People with chronic sinusitis typically undergo medical therapy to restore normal airflow and drainage. Persistent symptoms may necessitate sinus surgery to alleviate the condition. Different types of sinus surgery include functional endoscopic sinus surgery, image-guided endoscopic surgery, balloon sinuplasty and Caldwell-Luc surgery. Each surgery has advantages and risks. An ear, nose and throat physician can offer guidance and recommendations regarding surgical options for persistent sinusitis or other surgical sinus conditions.
Functional Endoscopic Sinus Surgery
Functional endoscopic sinus surgery, also known as FESS, utilizes a narrow fiber-optic instrument inserted into the nasal cavity through the nostril to visualize the sinus openings, explains the University of North Carolina at Chapel Hill School of Medicine. Delicate instruments used alongside the fiber-optic endoscope permit the surgeon to enlarge the sinus openings, facilitating drainage and healing of the inflamed sinus tissues. General anesthesia or monitored sedation, also known as "twilight" anesthesia, may be utilized for the procedure. Functional endoscopic sinus surgery is commonly conducted as a day surgery, with the patient returning home after the procedure.
Some people with sinus problems also have an off-center nasal septum, which is the dividing tissue of the nose. The surgeon may recommend correction of a deviated septum at the time of sinus surgery to enhance normal airflow. This procedure can be performed at the same time as functional endoscopic sinus surgery.
Image-Guided Endoscopic Sinus Surgery
Image-guided endoscopic sinus surgery is an enhanced version of FESS that compares images from a preoperative CT scan of the patient's sinuses to real-time data to help guide the surgeon during sinus surgery. In an interview with "ENT Today," Dr. Brent Senior of the University of North Carolina Medical Center at Chapel Hill noted that image-guided endoscopic sinus surgery is most useful for patients with structural abnormalities of the sinuses.
Balloon Sinuplasty
The U.S. Food and Drug Administration approved the first balloon sinuplasty instrument in 2005. Balloon sinuplasty utilizes a guide wire to position a small inflatable balloon device into the sinus opening. Once in place, the balloon is inflated to increase the size of the sinus opening, explains Cedars-Sinai Medical Center. The technology employed with balloon sinuplasty is similar to that utilized for balloon angioplasty of the coronary arteries.
Caldwell-Luc Surgery
Caldwell-Luc surgery is a procedure performed on the maxillary sinus within the cheekbone. An incision above the upper teeth provides a route of entry into the maxillary sinus. A new opening between the maxillary sinus and the nose is created to improve sinus drainage, reports the American Academy of Otolaryngology-Head and Neck Surgery. With functional endoscopic sinus surgery largely replacing Caldwell-Luc surgery for the treatment of sinusitis, the procedure is most commonly used to remove tumors of the maxillary sinus.
References
- UNC Otolaryngology/Head and Neck Surgery: Functional Endoscopic Sinus Surgery
- "ENT Today": Image Guidance: A Useful Adjunct to Endoscopic Sinus Surgery
- Cedars-Sinai Medical Center: Balloon Sinuplasty
- The New York Eye and Ear Infirmary: Caldwell-Luc Procedure: Operative Technique
- American Academy of Otolaryngology-Head and Neck Surgery: Sinus Surgery
