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When is sinus surgery needed?
Sinus surgery may be necessary on an urgent basis when complications of sinusitis develop. Less urgent sinus surgery may be indicated when chronic sinusitis fails to respond to medical therapy.
CT scans are very helpful in determining which sinuses are diseased. It can also identify obstructive or abnormal cells that can cause sinus pain or headaches. Nasal endoscopy is also used to obtain cultures, determine cause of sinus pain/headaches, and identify treatment options.
The late 1980’s and early 1990’s marked the evolution of Endoscopic Sinus Surgery, a minimally-invasive approach to surgery for sinusitis. This is sometimes referred to as Functional Endoscopic Sinus Surgery (FESS). It was quite a significant advance compared to prior open sinus procedures performed at the time. Simply explained, it involves removal of diseased tissues in key areas of sinus obstruction. Endoscopic Sinus Surgery is performed with the goal to reestablish physiologically normal sinus drainage pathways. The surgery is performed using fine instruments called endoscopes (small, rigid telescopes) which are inserted into the nose to open the sinuses. The scopes are attached to a camera allowing the surgeon to visualize the sinus cavities in a magnified form on the screen, while operating with fine instruments.
There are several advantages of Endoscopic Sinus Surgery over the open sinus procedures that preceded it. First, it provides great improvement in the ability to see within the nose and sinuses. No longer are facial incisions with resulting visible scars or gauze nasal packing used. The surgery is done through the nostrils and there are usually no visible signs that surgery has been performed. Recovery is usually faster, and there is less postoperative pain and bleeding.