Endoscopic Sinus Surgery

Endoscopic sinus surgery (ESS) is a surgical procedure used to treat sinusitis and other sinus-related disorders. The goal of ESS is to improve sinus drainage, reduce inflammation, and remove any blockages or abnormalities that may be causing symptoms.

Indications for Endoscopic Sinus Surgery

• Chronic sinusitis that does not respond to medical treatment
• Recurrent acute sinusitis
• Nasal polyps
• Tumors or cysts in the sinuses
• Deviation of the nasal septum
• Enlarged turbinates

Procedure Overview

ESS is typically performed under general anesthesia. The surgeon uses an endoscope, a thin, flexible tube with a camera and light on the end, to visualize the sinuses and surrounding structures.

The procedure involves the following steps:

1. The surgeon inserts the endoscope through the nostril and advances it into the nasal cavity.
2. The surgeon identifies the affected sinus and uses specialized instruments to remove any blockages, such as bone or tissue.
3. The surgeon may use a balloon sinuplasty device to dilate the sinus ostia (openings) and improve drainage.
4. The surgeon removes any diseased tissue, polyps, or tumors.
5. The surgeon may use packing or other materials to control bleeding and promote healing.

Types of Endoscopic Sinus Surgery

• Functional endoscopic sinus surgery (FESS): This is the most common type of ESS, which focuses on restoring normal sinus function and drainage.
• Extended endoscopic sinus surgery: This type of procedure involves more extensive dissection and removal of tissue to access deeper sinuses or more complex pathology.
• Revision endoscopic sinus surgery: This type of procedure is performed in patients who have undergone previous ESS and require additional treatment for recurrent or persistent symptoms.

Risks and Complications

As with any surgical procedure, there are risks and complications associated with ESS. These may include:

• Bleeding or hematoma
• Infection
• Cerebrospinal fluid leak
• Orbital injury (eye damage)
• Nasal septal perforation
• Adverse reactions to anesthesia

Postoperative Care and Recovery

After ESS, patients typically experience some discomfort, congestion, and nasal discharge. The surgeon may prescribe medications to manage pain, reduce inflammation, and promote healing.

Patients are usually advised to:

• Avoid heavy lifting, bending, or strenuous activities for several weeks
• Use saline irrigations to keep the nasal passages moist and clean
• Avoid blowing their nose or sneezing with their mouth closed
• Follow a postoperative care plan to promote healing and minimize complications

Outcomes and Prognosis

The success of ESS depends on various factors, including the underlying condition being treated, the extent of disease, and the patient's overall health.

In general, ESS can provide significant improvement in symptoms and quality of life for patients with chronic sinusitis and other sinus-related disorders. However, some patients may require additional treatment or revision surgery to achieve optimal results.