What is Endoscopic Sinus Surgery?
During ESS, pathologies in the sinuses are intervened with the help of some instruments used next to the endoscopes, which are placed in the nostrils without making any external incisions and provide a detailed view of the surgical field.
Today, ESC is one of the most frequently performed surgeries as a current treatment option in the treatment of conditions such as chronic sinus inflammations, sinus tumors, anterior skull base injuries, traumatic eye socket injuries, cerebrospinal fluid (CSF) leaks and optic nerve compression. At the same time, due to the advantage of creating minimal surgical trauma, it is increasingly preferred in lacrimal sac drainage surgeries (Dacryocystorhinostomy) and surgical treatment of pituitary gland tumors (Endoscopic hypophysectomy).
The narrow areas of the sinuses around the nose, the complexity of the anatomy, and the proximity of important organs such as the brain, eyes, optic nerves, tear ducts, and jugular veins require training and experience in endoscopic sinus surgeries as well as high technical skills with a low margin of error.
The main endoscopic surgeries performed in chronic sinus diseases are;
Cleaning inflamed tissues/polyps
Opening and widening of the ejaculatory channels connecting the sinuses to the nose
Correction of anatomical problems such as concha bullosa, multiple sinus discharge holes (accessory ostium), abnormal mucosa contact areas is performed.
During endoscopic sinus surgery, general anesthesia is preferred for the comfort of the patient and surgeon, especially in surgeries where advanced technological devices such as navigation, balloons and microdebriders are used.
The duration of surgery varies depending on the degree of prevalence of the pathology and whether there are additional interventions to be performed in the same surgery, such as correcting the curvature of the nose, aesthetic nose surgery, reducing the nasal flesh, and correcting anatomical variations. While intervention on a single sinus takes around 15 minutes, cleaning of the pathology affecting all sinuses can take more than two hours.
Except for rare cases, no tampon is placed inside the nose after sinus surgery, and patients can breathe easily through the nose.
At the end of the surgery, special tampons and various materials placed in the surgical area under the middle nasal flesh to prevent bleeding and tissue adhesions that may occur during healing do not adversely affect nasal breathing.
After Endoscopic Sinus Surgery
There is no serious obstruction or pain after the surgery, and simple painkillers are usually sufficient. Although it is recommended that patients stay in the hospital on the day of surgery, it may also be possible to be discharged on the same day, depending on the nature of the surgery.
It is recommended to continue antibiotic treatment for at least 10 days after the surgery. If necessary, this period can be extended or additional medications can be added.
After the surgery, sprays that mechanically clean the nose and moisturize the mucosa, usually containing sterile saline, should be used until the crusts disappear.
In patients with allergies and polyps, sprays containing cortisone and medications that reduce the risk of polyp formation are started after surgery. Oral fungal treatment is also recommended after surgery for patients with suspected allergic fungal sinusitis.
After endoscopic sinus surgeries, dressings are applied 3-4 times. At the end of the first week, during the first detailed dressing, the crusts formed in the nose and sinus drainage channels are cleaned, if any anti-adhesion materials have been placed in the sinuses, they are removed and infection control is carried out. Proper initial dressing is very important for the success of the surgery. Depending on the extent of the surgery, patients are required to come for check-ups at 7-10 day intervals until recovery is complete.
In some special cases of ESC, the possibility of failure or complications increases with the degree of difficulty of the surgery. These special cases;
Excessive bleeding in tissues during surgery
Severe inflammation in the sinuses
Surgeries, especially for tumors with high vascular content
Hypertension
Coagulation disorders (Bleeding diathesis) / Aspirin use
Anatomy has changed due to previous surgery/trauma
Hard healing tissue has formed due to previous surgeries
Common polyps that alter normal anatomy
Tumors inside/outside the paranasal sinus
Anatomical changes (variations)
These can be listed as surgeries for the posterior ethmoid, sphenoid and frontal sinuses.
There are some minor and major complications encountered during or after endoscopic sinus surgeries. The most important of these are
active bleeding
Intraorbital (inside the eye) bleeding
Carotid (jugular vein) rupture
Orbital (eye socket) trauma
Endophthalmitis (backward displacement of the eye)
Eye movement disorder and double vision (diplopia)
Nasolacrimal duct (tear duct) trauma
Cerebrospinal fluid leak
Intracranial complications
Abscess
Meningitis
Brain
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The information on this page varies from person to person.
Kenan Selçuk TUNCAY
Otolaryngologist