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What Is Sinus Surgery?

Sinus surgery, also known as sinusotomy, is a procedure that aims to alleviate symptoms caused by chronic sinusitis. Sinusitis is an inflammation of the sinuses, which are the air-filled cavities in the skull that are located around the eyes, nose, and cheeks. Sinusitis is a common condition that affects millions of people and can cause symptoms such as nasal congestion, facial pressure and pain, and difficulty breathing through the nose. There are different types of sinus surgery, but the most common one is called functional endoscopic sinus surgery (FESS). FESS is performed using an endoscope, which is a thin, flexible tube with a light and camera on the end. The endoscope is inserted through the nose and allows the surgeon to see inside the sinuses. This way, the surgeon can see the location and extent of blockages, such as nasal polyps or bone spurs, and remove them. The procedure can also widen the openings of the sinuses to improve drainage and reduce inflammation. FESS is usually done under general anesthesia and can take several hours to complete, depending on the complexity of the case. Recovery time varies, but most patients can return to normal activities within a week or two.

Another type of sinus surgery is called an open sinus surgery, which is less common and usually used when more extensive work is needed. This type of surgery is done through small incisions in the skin, usually on the upper lip or inside the nostrils, and the surgeon will be able to access the sinuses directly. Sinus surgery can be very effective in improving symptoms of chronic sinusitis, but it is not without risks. Possible complications can include bleeding, infection, or injury to the nose or surrounding structures. Your doctor will explain the risks and benefits of the surgery, and help you decide if it is the right option for you.

What Are The Types Of Sinus Surgery?

There are several different types of sinus surgery, each with its own indications and techniques. Some of the most common types include:

  1. Functional endoscopic sinus surgery (FESS): This is the most common type of sinus surgery. It is performed using an endoscope, which is a thin, flexible tube with a light and camera on the end. The endoscope is inserted through the nose and allows the surgeon to see inside the sinuses. The surgeon can then remove blockages, such as nasal polyps or bone spurs, and widen the openings of the sinuses to improve drainage and reduce inflammation. FESS is usually done under general anesthesia and can take several hours to complete, depending on the complexity of the case.
  2. Image-guided surgery (IGS): This type of surgery uses specialized imaging technology, such as computed tomography (CT) scans, to create detailed images of the sinuses. These images are used to guide the surgeon during the procedure, helping to ensure that the surgery is as precise and accurate as possible.
  3. Balloon sinuplasty: This is a minimally invasive procedure that uses a small balloon catheter to open up blocked sinus passages. The balloon is inflated to widen the opening of the sinus, and then deflated and removed. This procedure can be done in the office under local anesthesia.
  4. Open sinus surgery: This is less common and usually used when more extensive work is needed. This type of surgery is done through small incisions in the skin, usually on the upper lip or inside the nostrils, and the surgeon will be able to access the sinuses directly.
  5. Transoral endoscopic surgery: This is a new and developing technique for sinus surgery, which is performed through the mouth. The surgeon uses an endoscope to access the sinuses and remove any blockages or tissue causing the infection. This approach avoids any external incisions and is less invasive.

It’s important to note that these different types of sinus surgery have different indications and risks, and the choice of which one to use will depend on the individual case. Your doctor will explain the risks and benefits of the surgery, and help you decide if it is the right option for you.

How Should I Prepare for Sinus Surgery?

Preparing for sinus surgery will depend on the type of surgery you are having, as well as your overall health. However, there are some general steps you can take to prepare for the procedure:

  1. Schedule a preoperative appointment: You will likely need to schedule a preoperative appointment with your surgeon to discuss the details of your surgery and go over any instructions or preparation guidelines.
  2. Stop smoking: If you smoke, it’s important to stop before your surgery. Smoking can increase your risk of complications during and after surgery.
  3. Follow any specific instructions from your surgeon: Your surgeon may provide you with specific instructions on how to prepare for your surgery. Follow these instructions carefully.
  4. Arrange for transportation and help at home: Since you will be under anesthesia for the surgery, you will not be able to drive yourself home afterwards. Arrange for someone to drive you home and stay with you for a day or two to help you with your recovery.
  5. Stop taking certain medications: Your surgeon may advise you to stop taking certain medications, such as blood thinners, before your surgery. Be sure to follow these instructions.
  6. Fast before surgery: You will likely be instructed not to eat or drink anything for a certain period of time before your surgery. Be sure to follow these instructions to avoid any complications during the procedure.
  7. Get your home ready: Make sure your home is prepared for your recovery. This may include stocking up on groceries, preparing meals in advance, and arranging for any necessary medical equipment.
  8. Get enough rest: It’s important to get enough rest in the days leading up to your surgery. Your body needs to be in good condition to recover well.

It’s important to make sure you are well prepared for your surgery and follow the

instructions provided by your surgeon to reduce any potential risks and ensure a smooth recovery.

After Surgery and Recovery

Depending on your work, Dr. Mourad typically recommends taking a minimum of 3 days off before returning to work. He also discourages his patients from any heavy lifting. If you wear glasses, you may require some alterations if applicable. Dr. Mourad will provide you with pain medications, ointments, nasal sprays, all to help maximize your results. Dr. Mourad will then see you in visitations two weeks later, and then one month after that. Dr. Mourad enjoys the continued visitation of his patients and will see them in follow up for many years thereafter.

Associated Risks

  • Anesthesia: Depending on the type of anesthesia administered, patients may have a reaction. This is exceedingly rare, and it is important to discuss your personal risk with your anesthesiologist.
  • Infection: In rare circumstances patients may develop an infection following sinus procedures. These are usually managed with intraoperative and postoperative antibiotics.
  • Bleeding: Although rare, patients may have bleeding episodes following nasal surgery. Your surgeon will likely order blood work to make sure you are healthy enough to undergo the procedure. Your surgeon should also go over all medications and supplements that you take to minimizing bleeding risk.
  • Need for secondary and revision surgeries: Depending on the complexity of the surgery, sometimes multiple surgeries are required to ensure the best aesthetic and functional outcomes.
  • Scarring (Synechia) and Poor wound healing: Some patients with underlying medical conditions or more prone to poor wound healing and scarring. It is important to understand these risks prior to embarking on a treatment strategy.
  • Local Reactions: Sometimes you may experience local reactions to the ointments, sutures, taping material, and nasal packing used during surgery and postoperatively. This is rarely seen, but may occur. If you have any allergies to certain materials or adhesives you should discuss with your surgeon.
  • Changes in nasal sensation: Patients may experience altered sensations in their nose (pain or numbness). This is exceedingly rare, and if it occurs it is most often temporary.
  • Persistent or Recurrent Sinus Infections: Although the goal of surgery is to reduce the severity and number of sinus infections, patients may continue to experience some infections. This may be related to underlying medical issues (e.g. asthma, or nasal polyps). In rare circumstances, if the infections are similar in frequency and severity as prior to the surgery, a secondary surgery may be required.
  • Persistent, New, or Recurrent Nasal Airway Obstruction: Altering the nose may result in changes to breathing. Sometimes patients may develop new, persistent or recurrent airway problems. This is rare, but oftentimes is due to poor wound healing or scarring (see above). This may require secondary surgeries to optimize outcomes.
  • Continued need for medical therapies: If you have sinus complaints related to medical causes (e.g. allergies), then you may continue to require medical nasal therapies (e.g. nasal steroids and sprays). Oftentimes, medical therapies are used in conjunction with surgery to maximize the benefit of each therapy.
  • Nasal Septal Perforation: A hole in the septum may develop. Oftentimes these do not cause any problems. Other times however, they may cause crusting, bleeding, and breathing difficulties. These require secondary surgeries for repair.
  • CSF Leak: The sinuses are situated near the skull base. Sometimes this area may be injured or involved with disease causing leakage of cerebrospinal fluid (link to CSF leak article). This is rare, but if it occurs may lead to infections, and often require secondary surgeries for repair. The risk of CSF leaks is reduced by use of intraoperative navigation technology, to insure the safety of the patient.
  • Orbital Complications: The sinuses are located near the eye. This area may be injured or involved with disease. This may lead to complications such as blurry vision, double vision, or loss of vision. This is exceedingly rare, and is usually rare. In the rarest of circumstances this may be permanent. However, the use of intraoperative navigation systems minimize the risk of this occurring.

Will Insurance Pay For My Sinus Surgery?

Almost all insurances will consider sinus and breathing disorders as functional surgery that is covered by insurance. Our office will check your benefits and let you know what they are before you come into the office so there are no surprises. We will submit your paperwork and obtain approvals for your procedure. Dr. Moustafa Mourad has highly trained in sinus surgery as well as rhinoplasty, broken noses and valve repair. If you have sinus problems please feel free to give us a call so we can help.

Meet Moustafa Mourad, MD, FACS

Moustafa Mourad, MD, FACS is board-certified in head and neck surgery and highly-trained in cosmetic plastic surgery and facial reconstruction. Dr. Mourad is also a Fellow of the American College of Surgeons. He treats many conditions, both cosmetic and complex, that affect the head, neck... Learn More »

The Results