Endoscopic surgery of the paranasal sinuses

Endoscopic surgery of the paranasal sinuses



About the surgery

Endoscopic sinus surgery is most often performed on patients who suffer from chronic sinusitis (CRS).

CRS symptoms include headache, nasal discharge, nasal congestion, and smell disorders. CRS therapy ought to be started with pharmacological treatment, and then – if the patient’s clinical condition does not improve – surgery ought to be considered.

The scope of endoscopic surgery depends on the patient’s ailments and the extent of changes in computed tomography. The possible surgery range is:

  •  Functional Endoscopic Sinus Surgery – FESS,
  •  the full house FESS,
  •  Endoscopic frontal sinus surgery: from ballooning to surgery requiring the use of a drill – Draf IIb, III.
Preparation
  • An interview as for co-existing diseases, medications taken, surgeries performed, allergies.
  • Explaining questions about the surgery.
  • Vaccination against hepatitis B (2 doses) in the event of insufficient levels of antibodies in the blood (the family doctor).
  • Oral steroids (e.g. Encorton in decreasing doses), possibly an antibiotic 7-14 days before the surgery.
Post-surgery care
  • Collecting the histopathological examination result in about 2 weeks.
  • Daily rinsing of the sinuses with saline solution several times a day – with the Sinus Rinse/ FixSin kit with 1 ampoule of the Nebbud preparation – 1/2 bottle for each nasal passage or rinsing only with the kit, followed by the administration of Nebbud in an atomizer.
  • Encorton dose 1mg/kg max 60mg/a day in reducing doses for approx. 2 weeks.
  • Dexilant 30mg 1 × 1 in the morning throughout the period of using Encorton.
  • Moistening the nasal cavity with Hysan/ Euphobium/sea salt several times a day (choice according to patient’s preferences.
  • A careful lifestyle – avoiding hot baths, excessive physical exertion, hot and spicy food and drinks, alcohol, blowing the nose forcefully, bathing in the swimming pool for about 2 weeks.
  • In the event of fever or other disturbing symptoms, consultation with the surgeon is recommended.
Risk

After the FESS surgery the following consequences or complications may occur: Frequent but not harmful:

  • Early bleeding (up to 24h), may require tamponade
  • Late bleeding (most often up to 7 days, rarely later), may require tamponade
  • Emphysema on the face, emphysema within the eyelids →Swelling, bruising, pain in the nose and eye socket, orbital tissue inflammation
  • Bone inflammation, infection recurrence
  • Scab formation, clots, evacuation of tissue fragments, unpleasant smell
  • The need to clear the nose and apply ointment,
  • The development of intranasal adhesions
  • Neuralgia complaints
  • The re-growth of polyps or the hypertrophy of inflammatory tissues (with recurrent infections)

    Very rare: massive bleeding requiring the ligation of the artery in the neck, persistent lack of smell after surgery, orbital hematoma, optic nerve damage, persistent orbital symptoms: visual disturbances (splitting), tearing, fluid flow, meningitis, cavernous sinus bleeding, intracranial oedema with the need for neurosurgery, blindness on the operated side, injury and internal carotid haemorrhage.

    A detailed discussion of the aforementioned risk will take place with your doctor.