Endoscopic Sinus Surgery

Functional Endoscopic Sinus Surgery (FESS) is a technique described by Dr. Messerklinger from Austria and brought to the U.S. in the mid 1980s.  FESS is recommended in patients who have failed medical therapy for their chronic sinus conditions.  Dr. Karanfilov’s training during fellowship allowed him to learn advanced FESS techniques from his mentor, Dr. Kuhn, an internationally recognized rhinologist and expert on complicated frontal sinus anatomy. The great majority of FESS performed at Ohio Sinus Institute are revision procedures, and Dr. Karanfilov has performed thousands of surgeries and more revision complicated FESS than any surgeon in Central Ohio.

Sinus surgery was once performed through external incisions (surgical cuts on the face and in the mouth), required extensive nasal packing ( i.e. gauze or other material placed in the nose to control bleeding after surgery) , caused significant pain and discomfort, and was often followed by a long recovery period.  With recent advances in technology, including the nasal endoscope, sinus surgery is now commonly performed entirely through the nose, without face or mouth incisions.  The nasal endoscope is a small, lighted metal telescope placed into the nostril.  The endoscope allows the surgeon to see inside the nose and sinuses with a high resolution video camera attached to the endoscope.  Today, endoscopic sinus surgery is typically done with minimal to no nasal packing, mild pain, and short recovery times.

The most common reason for performing endoscopic sinus surgery is “chronic rhinosinusitis”, or more commonly “chronic sinusitis”.  Chronic rhinosinusitis is a general term for inflammation (swelling) of the nose and sinuses that does not improve sufficiently with medical treatment.  Less common reasons to have sinus surgery may include: recurrent infections, sinus infections that spread to the eye, face or brain, nasal polyps, tumors of the nasal and sinus cavities, leaking brain fluid into the nose and tear duct blockage.  Additionally, recent advances in endoscopic sinus surgery allow your sinus surgeon to reach areas of the brain and pituitary gland for neurosurgeons, or to the orbits (eye sockets) for certain ophthalmology procedures.

If medical treatments have not been successful in improving your sinus symptoms, endoscopic sinus surgery may be helpful.  The main goal of sinus surgery is to improve the drainage pathway of the sinuses.  By widening the natural drainage pathway of the unhealthy sinuses, sinus infections should be reduced.  One of the most important benefits of surgery is the ability to deliver medications (sprays, rinses, nebulized drugs) to the lining of the sinuses after they have been opened. Therefore, sinus surgery is done in addition to, and is not a replacement for, proper medical treatment of the sinuses. It is important to note that if you are one of the patients who have diseased mucous membranes or form nasal polyps, no amount of surgery can change this fact. For many patients, surgery may not be a cure for sinusitis but is one of the many critical steps in managing sinus disease.

Endoscopic sinus surgery may be done under local or general anesthesia.  The majority of sinus surgery is done under general anesthesia.  The goal of the surgery is to identify the narrow channels that connect the sinuses to the nose, enlarge these narrow openings/channels, and improve the drainage from the sinuses into the nose.  Most people have four sinuses on each side of their face.  These are the maxillary, ethmoid, sphenoid, and frontal sinuses.  The maxillary sinuses are in your cheek, the ethmoid sinuses are between your eyes, the sphenoid sinuses are almost exactly in the center of your head, and the frontal sinuses are in your forehead.  Your symptoms, examination in the physician’s office, and CT scan will determine which sinuses need to be opened.  Sometimes during sinus surgery the nasal septum, which divides the two sides of the nose, is also straightened.  The turbinates, which filter and moisten air inside of the nose, may require surgery as well.  In some cases, balloons are used as tools to help enlarge the sinus passages(see more information on the section on balloon dilation)

Nasal packing is not frequently used, however, ethmoid stents coated in antibiotics and steroids are frequently used.  The recovery period will vary depending on the surgery performed and the individual patient but most patients require 1 to 2 weeks off work.  Most patients will be required to irrigate with saline spray three times daily after surgery. The majority of patients who have endoscopic sinus surgery do very well, with significant improvement in their symptoms.

Complications of sinus surgery are rare but include bleeding, damage to the eye or vision, anesthesia complications, and intracranial complications (brain injury, brain fluid leak, infection of the brain).  Failure to treat chronic rhinosinusitis itself may lead to severe problems, such as infection of the eye or brain. If you are uncomfortable with the risks of sinus surgery, it is important that you discuss this with your surgeon.

Over the course of the last ten to fifteen years, abnormalities that involve the areas of the bone at the bottom of the brain and brain itself that are next to the nose and sinuses have been removed via the nostril, without facial incisions. Using cameras and video equipment similar to those used for sinus surgery, these tumors can be removed without facial incisions. Dr. Karanfilov performed the first endoscopic skull base surgery in Central Ohio in 2004. Because this technique may be significantly less painful, requires less traction on the brain and necessitates a shorter hospital stay, it is an attractive option for some patients and tumors.

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