What is sinus surgery?
When sinus symptoms cannot be controlled with medications and other treatments, surgery for the sinuses can be very effective. The goal of surgery is to open the drainage pathways of the sinuses. The term “endoscopic" refers to the use of small telescopes that allows the surgery to be performed through the nostrils. This means there is no need for any skin incisions. Sinus surgery is usually performed on an outpatient basis. Surgery is typically performed in the operating room under a general anesthetic. Sometimes surgery can be performed in the office with a local anesthetic.
What is image guided surgery?
Image guided surgery is a 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 safely and precisely through complex sinus passages to remove diseased tissue. This type of surgery may be recommended for severe forms of chronic sinusitis, in cases when previous surgery has altered anatomic landmarks, or where sinus anatomy is unusual.
What to do BEFORE surgery
Here are a few things you can do before surgery to help things go more smoothly:
- Purchase a Neil Med® Sinus Rinse Kit for saline rinses you will perform after surgery . These are available at grocery stores, pharmacies, big box stores, and Amazon.
- Eliminate ALL medications that thin your blood for two (2) weeks before surgery, unless directed otherwise by your surgeon. Please see this list- Medications to Avoid prior to Surgery
- Stop smoking at least 3 weeks before your surgery date.
- No food 8 hours prior to surgery. No liquids for 4 hours prior to surgery.
- Arrange for a ride home after the procedure
In most cases you will receive general anesthesia for your surgery. With general anesthesia, you will be asleep for the entire surgery. Surgery typically lasts 1-3 hours. When your surgery is over, you will spend one to two hours in the recovery area. Most people feel well enough to go home the day of surgery.
What to expect AFTER surgery
You can expect some nasal stuffiness and crusting for weeks after surgery. Many patients are back to work or school the week following surgery. Following these suggestions can help you prevent complications and recuperate more quickly.
- Change the gauze bandage under your nose as needed. Oozing is expected and normal for the first week after surgery. If bleeding is more than minimal use Afrin decongestant spray every 6-8 hours for 1-3 days.
- Sleep with your upper body elevated to keep pressure off of your head.
- Use mild non-aspirin pain relievers (Tylenol) as first line treatment for pain and prescription pain medication as directed by your doctor for breakthrough pain.
- Drink plenty of fluids to prevent dry mouth. A bedside humidifier may be helpful.
- Beginning the day after surgery rinse your nose with saline rinses at least three times a day but may be performed more often.
- Avoid any strenuous activity, lifting more than 10 pounds, exercise, straining, or nose blowing for at least 10 days after surgery. Your surgeon will let you know when you are clear to resume these activities.
- You will need several visits after surgery to clear out old blood and mucus that has built up in the sinuses. During these visits, any persistent inflammation or scar tissue will be removed after a topical anesthetic is applied into the nose. For your comfort, we recommend that you take a dose of your prescribed pain reliever immediately before these visits. (Do not take pain medications on an empty stomach). You will need a ride to the appointment if you take pain medication.
- For several weeks, you will have some thick discolored drainage from your nose. This occurs as the sinuses begin to clear themselves. This is normal and does not indicate an infection.
- Cough and sneeze with your mouth open.
CALL YOUR DOCTOR IF:
- You are bleeding excessively.
- You have decreased or double vision, swelling of the eyes, a stiff neck, or extreme fatigue.
What are the risks of Sinus Surgery?
As with any surgical procedure, FESS has associated risks. Although the chance of a complication occurring is small, it is important that you understand the potential complications and ask your surgeon about any concerns you may have.
Bleeding: The most common risk of sinus surgery is bleeding. Most sinus surgery involves little blood loss. If there is significant bleeding surgery may need to be stopped.
Scar tissue formation: Most patients heal well following surgery. However, some patients form scar tissue which can block the nasal passages or sinuses. Most scar bands can be removed through a simple office procedure, but some patient may require a repeat surgical procedure to remove scar.
Recurrence of disease: Most patients do well with surgery, however some patients can continue to have sinus problems following surgery. In some patients sinus surgery improves the frequency and severity of infections but they may require continued medical care. In some instances, additional “touch-up” surgery may be necessary to optimize your surgical outcome. This may be necessary in 5-10% of cases.
Spinal fluid leak: The sinuses are located near the brain. This means there is a rare chance of creating a leak of spinal fluid (the fluid surrounding the brain) or injuring the brain. Also called a cerebrospinal fluid (CSF) leak, the reported incidence of this is less than 1% of cases. Should the rare complication of a CSF leak occur, it may create a potential pathway for infection, which could result in meningitis. If a CSF leak were to occur, it might require surgical closure and extend your hospitalization.
Visual problems: There have been isolated reports of visual changes or loss after sinus surgery. The potential for recovery in such cases is not good. In addition, orbital (eye) injury resulting in double vision, blurring vision, or excessive tearing from the eye are additional potential complications. Fortunately, such a complication is rare. The reported incidence is less than 1% of cases.
Other risks: Other uncommon risks of surgery include alteration of sense of smell or taste; persistence and/or worsening of sinus symptoms and facial pain and swelling or bruising of the area around the eye.