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  • Dr. Glicksman

What is sinus surgery?

Sinus surgery is a very common operation performed by Otolaryngologist– Head & Neck Surgeons in North America. Having completed a fellowship (advanced training) in Rhinology & Skull Base Surgery at the University of Pennsylvania it is one of the most common surgeries that I perform in my practice.

The most common set of procedures performed in sinus surgery fall under the label of "Functional Endoscopic Sinus Surgery," commonly referred to as FESS or ESS. This is a group of procedures that are aimed at opening up the sinuses. The word endoscopic refers to the use of a telescope that is inserted through the nostrils to facilitate visualization of the nasal cavity and sinuses. This telescope is connected to a video monitor in the operating room. This allows the surgeon an excellent view without having to make any cuts on the face.

Operating Room Set Up for Sinus Surgery
Operating Room Set Up for Sinus Surgery

The nasal sinuses include the maxillary sinuses (cheek sinuses), ethmoid sinuses (between the eyes), sphenoid sinuses (in the back of the nasal cavity and middle of the head) and the frontal sinuses (forehead sinuses). The nose is divide into left and right sides by a structure called the nasal septum which derives its support at the front from cartilage and in back by bone.

Sinus Anatomy
Sinus Anatomy

Acute Rhinosinusitis (ARS) and Chronic Rhinosinusitis (CRS) are common conditions that lead to sinus surgery being offered to patients. ARS refers to sinus infections and CRS is an inflammatory condition that results in sinus symptoms for months (or longer) at a time. Most of the time sinus surgery is only offered to patients who have tried medical therapy (such as saline rinses, steroid sprays and rinses and/or oral steroids like prednisone) without relief. For patients that have frequent sinus infections (ARS) or persistent CRS symptoms sinus surgery can be very effective. It's important to note that sinus surgery is not a cure for most patients, but rather facilitates the ability of medical therapy to be more effective in controlling symptoms.

It is also important to note that surgery is elective in most cases. The goal of surgery is to improve quality of life as it relates to nasal symptoms. I have seen patients with massive polyps that feel fine and choose not to have surgery. I have seen patients with much less inflammation in their nose who find the symptoms very bothersome and get tremendous relief with surgery. I strive to cater the treatment and care that I offer to the specific needs of the individual patient.

The set of procedures performed during FESS include the opening of the maxillary sinus (Maxillary Sinusotomy), opening of the ethmoid sinuses (Ethmoidectomy), opening of the sphenoid sinus (Sphenoid Sinusotomy) and opening of the frontal sinuses (Frontal Sinusotomy). Additionally the nasal septum may be straightened (Septoplasty) to help with access to the sinuses and improve air flow. During surgery inflamed tissue like polyps are removed and trapped secretions, bacteria and fungus are removed as well, if present.

Before (right) and after (left) FESS
Before (right) and after (left) FESS

Surgery is typically a same day procedure. This means that patients will arrive the same day as their surgery and get to go home that day as well. Recovery varies between patients, but I typically see patients feeling substantially better between 1-2 weeks. I usually tell my patients to avoid heavy lifting for 2 weeks, and patients that don't do heavy lifting for work are usually back to work by 1 week after surgery.

In the immediate post-operative period a variety of medications may be prescribed depending on what is found during surgery. This may include saline (e.g. salt water) rinses, steroids (e.g. prednisone) and/or antibiotics (e.g. amoxicillin, clindamycin, etc...).

After surgery I have patients return to the office examine the nasal cavity and ensure scar tissue isn't forming that could block of the recently opened sinuses. Eventually patients are transitioned to a medical regimen that is catered to their specific needs. Common regimens will include saline irrigations that have a topical steroid added to it, or saline irrigations combined with a topical steroid spray.

Sinus surgery is very safe overall. It is important to remember that no operation is without risks, however. The most common risks of sinus surgery are postoperative bleeding (which is usually minor) and the recurrence of symptoms of the disease process. Sometimes this leads to revision surgery in the future. With any surgery nearby structures can be injured. Care is taken during surgery to avoid injury to the eyes, nasal septum or the separation between the nose and the brain. For this reason it is important to be careful choosing your surgeon.

Having a fellowship in Rhinology & Skull Base Surgery means that I spent extra time after residency learning the anatomy and advanced surgical procedures around the nose and sinuses under the guidance of world leaders in this type of surgery. It allows me to safely perform more complex surgery and revision surgeries when needed.

If you think you'd benefit from sinus surgery or are experiencing problems with your nose I'd be pleased to meet you review your health needs in person during a consult. My goal is always to minimize your need for surgery by treating with appropriate medications. However, it is good to know that when appropriate sinus surgery is an option.

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