Sinus Surgery
Sinus Surgery
When considering Sinus Surgery, it is important to first understand the anatomy and physiology of the sinuses. The para-nasal sinuses are four paired cavities within the bone that surrounds the nose. These bony cavities are aligned with a thin membrane called mucosa. The mucosa membrane within the sinuses contains many mucous glands. These glands produce roughly one quart of mucous per day, which drains into the nose and is swallowed through the day. The mucosa membrane of the sinus cavities is susceptible to the same infections as the nasal cavity. Viral infections are the most common form of infection in the sinuses. Bacterial infections are also common. Much less commonly, fungus infections can occur.
Viral sinus infections are self-limiting and typically resolve within two weeks. Nasal decongestant sprays, oral decongestants, and pain medications can help patients. Antibiotics are necessary in bacterial or fungal sinus infections. Cultures obtained form the nose can guide in the choice of best antibiotic. Chronic sinus infections and nasal allergies can lead to mucosa membrane thickening within the sinuses and form polyp formation. Polyps and membrane thickening in the sinuses can interfere with proper sinus drainage, which in turn can exacerbate sinus infections and lead to further membrane thickening. Symptoms of sinus polyps include: nasal congestion, headache, poor sense of smell, heaviness of the eyes, and ear congestion.
If membrane thickening and polyp formation is minimal, patients can respond to a prolonged course of antibiotics combines with a short course of steroid tablets. However, when significant polyp formation has occurred, or when a patient fails to respond to the above noted treatment, sinus surgery can be curative. All patients obtain a CT scan of the sinuses prior to surgery, in order to evaluate the extent of polyps. Sinus surgery is performed through the nose utilizing endoscopic visualization. The operation can involve any four of the paired sinus cavities, depending the extent of disease. Additional techniques such as intra operative CT guidance or balloon dilatation sinuplasty can be utilized during the surgery. Sinus surgery typically lasts under two hours. Although the surgery is performed under general anesthesia, patients go home the same day. Dr. Khosh does not use packing inside the nose or sinus cavities. Patients have mild to moderate pain for about three days, and experience scant oozing of blood for two days.
The following CT scan shows an example of polyps and mucosa thickening in the left maxillary and ethmoid sinus. The right side is normal and the sinuses are filled with air, which in CT scan appears as black.
Sinus surgery can be combined with cosmetic rhinoplasty. In such cases, the sinus surgery is first performed first, followed by rhinoplasty.
Sinus Surgery: 212-223-1333
