The sinuses are cavities within the skull located around the eyes, nose, and the front of the face. These cavities help lighten the weight of the skull. They also produce mucus, which adds moisture to the nasal passages. Mucus forms a protective layer that helps prevent unwanted particles such as pollutants, dust, and infectious organisms from entering.
The sinuses are lined with cilia, which are very fine, hair-like cells. The cilia help move mucus from the sinus passages into the nose for drainage.
Sinus surgery is a procedure aimed at opening the sinus pathways and removing blockages. It is an option for people who have persistent and recurrent sinus infections, those with abnormal sinus structures, or abnormal growths in the sinuses. Dr. Narges Mikaniki often performs other treatments and methods before resorting to surgery. If these do not work, surgery may be performed.
The goal of surgery is to remove anything that blocks the sinus drainage pathways. This procedure may involve removing:
A person may need sinus surgery to treat various issues.
Sinusitis is the swelling of the sinuses or nasal passages. It is sometimes called a sinus infection. A person with sinusitis may experience the following symptoms:
Sinus surgery may also be required due to other infections, persistent blockages, abnormal growths, and other issues that cause inflammation in the nasal passages and sinuses.
Nasal polyps are swellings of the lining inside the nasal passages and sinuses. Their size can vary, but they are usually shaped like a drop. Larger polyps or clusters may cause breathing problems and affect a person's sense of smell. They can also block the sinuses, leading to infection. Some people with nasal polyps may have no symptoms. However, common symptoms include:
The most common type of sinus surgery is endoscopic sinus surgery. However, there are other procedures that may also be performed.
Image-guided endoscopic surgery is a newer technique that may be recommended for severe forms of sinus blockage or after previous sinus surgeries. In this type of surgery, in addition to using an endoscope, a nearly three‑dimensional mapping system is employed to show the surgeon the position of the surgical instruments. This is done using CT scans and infrared signals. With the help of this guidance, the surgeon can navigate the complex sinus pathways and precisely remove tissues and other obstructions.
This is a less common and more invasive procedure, usually performed when there is a growth inside the sinus cavity. The goal of the Caldwell‑Luc operation is to remove lesions and improve sinus drainage. It creates a passage between the nose and the cavity beneath the eye, called the maxillary sinus. This opening then helps the sinuses drain. The surgeon makes an incision in the upper jaw, above one of the second molar teeth inside the mouth, and then enters the sinus cavity through this incision. This surgery may be performed under local or general anesthesia.
FESS is performed using an instrument called an endoscope. This device is a thin fiber‑optic tube with a light. The endoscope is inserted into the nose to reach the openings of the sinuses. Then, micro‑telescopes and surgical instruments can be passed through the endoscope and used to perform the procedure. The surgeon uses these instruments to remove obstructive tissues and other blockages to clear the sinuses.
The entire procedure is done through the nostrils, leaving minimal scarring. Some swelling may occur, but it disappears quickly. A person undergoing this surgery usually experiences only mild discomfort for a short period.
FESS can be performed repeatedly if necessary, and it can also be done on an outpatient basis.
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After sinus surgery, nasal packing may be used. Nasal packing involves placing sterile gauze-like materials into the nasal passages to control bleeding. The use of packing depends on the type of surgery performed. The packing may be absorbable and dissolve over time. If the packing is non‑absorbable, the doctor will need to remove it.
The recovery period varies depending on the surgery performed and other factors such as age and overall health. However, many people experience very little discomfort after sinus surgery. Most individuals can go home the same day as the surgery.
Depending on the extent of the surgery, pain medication may be prescribed during the recovery period. After the procedure, the following are commonly experienced:
Patients should carefully follow their doctor’s post‑operative care instructions and take all medications as prescribed. They may need to make adjustments to their daily routine during the first two weeks after surgery.
Common medications prescribed after surgery often include saline rinses, steroids, and antibiotics.
Complications that may occur during sinus surgery are often rare and include the following:
Bleeding after surgery usually occurs within the first 24 hours. However, it can sometimes happen later—after several days or even weeks. If a clot forms in the bony partition between the nasal passages, commonly called the septum, it should be removed.
The sinuses affect the resonance of a person’s voice. A complication of sinus surgery can sometimes lead to a change in the individual’s voice.
Sinus surgery usually improves airflow. However, in rare cases, the procedure can make this problem worse. A small amount of scar tissue may also form in the nasal passage, which would require removal through another procedure.
The septum is attached to the roof of the nose. This thin layer of bone may be damaged during sinus surgery; however, it is a very rare complication. Cerebrospinal fluid can leak into the nose, and in severe cases, this may lead to an infection of the brain’s inner lining, such as meningitis. While this problem is extremely rare, it is often identified and repaired during the initial surgery.
After sinus surgery, a person’s sense of smell usually improves due to restored airflow. However, depending on the degree of swelling or infection, it can rarely worsen. This is often temporary but may persist for a longer period.
Because the sinuses are very close to the eyes, bleeding in the eye can sometimes occur. This happens when the thin layer of bone that separates the sinus from the eye is damaged. This is rare and, again, is usually detected and treated during surgery. Other cases may lead to changes in how the tear ducts function, causing excessive tearing.
Treating sinus infections is the main reason for performing sinus surgery. A person with sinusitis may, as a result of the surgery, develop other infections in the area. However, this complication is also possible if the person does not undergo surgery for a long‑term sinus infection.
Before resorting to surgery, a doctor will try various other treatments. There is a wide range of medications that may be prescribed, as well as other methods that can help improve symptoms.
