious complications of FESS are very rare, but the following have been reported in a few cases:
Postsurgical Care. Postsurgical care involves the following:
Success Rates. It may take several months for the mucus membranes to completely recover, but 85 - 90% of patients have good to excellent relief of their symptoms after surgery. Children may need a second procedure 2 - 3 weeks after the first surgery to remove crusty matter.
A new type of surgical procedure threads a small balloon through the sinus passages. As the balloon is gently opened, the sinus passages expand, allowing drainage to occur. Some doctors think that this procedure is only appropriate for select patients with sinusitis disease in the maxillary (behind cheek bones), frontal (behind the sides of the forehead), and sphenoid (behind the eyes) sinus regions. It may not work for patients with disease in the ethmoid (between the eyes) sinuses, even though sinusitis commonly occurs in this location. More long-term studies are needed.
Endoscopy is now used in most cases of chronic sinusitis, but in severe cases, invasive surgery using conventional scalpel techniques to remove infected areas may be required. This may be the case with acute ethmoid sinusitis in which pus breaks through the sinus and threatens the eye, with very severe frontal sinusitis, with invasive fungal sinusitis, or when cancer is present in the sinuses.
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