SURGERY

THE LAST RESORT: SURGERY FOR EXTREME CASES

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There are times when medications and holistic remedies are not effective enough to make you feel better. For some people, repeated sinus infections or structural abnormalities have created situations in which inflammation and obstruction still exist, even after long courses of medication. In the past, sinus surgery was painful and did not offer great results. However, over the last 2 decades, there has been a great refinement in the medical management

When to Consider Surgery

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Sinus Surgery TimeChronic airway-digestive inflammatory disease (CAID) rarely, if ever, leads to death. Therefore, considering sinus surgery is more a quality - of-life issue than a life-or-death decision. Obviously, for those patients who suffer severely from sinus problems, this surgery can improve their quality of life immensely. Sinus surgery should never be performed for chronic

COMPLICATIONS TO CONSIDER

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Sinus surgery is performed between the eyes and below the brain, so there is a possibility of complication at these sites. Complications of the eyes include visual disturbances, double vision, and blindness. Complications in the central nervous system may include a leak of the cerebrospinal fluid, the fluid that buffers the brain and spinal cord. The incidence of these complications is very rare. Just the same, an untreated

FESS: Functional Endoscopic Sinus Surgery

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FESS is an entirely new way to return the nose and sinuses back to their original, anatomical state. I am fortunate to be one of the early practitioners in this type of surgery. It was a privilege to be the first fellowship-trained nasal and functional endoscopic sinus surgeon

IS FESS RIGHT FOR ME?

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The FESS approach is beneficial to both the doctor and the patient. First, it permits physicians to make a more accurate diagnosis and target the medical and surgical treatment more precisely. After surgery, the endoscopic technique provides the tools to continue treatment right in the doctor’s office. During these subsequent

SURGERY DOES NOT STAND ALONE

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FESS is a philosophy whereby your physician or group of physicians and practitioners come together to make a more accurate diagnosis. This occurs by taking an accurate history, performing a thorough physical examination, and then using an endoscope to perform an endoscopic exam to make an accurate diagnosis. Afterward, your physician will develop a treatment plan. Next comes the institution of the treatment, including surgery, if warranted

ANESTHESIA FOR FESS

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FESS surgeries can be performed either under local anesthesia with sedation or under general anesthesia. Both have advantages and disadvantages. I prefer to perform FESS under local anesthesia with sedation because I believe that the risks of general anesthesia outweigh the benefits. My patients who have had surgery under local anesthesia with sedation relay that their surgery was well tolerated. Furthermore, patients operated

FESS PROCEDURES Ethmoidectomy

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The ethmoid sinuses are shaped like a beehive and are composed of up to 22 smaller cavities or cells. When the anterior ethmoid sinuses are obstructed, typically the frontal and maxillary sinuses will not drain properly, because these two sinuses drain into the anterior ethmoid. This

Frontal Sinusotomy

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This surgery opens up the frontal sinus, located in your forehead. This procedure is done through the nose in most instances. The passageway up to the frontal sinus is a difficult and technically challenging sinus to open up for most surgeons. I have been sent many cases over the years by other otolaryngologists who are not comfortable with performing frontal sinus surgery. I applaud these surgeons for their honesty

Maxillary Middle Meatal Antrostomy Surgery

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In maxillary middle meatal antrostomy surgery, the natural ostium of the maxillary sinus is opened. This technique usually obviates the need for the surgeon to remove polyps in the maxillary sinus: it has been shown that they can resolve themselves if normal drainage patterns are returned. However, it is up to the discretion of the surgeon whether to remove any polyps.

Sphenoidotomy

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Opening up the sphenoid sinus is one of the most challenging procedures for your physician and requires considerable skill. The object of sphenoid sinus surgery is to open up the natural ostium of the sphenoid sinus. In the case where there is mucosal thickening and/or closure of the natural ostium, opening the natural ostium will provide the necessary relief However, if you suffer from considerable mucosal disease or formation of a cyst,

Traditional Sinus Surgery

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Most surgeons do not perform traditional sinus surgery any more. However, there are still indications for the traditional approach. The major indications for traditional sinus surgery include the following:

■ A mucocele (cyst in the sinus) that cannot be treated

TRADITIONAL FRONTAL SINUS SURGERY

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Frontal sinus surgery is performed either through an incision by the eyebrow and can be combined with the ethmoid surgery. Occasionally, the surgeon will leave a drain in this area for 24 - 72 hours, or longer. If the frontal sinus disease is bad enough or the scarring from the disease or previous

SEPTOPLASTY

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The nose houses many septums, but septoplasty refers to an operation on the largest septum, which is the middle part of your nose. This surgery is intended to straighten out the septum so that the airflow through the nose is corrected. This surgery is performed by making an incision into the soft tissues of the septum. The incisions are made inside your nose. The surgeon then lifts the membranes off the cartilage

TURBINATE SURGERY

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I believe in being very conservative with the turbinates. Many surgeons just snip or trim off a part of the turbinate. Then there are others that may carry this to the limit by which they remove most of the turbinate. I usually move the turbinate out toward the outside wall. This technique moves the turbinates

RHINOPLASTY ("THE NOSE JOB")

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Rhinoplasty corrects the overall structure of the nose. It can be performed for cosmetic as well as functional reasons. This surgery can be performed under local anesthesia with sedation or it can be performed under general anesthesia.

Techniques vary from surgeon to surgeon. Rhinoplasty can be performed by making cuts inside of the nose and then tunneling underneath and performing

NASAL VALVE SURGERY

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Nasal valve surgery is for those who have scarring and/or collapse of their nasal valves. This usually occurs after trauma or as a result of infection and/or previous surgery. When the nasal valve is collapsed or scarred, breathing is compromised significantly. These defects tend to be very difficult to repair and most surgeons do not even want to deal with these

defects because of the complexity.

What Do I Do about a Broken Nose?

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An acute nasal fracture, known as a broken nose, should be reset within the first 72 hours and as soon as most of the swelling goes down. This operation can sometimes be done in an office setting but often requires an immediate trip to the operating room. The surgeon can take an instrument and, without making any cuts, fracture

Image Guidance Surgery

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One of the latest improvements in nasal and sinus surgery is the use of image guidance systems. Different companies make instrumentation that can calibrate a computed tomography (CT) scan to a machine that hooks up to some of the surgical instruments that your surgeon uses while performing surgery. When your

Getting Ready for Surgery

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Once you and your ear, nose, and throat (ENT) specialist have exhausted all other medical options, you may be scheduled for surgery. Just like anything else, you need to prepare your mind and body before the procedure. About 2 weeks before surgery, begin following the steps outlined in the following sections. By doing so, you will be creating a healthy environment, thereby increasing the likelihood that your surgery will be a complete success.

STEP

Postsurgical Care

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You will most likely be feeling, and breathing, much better immediately after your surgery. However, don’t mistake or underestimate the amount of surgery that you have just been through because you feel good. All types of surgery require a healing phase. During this time, it’s more important than

BACK IN THE DOCTOR'S OFFICE: FOLLOW-UP CARE

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FESS is not over once you leave the operating room. FESS has brought with its development three major advances in the treatment of sinus disease. The first advance is that it has allowed physicians to diagnose sinus disease more accurately. Second, the technique used in the operating room is less invasive and yields greater results. But I believe that the greatest advance that occurred

AT-HOME CARE

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Without a doubt, sinus infections can recur. As mentioned earlier, surgery does not change the way you respond to the environment. At best, your sinuses will be near normal. Patients with significant sinus disease can expect that they will continue to get milder sinus infections, usually

Feeling Better, and Loving It

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By following the guidelines I’ve outlined and choosing your surgeon carefully, I believe that you will find significant relief from your sinus problems. Most of my patients report that they feel so much better after surgery. Of course, it is important to try medical alternatives first and opt for surgery only when it is indicated. Many patients put surgery off because they are afraid.

This initial hit of inflammation would probably lead you to believe that you had come down with a simple cold.