Endoscopic Sinus Surgery

General Information:

Sinus problems can develop because of a blockage of the sinus cavities. The symptoms that are typically encountered are:

- sinus headaches,
- facial headaches,
- facial pressure or pain,
- nasal congestion,
- recurrent sinus infections,
- postnasal drip and drainage,
- decreased sense of smell,
- decreased breathing through the nose.

Sinus problems can be quite chronic in nature, can affect the quality of life, and can lead to a decreased sense of energy. The sinus cavities are hollow chambers inside of the head and face that can become repeatedly infected and need to be surgically opened to reduce the symptoms. Millions of people are plagued by blocked sinus cavities that do not respond well to medication and have to be opened with endoscopic sinus surgery. Endoscopic sinus surgery opens the internal sinuses. It also involves removing polyps on the inside of the sinuses as well. All of the surgery is done from the inside of the nose using telescopes. The recovery is less painful, and there is no visible bruising or scarring on the outside portion of the nose. "Endoscopic" sinus surgery is a telescope that allows Dr. Portuese to view the inside of the patient's sinuses.
There are four sets of sinuses inside everyones's face:

- frontal sinuses,
- maxillary sinuses,
- ethmoid sinuses,
- sphenoid sinuses.

Each one of these sinuses has a narrow passageway through which aeration occurs, and through which the mucus drain out of the sinuses and into the nasal cavity. From the nasal cavity, the mucus drains down the back of the throat. When the sinuses are blocked, this becomes a sinus infection with all the accompanying symptoms of headaches, facial pain, and pressure. Sinus problems can be a recurring and ongoing problem that can develop either from one sinus being blocked or multiple sinuses being blocked.

The Decision:

Dr. Portuese will take a thorough medical history on patients to try to evaluate the symptoms and the cause of their sinus problems. It is important to know that allergy medication, antibiotics, decongestants, and nasal sprays have no longer helped the problem. Examination of the nose can be done with a magnified nasal scope and a headlight, looking for mucus, infection, redness, polyps, and obstruction. If the medical history is suggestive of long-term sinus infection, and the examination also supports what the medical history shows, then a CT scan, which is a computer x-ray, of the sinuses is performed. This is typically done at an x-ray center and takes approximately 15-20 minutes to perform. The CT scan gives a very clear three-dimensional, cross-sectional view of the sinuses. This is a road map as to where Dr. Portuese will operate inside the sinuses and nose.

The decision to perform endoscopic sinus surgery really depends upon medical history, physical examination, and CT scan findings of polyps inside the sinuses. The decision to perform the surgery is dependent upon the severity of symptoms. When the symptoms are recurrent, become bothersome and medicatons have failed, then endoscopic sinus surgery in indicated.

The Procedure:
Endoscopic sinus surgery is done under general anesthesia in our Medicare-certified outpatient surgery center. Magnified endoscopes (telescopes) with instrumentation are used to open up the blocked sinuses. Special attention is usually directed at the middle meatus, which is the area where most sinus cavities drain into the nose. Polyps are removed with the endoscopes. If the ethmoid sinuses are blocked, an ethmoidectomy will be performed to remove the ethmoid air cell. The maxillary sinuses are opened only if needed, provided they have polyps or the skin lining on the inside of the sinuses is swollen. This procedure takes 30-45 minutes to perform, and two sponges are placed inside the nose to help with bleeding. These are removed by the patient the following day.
If you have further questions about Endoscopic Sinus Surgery, please feel free to contact our office.

General anesthesia is used for Endoscopic Sinus Surgery. Board certified physician anesthesiologists are present to monitor the anesthesia and the patient's vital signs while Dr. Portuese performs the surgery. Therefore, patients must have transportation arrangements and someone to take care of them for the first twenty-four hours.

Postoperative Course:
After the surgery, patients will typically be kept in the recovery room for approximately one or two hours, depending upon how they feel. They are then discharged home in the care of a family member or friend. There is a mild amount of oozing which drains down the back of the throat, for which the sponges do help. The patients will remove the sponges themselves the day after surgery. Most patients wear a moustache dressing to help prevent the drainage from coming down the front portion of their nose. Patients are asked to use salt water rinses four times a day with a Waterpik for the first month after surgery.
Full instructions are given to the patients. Humidification in the bedroom at night wil help keep the mucus and blood from drying up inside the nose, which can be helpful in the healing phase. There are several things in the first two weeks of the postoperative phase which should not be done. This includes blowing the nose, so as to not put any pressure on the nose. There should be no exercising, straining, heavy lifting, or bending forward. Travel plans by airplane should be curtailed for the first two weeks after surgery. Visits to Dr. Portueses's office are performed at one week, two weeks, four weeks, three months, six months, and again at one year after surgery. It is also important to be allergy tested, since the polyps located inside the nose are allergic nasal polyps caused by allergies. It is thought that if the allergies can be kept under control the polyps may be curtailed from returning.

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