Endoscopic Sinus Surgery
With endoscopic surgery becoming widespread worldwide from the second half of the 1980s onward, it also began to be used extensively in the field of ENT. Endoscopic Sinus Surgery (ESS) is currently one of the most frequently performed ENT operations and is used primarily in the treatment of sinusitis that does not respond to medication, as well as tumors in this region, anterior skull base injuries, trauma-related eye damage, and optic nerve compression. Due to its many advantages, this technique has also found widespread use in tear sac obstruction surgeries (DCR = Dacryocystorhinostomy) and pituitary gland tumor surgeries (Endoscopic hypophysectomy).
Approximately 200,000 ESS procedures are performed annually in the United States for chronic sinusitis, which affects 14% of the population.
The narrow regions in which the sinuses around the nose are located, the complexity of the anatomy, and the proximity of important organs such as the brain, eyes, optic nerves, tear ducts, and carotid arteries require not only training and experience but also high technical skill with a low margin of error in endoscopic sinus surgeries.
In chronic sinus diseases, the main procedures performed with ESS are:
- Removal of inflamed tissues/polyps
- Opening the holes called ostia that connect the sinuses to the nose
- Correction of anatomical problems such as concha bullosa, multiple drainage openings (accessory ostium), and mucosal contact point problems.
Although general anesthesia is generally preferred in ESS operations, local anesthesia may also be used in unavoidable situations and in cooperative patients. The duration of the operation varies depending on the extent of the disease and whether additional procedures such as correction of intranasal deviation, reduction of the nasal turbinates, and correction of other anatomical problems will be performed during the same operation. While intervention in a single sinus takes approximately twenty minutes on average, removal of pathology involving all sinuses may take more than two hours.
If no additional procedures such as intervention on the nasal cartilage or reduction of the nasal turbinates have been performed, no packing is placed inside the nose, and patients can breathe comfortably through the nose. Sometimes, special packing materials and various substances placed at the end of the operation in the surgical area beneath the middle turbinate to prevent bleeding and tissue adhesions that may occur during healing do not adversely affect nasal breathing.
There is no serious complaint of pain after surgery, and simple painkillers are generally sufficient.
Although patients are sometimes advised to stay in the hospital on the day of surgery, same-day discharge is generally possible depending on the content of the operation.
Patients are advised to continue antibiotic treatment for at least 10 days after surgery. When necessary, this period may be extended or additional medications may be added. Sprays that mechanically clean the nose and moisturize the mucosa, generally containing sterile saline, are recommended until crusting disappears. In patients with allergies and polyps, sprays containing corticosteroids and medications that reduce the risk of polyp formation are started from the second week onward.
The patient is examined 2-3 times during the 8-week postoperative period. During the first dressing performed at the end of the first week, the crusts that have formed in the nasal and sinus passages are cleaned, anti-adhesion materials placed inside the nose are removed if present, and infection control is performed.
In some special situations during ESS, the difficulty of the operation increases and the possibility of failure or complications rises. These special situations include:
- Excessive bleeding from the tissues during surgery
- Severe inflammation
- Especially surgeries involving tumors with a high vascular content
- Hypertension
- Coagulation disorders (bleeding diatheses) / Aspirin use
- Altered anatomy due to previous surgery / trauma
- Formation of hard scar tissue due to previous surgeries
- Extensive polyps
- Anatomical differences (variations).
Although very rare, depending also on the surgeon’s experience, the following problems (complications) may occur during or after ESS:
- Active bleeding
- Intraorbital bleeding
- Carotid artery rupture
- Orbital trauma
- Enophthalmos (backward displacement of the eye)
- Eye movement disorder
- Damage to the nasolacrimal duct (tear duct)
- Cerebrospinal fluid leakage
- Intracranial complications
- Abscess
- Meningitis
- Air entering the brain (Pneumocephalus)
- Pituitary gland damage
can be listed.
Surgery Cost:
There are many variables that determine the cost of endoscopic sinus surgery, the main ones include:
- The scope of the surgery to be performed: unilateral or bilateral surgery
- Specific sinuses to be treated: frontal sinus, sphenoid sinus
- Surgical method: standard surgery, surgery with the balloon sinuplasty method, combined surgery
- Advanced technology to be used: surgical navigation (computer-assisted surgery), Microdebrider (shaver)
- Other surgeries that need or are requested to be performed at the same time: turbinate reduction, nasal cartilage deviation surgery, rhinoplasty, etc.
- Additional materials and technologies to be used in the additional surgery: radiofrequency, nasal splints, etc.
- The hospital where the surgery will be performed.
This operation is performed in an anatomical region adjacent to the brain and eyes, without direct vision, by using small and delicate surgical instruments while viewing images obtained through endoscopic systems on a monitor. In addition to surgical knowledge and experience, the quality and adequacy of the available surgical equipment and endoscopic systems have very important effects on the success of the surgery and the prevention of undesirable outcomes (complications). Although having all these resources available does not affect the surgeon’s fee, it affects hospital fees and therefore increases the total cost.
Frequently Asked Questions
What Is Endoscopic Sinus Surgery?
Endoscopic Sinus Surgery is a modern surgical method used in the treatment of chronic sinusitis and other sinus diseases, performed through the nose with the help of an endoscope. No external incision is made during the procedure.
In Which Situations Is Endoscopic Sinus Surgery Performed?
This surgical method may be used in cases of chronic sinusitis, nasal polyps, recurrent sinus infections, sinus cysts, and sinus diseases that do not respond to medical treatment.
How Is Endoscopic Sinus Surgery Performed?
The operation is performed through the nose using a thin endoscope and special surgical instruments. Blocked sinus passages are opened, diseased tissues are removed, and the natural drainage of the sinuses is restored.
What Are the Advantages of Endoscopic Sinus Surgery?
This method offers advantages such as requiring no external incision, causing less tissue damage, providing faster recovery, and allowing the normal sinus structures to be largely preserved.
How Long Does Endoscopic Sinus Surgery Take?
Although the duration of the operation varies depending on the extent of the disease and the procedures to be performed, it is generally completed within 30 to 90 minutes.
What Is the Recovery Process Like After Surgery?
Patients can usually return to their daily activities within a few days. The complete recovery process may take several weeks, and it is important to follow the doctor’s recommendations during this period.
Is Endoscopic Sinus Surgery a Painful Procedure?
Mild pain, nasal congestion, and a feeling of fullness may generally occur after surgery. These complaints can usually be controlled with prescribed medications.
Are There Any Risks Associated with Endoscopic Sinus Surgery?
As with every surgical procedure, bleeding, infection, and, rarely, complications involving surrounding tissues may occur. When performed by experienced surgeons, these risks are quite low.
What Should Be Considered After Endoscopic Sinus Surgery?
Nasal cleaning should be performed regularly, strenuous physical activities should be avoided for a while, prescribed medications should be used regularly, and follow-up examinations should not be neglected.
What Is the Success Rate of Endoscopic Sinus Surgery?
When performed on appropriately selected patients by experienced surgeons, Endoscopic Sinus Surgery has a high success rate and provides significant improvement in sinus-related complaints in many patients.
