A surgical procedure called sinusotomy might be recommended for severe inflammation of sinuses. A chronic or abnormal condition, particularly of the sinuses connected to the nasal passage, might present physical symptoms sufficiently debilitating to warrant it. Although successful outcomes of sinus operations, including minimally invasive techniques, is highly likely, they are inherently difficult and not without serious risks.
A sinus is a sac, cavity or channel in any organ or tissue, but most commonly, the term refers specifically to the four pairs of hollow paranasal passageways in the human skull that are connected to the nose. Though biologists are still not indisputably certain of the primary function of nasal sinuses, doctors do know that 90 percent or more of the human population has experienced nasal sinus inflammation or infection, otherwise called sinusitis. Most cases are acute — brief, self-resolving bouts resulting from viral infection of the upper respiratory tract or irritant allergens lodged within the cavities. The swelling constricts the chambers, congests them with immune response mucus secretions and creates distended pressure that can result in headache and fever.
Chronic sinusitis, diagnosed to be the persistence of symptoms for eight weeks or more, will have initially followed a standard course of therapies that might include decongestant, anti-inflammatory or vasoconstrictor medication. At this point, other agents are suspect, such as bacterial or fungal infection and polyp growths or other deformed structures. Malignant tumors are very rare. Diagnostically, X-ray, computed tomography (CT) scans and visual nasal endoscopy are often indeterminate, and several biopsies for lab analysis might be necessary to confirm the cause. Most otolaryngology specialists will consider sinus surgery, collectively called a sinusotomy, to be a treatment of last resort.
The most significant concern of sinusitis is the close proximity of the paranasal sinuses to the brain and a potentially fatal spread of infection. In addition to the brain, the internal carotid arteries, the optic and facial motor nerves must also be avoided in a demandingly precise surgical operation, but a sinusotomy can usually eliminate a chronic condition. What was once a risky operation requiring the opening of a facial or oral incision has been revolutionized by nasal endoscopes. The fiber-optic tube with an illumination source and magnifying video camera at its end is inserted through the nostril numbed by local anesthetic. Miniaturized to less than an eighth of an inch (less than 3 mm) in diameter and flexible enough to navigate the convoluted cavities of nasal sinuses, they provide a direct view with which to guide the manipulation of attached surgical instruments.
The sinusotomy called functional endoscopic sinus surgery (FESS) allows for targeted approach to the affected internal area, reduced patient trauma and tissue damage and minimized postoperative recovery and complications. Appropriate treatment might be relatively minor, such as the clearing of a sinus area or the widening of a sinus’ orifice to the nasal cavity, both to improve drainage. More difficult procedures might require three or more hours of general anesthesia — removing pathological obstructions such as polyps, tumors or diseased tissue or straightening the nose’s central septum and chipping the bony partitions that delimit the size of a sinus tract. In either case, FESS is often an outpatient procedure.
Post-operative pain and discomfort following endoscopic sinusotomy is minimal. Normal bleeding, dried blood or mucus discharge is irrigated with a saline solution; antibiotics are prescribed in lubricant nasal sprays. Excessive respiratory activities are restricted for a few weeks. The postoperative program, which includes follow-up endoscopic visual monitoring, is essential because a full cure from severe surgical cases might yet take months of further medical therapy and because, although very rare, the short list of possible complications includes vision loss, meningitis of the brain and worse. The greatest adjustment following sinus surgery might be a resonant change in voice tone.
