Sinuses are cavities inside a person's skull that are situated around the eyes and nose and within the front of the face.
These cavities help to make the skull lighter. They also produce mucus that adds moisture to the nasal passages. The mucus provides a protective layer to help keep out unwanted particles like pollutants, dirt, and infectious organisms.
Sinuses are lined with cilia, which are very fine hair-like cells. The cilia help to drain mucus through the passages of the sinuses and out into the nose.
Sinus surgery is a procedure that aims to open the pathways of the sinuses and clear blockages. This is an option for people with ongoing and recurrent sinus infections, for people with abnormal sinus structure, or abnormal growths in the sinus.
A doctor will often attempt other treatments and procedures before resorting to surgery. If these don't work, surgery may be carried out.
Sinus surgery can be done with little discomfort. It is a brief procedure that has few complications.
The goal of the surgery is to remove whatever is blocking the drainage pathways of the sinuses. This may include removing:
- thin pieces of bone
- mucous membranes
- nasal polyps
- swollen or damaged tissue
- tumors or growths blocking the nasal or sinus passage
A person may require sinus surgery to treat a variety of issues. Common reasons include sinusitis and nasal polyps.
Sinusitis is the swelling of the nasal sinuses or passages. It is sometimes called a sinus infection. A person with sinusitis may have the following symptoms:
- pressure around the nose, eyes, or forehead
- a stuffy nose
- thick and discolored nasal drainage
- a cough
- head congestion and headaches
- bad-tasting post-nasal drip
- blocked ears or changes in hearing
Nasal polyps are swellings of the nasal lining inside the nasal passages and sinuses. They can vary in size but are usually teardrop-shaped.
Larger polyps or clusters may lead to breathing issues and can affect someone's sense of smell. They can also block a person's sinuses leading to infections.
Some people may experience no symptoms from nasal polyps. However, common ones include:
- a blocked nose, leading to difficulty breathing
- a runny nose
- recurrent sinus infections
- post-nasal drip
- a reduced sense of smell or taste
- facial pain
- sleep apnea
Sinus surgery may also be required due to other infections, ongoing blockages, abnormal growths, and other issues that cause inflammation in the nasal passages and sinuses.
The most common type of sinus surgery is endoscopic sinus surgery. However, there are other procedures that may be carried out.
Functional endoscopic sinus surgery (FESS)
FESS is carried out with a tool called an endoscope. This is an illuminated, thin fiber-optic tube. The endoscope is inserted into the nose to reach the openings of the sinuses.
Micro-telescopes and surgical instruments can then be passed down the endoscope and used to carry out the procedure. The surgeon will use these tools to remove obstructive tissues and other blockages to clear the sinuses.
The entire procedure is carried out through the nostrils and leaves little to no scarring. Some swelling may occur, but it will disappear quite quickly.
A person who has this surgery will usually only feel mild discomfort for a short period of time.
FESS can be performed frequently. It can also be carried out on an outpatient basis.
Image-guided endoscopic surgery is a newer procedure that may be recommended for severe forms of sinus blockages or after previous sinus surgeries.
In addition to using an endoscope, this type of surgery uses a near-three-dimensional mapping system to show the surgeon the position of the surgical instruments. This is done using CT scans and infrared signals.
Using this guidance, a surgeon can navigate difficult sinus passages and remove tissues and other blockages accurately.
This procedure is less common and more invasive. It tends to be carried out when there is a growth present inside the sinus cavity.
The Caldwell-Luc operation aims to remove growths and improve sinus drainage. It creates a pathway between the nose and the cavity beneath the eye called the maxillary sinus. This window then aids drainage.
The surgeon makes a cut in the upper jaw, above one of the second molar teeth inside the mouth. They then enter the sinus cavity through this cut. This surgery may be performed under local or general anesthetic.
After sinus surgery has taken place, nasal packing may be used. Nasal packing is the insertion of sterile gauze-like material into the nasal passage to control bleeding.
Use of packing depends on the type of surgery performed. The packing can be absorbable and will dissolve over time. If the packing is non-absorbable, a doctor will have to remove it.
Recovery periods vary depending on the surgery performed and other factors such as age and general health. However, many people experience very little discomfort after sinus surgery. Most individuals can go home the same day as surgery.
Depending on the extent of the surgery, a person may be given prescription pain medication during recovery. After the operation, it's common to experience:
- mild discomfort
- nasal congestion
- small amounts of bleeding
People should closely follow their doctor's instructions for aftercare and take all medications as prescribed. They may have to make changes in their daily routine for the first 2 weeks after surgery.
Common medications prescribed after your procedure often include saline rinses, steroids, and antibiotics.
The complications that can occur during sinus surgery are mostly rare and include the following:
Bleeding after surgery tends to happen within the first 24 hours. However, it can sometimes occur later, after days or even weeks. If a clot develops within the bony partition between the nasal passages, commonly called the septum, then it must be removed.
The septum attaches to the roof of the nose. This thin layer of bone may be damaged during sinus surgery. However, this is a very rare complication.
Brain fluid can leak into the nose and, in severe cases, can lead to an infection in the lining of the brain such as meningitis. While this issue is extremely rare, it is often identified and repaired while the initial surgery is taking place.
Damage to the eye or surrounding tissue
As the sinuses are so close to the eye, bleeding can sometimes occur into the eye. This happens when the thin layer of bone that separates the sinus from the eye is damaged. This is rare and, again, is usually spotted and treated while the surgery is taking place.
In extremely rare instances, visual loss and blindness have been reported. There have also been rare reports of damage to the muscles that move the eye, which can lead to temporary or permanent double vision.
Other instances may lead to a change in how the tear ducts work, causing excessive tearing.
Changes to a person's voice
Sinuses affect the resonance of a person's voice. A complication of sinus surgery can sometimes lead to a change in someone's voice.
Loss of smell or taste
After sinus surgery, a person's sense of smell usually improves due to the airflow being restored. However, it can worsen in rare cases depending on the extent of swelling or infection. This is often temporary but can be prolonged.
Dealing with sinus infections is the main reason why sinus surgery is done. A person with sinusitis can develop other infections in this area as a result of surgery.
However, this complication is also possible if a person doesn't undergo surgery for a long-term sinus infection.
Sinus surgery usually improves airflow. However, in rare cases, surgery can worsen this. Small amounts of scar tissue may also build up in the nasal passage that will require another procedure to remove.
Before resorting to surgery, a doctor will attempt a variety of other treatments. There is a range of medications that may be issued, as well as other procedures that may improve symptoms.
These other treatments include:
- nasal saline rinses or sprays
- nasal decongestant sprays
- nasal steroid sprays
- oral steroids
- allergy medications