When is sinus surgery necessary. What are the different types of sinus surgery available. How to prepare for sinus surgery and what to expect during recovery. What are the potential risks and complications of sinus surgery. How effective is sinus surgery in treating chronic sinusitis. What are the alternatives to sinus surgery for managing sinus problems. How long does recovery from sinus surgery typically take.

Understanding Chronic Sinusitis and Its Impact on Quality of Life

Chronic sinusitis is a condition characterized by persistent inflammation of the sinus cavities, leading to a range of uncomfortable symptoms that can significantly impact an individual’s quality of life. These symptoms often include nasal congestion, facial pain or pressure, reduced sense of smell, and recurrent infections. While many cases of sinusitis can be managed with conservative treatments, some individuals may require surgical intervention when other methods fail to provide relief.

Do you know what causes chronic sinusitis? The condition can arise from various factors, including:

• Bacterial, fungal, or viral infections
• Nasal polyps
• Allergies
• Structural abnormalities like a deviated septum

Understanding the underlying cause is crucial in determining the most appropriate treatment approach, including whether surgery may be necessary.

Evaluating the Need for Sinus Surgery: When Conservative Treatments Fall Short

Before considering surgery, healthcare providers typically explore a range of non-invasive treatments to manage chronic sinusitis. These may include saline nasal sprays, topical nasal steroids, over-the-counter pain relievers, and antibiotics for bacterial infections. However, in some cases, these conservative approaches may not provide adequate relief.

How can you determine if sinus surgery might be necessary? Consider the following factors:

• Persistent symptoms despite medical management
• Recurrent sinus infections
• Presence of structural abnormalities or nasal polyps
• Impaired quality of life due to chronic sinusitis

If you find yourself struggling with ongoing sinus issues despite trying various treatments, it may be time to consult with an otolaryngologist (ear, nose, and throat specialist) to discuss surgical options.

Exploring Different Types of Sinus Surgery: From Endoscopy to Balloon Sinuplasty

Advancements in medical technology have led to the development of various surgical techniques for treating chronic sinusitis. Each approach offers unique benefits and may be more suitable for certain patients depending on their specific condition. Let’s explore some of the most common types of sinus surgery:

Endoscopic Sinus Surgery

Endoscopic sinus surgery is a minimally invasive procedure that has become the gold standard for treating many cases of chronic sinusitis. During this procedure, the surgeon uses a thin, flexible instrument called an endoscope to visualize and access the sinus cavities through the nostrils.

What are the advantages of endoscopic sinus surgery?

• No external incisions, resulting in faster recovery
• Ability to remove polyps, scar tissue, and other obstructions
• Can be performed under local anesthesia in many cases
• Generally an outpatient procedure

Balloon Sinuplasty

Balloon sinuplasty is a newer, less invasive alternative to traditional endoscopic surgery. This procedure involves inserting a small balloon catheter into the blocked sinus passage and inflating it to widen the opening. The balloon is then deflated and removed, leaving the sinus pathway open to allow for better drainage.

What makes balloon sinuplasty an attractive option for some patients?

• Minimal tissue removal or alteration
• Shorter recovery time compared to traditional surgery
• Can be performed in-office under local anesthesia
• Lower risk of complications

Image-Guided Surgery

Image-guided surgery combines endoscopic techniques with advanced imaging technology to provide surgeons with real-time, three-dimensional views of the patient’s sinus anatomy. This approach is particularly useful for complex cases or revision surgeries.

How does image-guided surgery enhance the surgical process?

• Improved precision and accuracy
• Ability to navigate complex sinus structures safely
• Reduced risk of complications
• Enhanced outcomes for challenging cases

Understanding the Risks and Potential Complications of Sinus Surgery

While sinus surgery is generally considered safe and effective, it’s important to be aware of potential risks and complications associated with the procedure. Being informed about these possibilities can help patients make well-informed decisions and prepare appropriately for their surgery.

What are some of the risks associated with sinus surgery?

• Bleeding
• Infection
• Changes in sense of smell
• Cerebrospinal fluid leak (rare)
• Injury to nearby structures (e.g., eyes, brain)
• Need for revision surgery

It’s important to note that serious complications are rare, especially when the surgery is performed by an experienced surgeon. Discussing your individual risk factors with your healthcare provider can help alleviate concerns and ensure you’re well-prepared for the procedure.

Preparing for Sinus Surgery: What to Expect Before and During the Procedure

Proper preparation can significantly contribute to the success of your sinus surgery and help ensure a smooth recovery. Your healthcare team will provide specific instructions tailored to your individual case, but there are some general guidelines to keep in mind.

How should you prepare for sinus surgery?

• Undergo a thorough medical evaluation
• Inform your doctor of all medications and supplements you’re taking
• Stop smoking and avoid alcohol consumption prior to surgery
• Arrange for transportation home after the procedure
• Follow fasting instructions as provided by your healthcare team

During the procedure, you’ll likely be under either local or general anesthesia, depending on the complexity of your case and the surgical technique being used. The surgery itself typically takes between one to three hours, and most patients can return home the same day.

Navigating the Recovery Process: Post-Operative Care and Expectations

Recovery from sinus surgery varies from person to person, but understanding what to expect can help you navigate this period more comfortably. Your surgeon will provide specific post-operative instructions, which may include the use of nasal packing to absorb fluids and support the healing process.

What are some key aspects of post-operative care after sinus surgery?

• Sleep with your head elevated to reduce swelling
• Avoid blowing your nose for a specified period
• Use saline rinses as directed to keep nasal passages clean
• Take prescribed medications, including pain relievers and antibiotics if necessary
• Attend follow-up appointments for nasal debridement and monitoring

Most patients begin to feel significant improvement in their symptoms within a few days to a week after surgery. However, complete healing may take several weeks to months. It’s important to be patient and follow your doctor’s instructions closely to achieve the best possible outcome.

Long-Term Outcomes and Management: Life After Sinus Surgery

While sinus surgery can provide significant relief for many patients with chronic sinusitis, it’s important to understand that it may not be a permanent cure for all individuals. The goal of surgery is to improve sinus function and reduce the frequency and severity of symptoms, but ongoing management may still be necessary.

How can you maintain the benefits of sinus surgery long-term?

• Continue using nasal rinses and prescribed medications as directed
• Practice good nasal hygiene
• Manage underlying conditions such as allergies
• Avoid known triggers for sinus inflammation
• Attend regular follow-up appointments with your ENT specialist

Many patients experience significant improvement in their quality of life following sinus surgery, with reduced symptoms and fewer sinus infections. However, it’s important to maintain open communication with your healthcare provider and address any recurring issues promptly to ensure continued success.

Exploring Alternatives: Non-Surgical Approaches to Managing Chronic Sinusitis

While sinus surgery can be an effective treatment for chronic sinusitis, it’s not always the first or only option. Many patients find relief through various non-surgical approaches, which may be used alone or in combination to manage symptoms and improve sinus health.

What are some effective non-surgical treatments for chronic sinusitis?

• Nasal corticosteroid sprays to reduce inflammation
• Saline nasal irrigation to flush out irritants and mucus
• Oral or injectable corticosteroids for severe inflammation
• Antihistamines and decongestants for allergy-related sinusitis
• Immunotherapy for patients with significant allergies
• Lifestyle modifications, such as avoiding irritants and managing stress

For many patients, a combination of these non-surgical approaches can provide significant relief and may delay or even eliminate the need for surgery. It’s important to work closely with your healthcare provider to develop a comprehensive management plan tailored to your specific needs and condition.

The Role of Allergy Management in Sinus Health

Allergies can play a significant role in chronic sinusitis for many individuals. Effectively managing allergies can often lead to improvements in sinus symptoms and overall quality of life. Allergy testing and targeted treatment may be recommended as part of a comprehensive approach to managing chronic sinusitis.

How can allergy management contribute to improved sinus health?

• Identifying and avoiding specific allergens
• Using antihistamines and nasal corticosteroids to reduce allergic reactions
• Considering immunotherapy (allergy shots or sublingual tablets) for long-term allergy control
• Implementing environmental controls to reduce exposure to allergens

Emerging Therapies and Future Directions in Sinus Treatment

Research in the field of otolaryngology continues to advance, leading to new and promising treatments for chronic sinusitis. While some of these therapies are still in the experimental stages, they offer hope for improved outcomes and less invasive options for patients struggling with persistent sinus issues.

What are some emerging therapies for chronic sinusitis?

• Biologic medications targeting specific inflammatory pathways
• Photodynamic therapy to combat bacterial biofilms
• Novel drug-eluting stents to maintain sinus patency post-surgery
• Advances in minimally invasive surgical techniques

As research progresses, patients with chronic sinusitis may have access to an even wider range of treatment options, potentially improving outcomes and quality of life for those affected by this challenging condition.

Making an Informed Decision: Weighing the Pros and Cons of Sinus Surgery

Deciding whether to undergo sinus surgery is a significant choice that requires careful consideration of various factors. While surgery can offer substantial benefits for many patients with chronic sinusitis, it’s important to weigh these potential advantages against the risks and alternatives available.

What are some key factors to consider when contemplating sinus surgery?

• Severity and duration of your symptoms
• Impact of sinusitis on your quality of life
• Response to previous non-surgical treatments
• Presence of structural abnormalities or polyps
• Your overall health and ability to undergo surgery
• Potential risks and complications of the procedure
• Expected outcomes and long-term management requirements

Engaging in open and thorough discussions with your healthcare provider is crucial in making an informed decision. Don’t hesitate to ask questions, seek second opinions if needed, and take the time to fully understand your options before proceeding with any treatment plan.

The Importance of Choosing an Experienced Surgeon

If you decide to pursue sinus surgery, selecting a skilled and experienced surgeon is paramount to achieving the best possible outcome. Look for a board-certified otolaryngologist who specializes in sinus surgery and has a track record of successful procedures.

What qualities should you look for in a sinus surgeon?

• Board certification in otolaryngology
• Extensive experience in performing sinus surgeries
• Familiarity with the latest surgical techniques and technologies
• Clear communication and willingness to answer your questions
• Positive patient reviews and outcomes

Remember that your comfort and trust in your surgeon are essential components of a successful surgical experience. Take the time to find a healthcare provider who not only has the necessary expertise but also aligns with your personal preferences and communication style.

The Role of Patient Education and Engagement

Successful management of chronic sinusitis, whether through surgery or non-surgical approaches, often depends on active patient involvement. Educating yourself about your condition, treatment options, and self-care strategies can significantly impact your overall outcomes and quality of life.

How can you become more engaged in your sinus health management?

• Learn about the anatomy and function of your sinuses
• Understand the triggers and factors that contribute to your sinusitis
• Keep a symptom diary to track patterns and identify potential triggers
• Actively participate in discussions with your healthcare provider
• Adhere to prescribed treatments and follow-up recommendations
• Join support groups or online communities to share experiences and learn from others

By taking an active role in your care, you can work more effectively with your healthcare team to develop and implement a comprehensive management plan tailored to your specific needs and goals.

Sinus Surgery for Treating Chronic Sinusitis

Written by WebMD Editorial Contributors

• When Is Surgery Needed?
• Types of Surgery
• Surgery Risks
• After Surgery

Most sinus infections can clear up on their own, or with the help of antibiotics if they’re caused by a bacterial infection. Saline sprays, topical nasal steroids, and over-the-counter medicines often bring relief.

But there are exceptions.

It depends on the cause.

Sinusitis is swelling in your sinuses that causes congestion and discomfort. Several things can cause your nasal passages to become blocked and lead to this condition. Some of these are:

• Infections by bacteria, fungi or viruses
• Small growths called polyps on the lining of your sinuses
• Allergies
• A deviated septum, meaning a crooked wall in between your nostrils

If you don’t get relief from your medicine, nasal rinses, or other treatments, tell your doctor. They may send you to a specialist.

Surgery may be an option if your sinusitis is due to a deviated septum, polyps, or other structural problems.

The main goals of sinus surgery are to relieve your symptoms and cut down on how many infections you get. If they keep coming back, chances are there’s something in your nasal cavity that surgery could fix.

An operation should also help you breathe better through your nose. And if the chronic congestion has affected your sense of smell or taste, surgery might help with that, too.

If you decide to get surgery, you have a few different options. Among these are endoscopy and balloon sinuplasty.

Endoscopy. This is a common procedure. Doctors insert very thin and flexible instruments called endoscopes into your nose. One instrument has a small camera lens that sends images back to a screen. That way, the doctor can see where your sinuses are blocked and guide the other instruments that can gently remove polyps, scar tissue, and other.

Doctors won’t cut into your skin, so your recovery will be faster and easier. Endoscopy is usually done with a local anesthetic, meaning the area will be made numb and you can be awake. You’ll likely be able to go home when it’s over.

Balloon sinuplasty. If your doctor doesn’t need to remove anything from your sinuses, you may be a good candidate for this newer type of surgery.

The doctor puts a thin tube into your nose. Attached at one end of it is a small balloon. They then guide the balloon to the blocked area inside your nose and inflate it. This helps clear the passageway so your sinuses can drain better and you won’t be so congested.

The risks from these procedures are few. The most common are tissue injury and infection. More serious problems, such as injury to the brain or eyes, are rare.

As with any procedure, you should talk with your doctor first about the risks and benefits. Get a second opinion if you still have concerns.

Depending on the extent of the procedure, you may need what’s called nasal packing. This is when your doctor places gauze-like material in the nasal cavity to absorb blood or other fluids right after surgery. They will take them out at your next follow-up appointment. There are also dissolvable packing materials that don’t need to be removed.

Some things you’ll need to remember after surgery:

• Sleep with your head raised, perhaps using an extra pillow, for a while.
• Avoid blowing your nose for a week or so.
• Try to keep your mouth open when you sneeze. This will take some of the pressure off your nasal cavities.

You should start to feel better and have fewer symptoms a few days after the procedure.

Keep in mind that sinus surgery doesn’t always cure sinusitis. Instead, you should look at it as part of your overall treatment plan. For example, you may still get sinus infections from time to time. And in the days right after surgery, your doctor may tell you to continue with saline rinses, antibiotics or other medications to treat your condition.

So, while surgery may not be a permanent cure for your sinus problems, it could help you on the way to freer breathing.

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Types, recovery, risks, and alternatives

Sinuses are cavities inside a person’s skull that are situated around the eyes and nose and within the front of the face.

These cavities help to make the skull lighter. They also produce mucus that adds moisture to the nasal passages. The mucus provides a protective layer to help keep out unwanted particles like pollutants, dirt, and infectious organisms.

Sinuses are lined with cilia, which are very fine hair-like cells. The cilia help to drain mucus through the passages of the sinuses and out into the nose.

Sinus surgery is a procedure that aims to open the pathways of the sinuses and clear blockages. This is an option for people with ongoing and recurrent sinus infections, for people with abnormal sinus structure, or abnormal growths in the sinus.

A doctor will often attempt other treatments and procedures before resorting to surgery. If these don’t work, surgery may be carried out.

Sinus surgery can be done with little discomfort. It is a brief procedure that has few complications.

Share on PinterestSinusitis is an infection in the nasal passages which can cause pressure, headaches, a stuffy nose, and congestion.

The goal of the surgery is to remove whatever is blocking the drainage pathways of the sinuses. This may include removing:

• thin pieces of bone
• mucous membranes
• nasal polyps
• swollen or damaged tissue
• tumors or growths blocking the nasal or sinus passage

A person may require sinus surgery to treat a variety of issues. Common reasons include sinusitis and nasal polyps.

Sinusitis

Sinusitis is the swelling of the nasal sinuses or passages. It is sometimes called a sinus infection. A person with sinusitis may have the following symptoms:

• pressure around the nose, eyes, or forehead
• a stuffy nose
• thick and discolored nasal drainage
• a cough
• head congestion and headaches
• bad-tasting post-nasal drip
• blocked ears or changes in hearing

Nasal polyps

Nasal polyps are swellings of the nasal lining inside the nasal passages and sinuses. They can vary in size but are usually teardrop-shaped.

Larger polyps or clusters may lead to breathing issues and can affect someone’s sense of smell. They can also block a person’s sinuses leading to infections.

Some people may experience no symptoms from nasal polyps. However, common ones include:

• a blocked nose, leading to difficulty breathing
• a runny nose
• recurrent sinus infections
• post-nasal drip
• a reduced sense of smell or taste
• facial pain
• headaches
• snoring
• sleep apnea

Other reasons

Sinus surgery may also be required due to other infections, ongoing blockages, abnormal growths, and other issues that cause inflammation in the nasal passages and sinuses.

The most common type of sinus surgery is endoscopic sinus surgery. However, there are other procedures that may be carried out.

Functional endoscopic sinus surgery (FESS)

FESS is carried out with a tool called an endoscope. This is an illuminated, thin fiber-optic tube. The endoscope is inserted into the nose to reach the openings of the sinuses.

Share on PinterestThere are several different options for sinus surgery.

Micro-telescopes and surgical instruments can then be passed down the endoscope and used to carry out the procedure. The surgeon will use these tools to remove obstructive tissues and other blockages to clear the sinuses.

The entire procedure is carried out through the nostrils and leaves little to no scarring. Some swelling may occur, but it will disappear quite quickly.

A person who has this surgery will usually only feel mild discomfort for a short period of time.

FESS can be performed frequently. It can also be carried out on an outpatient basis.

Image-guided surgery

Image-guided endoscopic surgery is a newer procedure that may be recommended for severe forms of sinus blockages or after previous sinus surgeries.

In addition to using an endoscope, this type of surgery uses a near-three-dimensional mapping system to show the surgeon the position of the surgical instruments. This is done using CT scans and infrared signals.

Using this guidance, a surgeon can navigate difficult sinus passages and remove tissues and other blockages accurately.

Caldwell-Luc operation

This procedure is less common and more invasive. It tends to be carried out when there is a growth present inside the sinus cavity.

The Caldwell-Luc operation aims to remove growths and improve sinus drainage. It creates a pathway between the nose and the cavity beneath the eye called the maxillary sinus. This window then aids drainage.

The surgeon makes a cut in the upper jaw, above one of the second molar teeth inside the mouth. They then enter the sinus cavity through this cut. This surgery may be performed under local or general anesthetic.

After sinus surgery has taken place, nasal packing may be used. Nasal packing is the insertion of sterile gauze-like material into the nasal passage to control bleeding.

Use of packing depends on the type of surgery performed. The packing can be absorbable and will dissolve over time. If the packing is non-absorbable, a doctor will have to remove it.

Recovery periods vary depending on the surgery performed and other factors such as age and general health. However, many people experience very little discomfort after sinus surgery. Most individuals can go home the same day as surgery.

Depending on the extent of the surgery, a person may be given prescription pain medication during recovery. After the operation, it’s common to experience:

• mild discomfort
• fatigue
• nasal congestion
• small amounts of bleeding

People should closely follow their doctor’s instructions for aftercare and take all medications as prescribed. They may have to make changes in their daily routine for the first 2 weeks after surgery.

Common medications prescribed after your procedure often include saline rinses, steroids, and antibiotics.

The complications that can occur during sinus surgery are mostly rare and include the following:

Bleeding

Bleeding after surgery tends to happen within the first 24 hours. However, it can sometimes occur later, after days or even weeks. If a clot develops within the bony partition between the nasal passages, commonly called the septum, then it must be removed.

Intracranial complications

The septum attaches to the roof of the nose. This thin layer of bone may be damaged during sinus surgery. However, this is a very rare complication.

Brain fluid can leak into the nose and, in severe cases, can lead to an infection in the lining of the brain such as meningitis. While this issue is extremely rare, it is often identified and repaired while the initial surgery is taking place.

Share on PinterestAlthough eye damage is rare, surgery may cause bleeding or watery eyes.

Damage to the eye or surrounding tissue

As the sinuses are so close to the eye, bleeding can sometimes occur into the eye. This happens when the thin layer of bone that separates the sinus from the eye is damaged. This is rare and, again, is usually spotted and treated while the surgery is taking place.

In extremely rare instances, visual loss and blindness have been reported. There have also been rare reports of damage to the muscles that move the eye, which can lead to temporary or permanent double vision.

Other instances may lead to a change in how the tear ducts work, causing excessive tearing.

Changes to a person’s voice

Sinuses affect the resonance of a person’s voice. A complication of sinus surgery can sometimes lead to a change in someone’s voice.

Loss of smell or taste

After sinus surgery, a person’s sense of smell usually improves due to the airflow being restored. However, it can worsen in rare cases depending on the extent of swelling or infection. This is often temporary but can be prolonged.

Infection

Dealing with sinus infections is the main reason why sinus surgery is done. A person with sinusitis can develop other infections in this area as a result of surgery.

However, this complication is also possible if a person doesn’t undergo surgery for a long-term sinus infection.

Nasal issues

Sinus surgery usually improves airflow. However, in rare cases, surgery can worsen this. Small amounts of scar tissue may also build up in the nasal passage that will require another procedure to remove.

Before resorting to surgery, a doctor will attempt a variety of other treatments. There is a range of medications that may be issued, as well as other procedures that may improve symptoms.

These other treatments include:

• antibiotics
• nasal saline rinses or sprays
• nasal decongestant sprays
• nasal steroid sprays
• oral steroids
• allergy medications
• antihistamines

Methods for removing cysts of the maxillary sinus

Many scientific and practical articles have been published about cysts of the maxillary sinuses. To date, there is no reliably established cause of cysts. Often they are discovered by chance when examining patients with headache.

The main treatment for maxillary sinus cysts is surgery. Various surgical approaches have been developed to remove cysts. But, unfortunately, we have to state that in practice, to remove cysts of the paranasal sinuses, the classical method of surgery on the maxillary sinus according to Caldwell-Luc is often used.

It is worth noting that we are talking about rhinogenic sinus cysts, not odontogenic. Odontogenic cysts are an independent nosological form and their removal has its own characteristics.

There are false and true rhinogenic cysts. The difference lies in the presence of an epithelial lining in true cysts [1]. More often we are dealing with false cysts, which are considered as an accumulation of fluid under the epithelium of the sinus mucosa. The localization of cysts is very different, but more often they are found on the lower wall of the maxillary sinus. The size of the cysts is also different.

If a cyst is detected, regardless of the reason for the examination of the patient, he should be carefully questioned and the state of the intranasal structures should be studied. In these cases, you can find a lot of predisposing moments: the presence of allergies, a history of frequent respiratory diseases, a permanent violation of nasal breathing, etc.

On examination, most often you can see a deviated septum and other violations of the intranasal structures, the list of which would take more than one page. If a cyst is found on an X-ray or computer image, the condition of the nasal cavity should be paid special attention.

The rhinogenic origin of most pathological processes in the paranasal sinuses is well proven and this should not be forgotten. Detected changes in the nasal cavity should be eliminated. Since such a patient usually gets used to some symptoms or diseases, it is necessary to adequately evaluate the data of endoscopy, computed tomography of the nasal cavity and paranasal sinuses with an explanation of the prospects for the further development of the identified changes and their impact on the patient’s quality of life and health.

There are several surgical approaches to remove cysts, in particular the maxillary sinus. Given the excessive trauma of radical surgery on the maxillary sinus, let’s focus on modern endoscopic methods.

There are such methods as microsiniotomy and cyst removal through the middle nasal passage [2, 3]. These methods have proven themselves well [4]. But with micromaxillary sinusitis, 31.25% of patients have impaired function of the trigeminal nerve [4]. But what if this cyst is small, located in the anteromedial angle of the maxillary sinus and it is a problem to remove it through the middle nasal passage? There is a need to significantly expand the fistula of the sinus, and this is an undesirable injury. We understand quite well when it is necessary to intervene by a minimally invasive and when by a radical method in the area of ​​the osteomeatal complex. We are trying to preserve the uncinate process. A method of balloon dilatation of the anastomosis has appeared, which makes it possible to minimally injure the structures of the osteomeatal complex.

Micro maxillary sinusectomy can be used. What trocar should be used? The point is not in the author’s version of the instrument, but in its shape and diameter.

Only an endoscope can be inserted through a standard trocar, the sinus can be examined, but it must be removed blindly if there is no special instrument (Fig. 1). Special tongs have a working part with a controlled change in the angle of the working part (Fig. 2). These forceps are inserted into a standard trocar, the sinus cavity is examined through a 1.7 mm endoscope, and by changing the angle of the working part, the cyst membrane is captured and removed. The disadvantage of the tool is its rapid wear and high price.

Rice. 1. Trocar V.S. Kozlov.

Rice. 2. Forceps combined with an endoscope for removing cysts.

A wide trocar in the form of an ear funnel makes it possible to visually remove the cyst, but the bone wall is more injured, and often the second branch of the trigeminal nerve with it. You can open the sinus through the front wall, making a hole with a bur. During micromaxillary trocar in the form of an ear funnel, the bone structures of the anterior wall of the maxillary sinus break and penetrate into the sinus cavity. Therefore, a more gentle way is to open the front wall with a bur [4, 5].

The known access to the maxillary sinus through the lower nasal passage was left without due attention. It is well described in the classic manuals on intranasal surgery and in the book by F.S. Bokshtein [6]. But this method also has its own characteristics. We are talking about trauma to the nasolacrimal canal during puncture of the maxillary sinus, and when opening the sinus through the lower nasal passage, the likelihood of injury to the nasolacrimal canal is more likely. So what to choose, what approach?

As always, the question of approach is decided individually. In this work, I express my opinion in favor of the surgical approach, guided by the following considerations.

First of all, to be or not to be an operation? If the patient has recently suffered acute rhinitis of various etiologies and at the same time a slight swelling of the mucous membrane and the presence of a small cyst are found in the sinus, there is no need to rush the operation. All these changes may disappear. An indication for surgery in the presence of a cyst should be considered a headache. A large cyst can more often cause discomfort and facial pain. Any headache in the presence of a cyst of any size in the sinus dictates the need for its removal.

Consider three options. In the presence of a large cyst, a thorough examination of the nasal cavity through the endoscope is necessary (Fig. 3). During the operation, the detected violations of the intranasal structures are eliminated. The necessary correction of the septum and turbinates is carried out. The structures of the ostiomeatal complex of the affected side are examined. If there is a block, it must be eliminated with the least possible resection of the uncinate process. Resection is carried out with a reverse puncher in the lower part of the process. The anastomosis with the sinus is being restored. An inspection is being carried out. A large cyst is well visualized, grasped with forceps and removed (Fig. 4).

Rice. 3. 4mm endoscope 45 degrees. Middle nasal passage. Large maxillary sinus cyst.

Rice. 4. 4mm endoscope 45 degrees. Large maxillary sinus cyst. Removal of the cyst with Blaxley forceps.

As a rule, only part of the shell can be removed at the first moment. Fluid pours out of the cyst, its shell shrinks. By suction, the shell is attracted to the anastomosis and its remainder is removed. The sinus is examined through a 45 degree endoscope or through an endoscope with a variable angle of view from 30 to 90 degrees. The remainder of the shell can be removed with Binner forceps (Fig. 5). On the second day after the operation, the sinus is washed with saline, and the patient can be released for outpatient observation.

Rice. 5. Binner forceps.

If the cyst is small in the zygomatic pocket or on the lateral wall of the sinus, it is more convenient to remove it using the micro maxillary sinusectomy method. The standard Storz trocar causes minor surgical trauma, but, as already noted, only an endoscope can be passed through it. You can aim the trocar tube at the cyst, bring the shaver to it and remove the sheath. Then check the result. This procedure is quite successful, but the removal occurs without visual control. A small hole made by a burr in the anterior wall of the maxillary sinus after a small incision in the mucous membrane makes it possible to visually remove the cyst located at the bottom of the sinus cavity and in the zygomatic pocket.

Trocars in the form of an ear funnel allow you to remove the cyst under visual control, but the trauma to the soft tissues and bone wall that occurs in this case is much greater. When approaching through the anterior wall, the branches of the trigeminal nerve are always injured, which, at best, is accompanied by a short decrease in the sensitivity of the upper lip. In rare cases, severe trigeminal neuralgia occurs.

Approach through the lower nasal passage is indicated when the cyst is located in the anteromedial angle of the sinus. Such a cyst can be removed through the middle nasal passage only with a significant expansion of the anastomosis and the use of endoscopes with a variable angle of view. The approach through the lower nasal passage excludes trauma to the branches of the trigeminal nerve and is performed as follows.

Using a nasal mirror or raspator, the inferior turbinate is displaced medially, the inferior nasal passage is opened (Fig. 6). A grooved chisel 5-6 mm wide is installed on the lateral wall of the lower nasal passage behind the edge of the piriform opening. It is necessary to study the computer image well and determine the thickness of the bone of the edge of the piriform opening, since by setting the chisel too anteriorly, the surgeon can go into the soft tissues of the cheek, which is unacceptable. It is necessary to take into account the height of the bottom of the maxillary sinus. The chisel is pressed at the level of the bottom of the nasal cavity below the puncture point of the maxillary sinus. With a light blow, the chisel pierces the lateral wall of the lower nasal passage, which is displaced in the medial direction by the same chisel. An overview of the bottom and lateral wall of the sinus opens (Fig. 7). A sufficiently wide opening is created for visual removal of a cyst or foreign body, polypous tissue. You can work as a shaver. Through this approach, the entire sinus can be viewed well using a variable-angle optic (Fig. 8).

Rice. 6. The lower sink is shifted to the partition. The lower nasal passage is open.

Rice. 7. An approach to the sinus has been created.

Rice. 8. Endoscopy of the left maxillary sinus. A 4-mm 45-degree endoscope was inserted into the maxillary sinus through a hole in the lateral wall of the lower nasal passage. A cyst is seen in the anteromedial angle of the maxillary sinus.

Then the lateral wall of the lower nasal passage is shifted laterally to its original place. As a rule, the edges of the mucous membrane are in contact. The lower sink is also installed in its original place. It is imperative to monitor the state of the osteomeatal complex. If there is a block, it must be eliminated. The natural fistula can be expanded with a spoon to open the frontal sinus by the type of balloon dilatation. After a day, the sinus should be washed. Irrigation can be performed through the lower nasal passage by inserting the needle through the site of the surgical approach or through the middle nasal passage.

Nasal tamponade is an individual matter, but is generally not required for all of the above methods. The patient can be released for outpatient observation the next day after the operation.

Tooth root in the maxillary sinus

The most common reason for visiting the ENT department of our Center is a foreign body in the maxillary sinus. Usually these are fragments or even whole roots of the upper chewing teeth, which anatomically border on the sinus, break off during rough removal and penetrate into its lumen. For more than 20 years, Doctor Levin has been helping patients after unsuccessful tooth extraction. Programs of sparing surgical treatment have been developed. Operations are performed in medical sleep by experienced maxillofacial surgeons with ENT training .

Why the roots of the tooth get into the sinuses

The maxillary sinus (maxillary sinus) is normally filled with air, its lower wall, lined with epithelial tissue, is very thin, separating the sinus from the oral cavity.

The most common cause of dental roots getting into the sinus is medical errors. For example, if the root is located in the maxillary sinus or is separated from it by a thin layer of bone, if the root system of the teeth is massive, intertwined. Complicated tooth extraction requires great experience and skill of the doctor. The use of brute physical force, haste can lead to damage and perforation of the thin bone layer between the oral cavity and the nasal sinus. And the fragments of the roots go straight to the sinus.

The anatomical features of the patient only complicate the situation:

• Individual features of are the roots of premolars and molars close to the sinus wall. Sometimes only 1 mm separates them from the bone edge. Some do not even have this millimeter – the roots of the tooth are initially located in the sinus itself and are separated by the thinnest mucous membrane.
• Thinning of the septum – melting of bone structures as a result of periodontitis, pulpitis, cysts and other inflammatory diseases of the teeth.
• Loosening of bone tissue – caused by various diseases of the body as a whole, such as osteoporosis.

How to avoid the consequences

The situation can be prevented by proper planning of the removal on a computed tomography, the consequences can be avoided by following gentle removal protocols.

Operation planning

If a standard extraction protocol is used in patients at risk, sinus perforation and related complications are certain. But to determine the thickness of the bone septum, the location of the tooth roots is possible only on the image that the computer tomograph builds in the extended ENT mode. Not every clinic has such equipment. In our Center, this allows us to make a high-precision computer tomograph SIRONA-SIEMENS and a diagnostic software package GALILEOS. Unlike conventional dental images, it allows you to assess not only the condition of the teeth, but also to fully analyze the condition of the maxillary sinuses. Based on the information received, the surgeon plans the operation, taking into account possible risks.

Gentle disposal

Rough actions of a doctor without taking into account individual parameters are a direct threat of sinus perforation and penetration of fragments of dental roots into it. In our Center, complex extraction of teeth adjacent to the maxillary sinuses is carried out only by maxillofacial surgeons with an understanding of the structure of the maxillary sinuses. We do not use chisels, saws and other punitive tools that can damage not only the tooth itself, but also the surrounding bone tissue. PiezoSurgery®, a gentle, minimally invasive ultrasound protocol, is used. The device gently acts on hard tissues, while turning off when approaching soft structures – gums, nerves, blood vessels, sinus mucosa.

Postoperative control

Regardless of the complexity, any extraction of teeth adjacent to the maxillary sinuses must end with mandatory X-ray control on CT. If perforation nevertheless occurred and fragments of roots were found on the image, there are 9 of them0099 The extraction and closure of the perforation must be immediate. Correcting the situation here and now is not difficult at all. Otherwise, a fistula may form between the oral cavity and the sinus. This is due to the fact that bone tissue is always restored much more slowly than epithelial tissue. That is, the gum will close the hole formed faster, and the bone tissue will simply have nowhere to grow. Such a message is fraught with the penetration of food into the lumen of the sinus, constant infection, inflammation of the sinuses. And the presence of a non-sterile foreign body will further aggravate the situation.

What symptoms should alert you

If you have recently had a posterior tooth removed in the upper jaw, carefully monitor your condition.

Suspicion of sinus perforation should cause:

• air bubbles, whistling and squelching in the hole of the extracted tooth;
• frothy yellowish or bloody nasal discharge;
• suspicious organic smells in the nose and mouth without cause;
• nasality, change in voice timbre.

Without help, the perforation will never heal on its own, a fistula will form between the oral cavity and the sinus, and the infected tooth root will remain in the sinus lumen. A complication in the form of a foreign body in the sinus can give rise to odontogenic sinusitis, that is, dental sinusitis that has arisen due to an infection that has penetrated from the oral cavity.

Inflammation of the maxillary sinus develops with characteristic symptoms:

• Nasal congestion and nasal breathing in general
• Abundant mucous discharge, not similar to a common cold
• Persistent unpleasant smell from the nose of a putrid nature
• Headache of unknown etiology
• Unpleasant sensations in the nose and cheekbones – pain, feeling of pressure and fullness
• Signs of intoxication – drowsiness, lethargy , nausea, chills, fever

What is the dangerous situation

The situation is complicated by the fact that symptoms can sometimes appear the next day, and sometimes inflammation can occur in a latent form, manifesting itself gradually even after several months or years. It all depends on the individual response of the body’s immune system, the size of the foreign body and its sterility. A person may not feel, not notice, suppress painkillers, or not pay attention to body signals at all.

Ignoring the problem can lead to serious complications:

• Fouling of a foreign body with secondary infections, formation of neoplasms
• Infection of adjacent tissues, development of periostitis and osteomyelitis of the upper jaw
• Transition of inflammation to other cranial sinuses – sphenoid, frontal and ethmoid

Due to the immediate proximity of the brain, the occurrence of an infectious lesion of the meninges is not excluded – meningitis or meningoencephalitis. Diseases that are life-threatening or even fatal .

Why it is worth entrusting treatment to the ENT department of dentistry “Doctor Levin”

ENT dentistry is a comprehensive approach to the treatment of diseases of odontogenic origin. Symbiosis of two directions – dentistry and otolaryngology.

Symptoms of odontogenic inflammation of the sinus are very similar to the manifestations of the next seasonal SARS and rhinogenic sinusitis. A person first of all goes to the ENT clinic, where without an adequate diagnosis, the connection with the extraction of teeth is not carried out. Standard treatment is prescribed, which, without eliminating the cause, does not bring results. Doctors, treatment regimens change, painful punctures are prescribed, but relief does not come. The person becomes a hostage of the situation.

An experienced doctor should carefully collect an anamnesis, asking the patient:

• whether he was at the dentist, when, what teeth he treated
• whether he has complaints of pain in the teeth of the upper jaw
• inflammation of the maxillary sinus is observed on both sides or with only one, since in our case the inflammation is usually unilateral.

But the problem of state medical institutions is the narrow specialization of doctors, the lack of joint consultations, and inadequate examination. This leads to errors in the diagnosis and choice of treatment tactics. Only a maxillofacial surgeon with ENT training, on the basis of a thorough diagnosis, is able to identify pathology, treat quickly, accurately and efficiently.

Our specialists are candidates of medical sciences, surgeons who have undergone special ENT training. They are well versed in the structural features of the maxillofacial region. The most complex operations are performed daily to eliminate the complications of traumatic and inflammatory processes affecting the oral cavity and adjacent sinuses.

How we treat

Only surgical treatment – without removing the root of the tooth from the maxillary sinus, as a source of the inflammatory process, recovery is impossible.

Diagnosis and planning

Thorough diagnosis is the key to successful treatment. The modern high-precision Sirona Galileos 3D tomograph with ENT-mode settings allows you to examine the condition of the upper jaw and maxillary sinuses. Determine the exact location of the tooth root, identify the extent of the inflammatory process, the degree of its activity and spread to neighboring areas. Based on the data obtained, the tactics of further treatment is determined.

3D tomography allows you to get a complete picture of the localization of the root in the sinus, the extent of the inflammatory process operations. Sanitation of the entire oral cavity is mandatory – hygienic cleaning is performed, caries is eliminated, the canals of adjacent teeth are healed.

Home medications, including antibiotic therapy, are prescribed for the healing period. After 10-14 days, we invite the patient to remove the sutures, assess the quality of treatment. We carry out a control CT scan, set a date for a medical examination.

Sedation instead of general anesthesia

Operations in our Center are absolutely comfortable for patients – in a state of controlled drug sleep.

A person is in a state of pleasant drowsiness, and, moreover, can respond to the doctor’s requests, depending on the degree of influence. The nervous system is in a state of complete rest, there are no unpleasant sensations at all. The risks of undesirable consequences are minimized, the exit from artificial sleep is easy, without the complications of general anesthesia.

Sedation is not general anesthesia !

Severe headaches, confusion, memory loss, nausea and dizziness are all complications of general anesthesia. Therefore, drugs are not used in our Center. Only ultrashort-acting sedatives Propofol and Diprivan are absolutely safe and are excreted from the body in 30-40 minutes.

Levin Dmitry Valerievich

Chief Physician and Founder of Doctor Levin

Advantages of sedation over general anesthesia:

• milder, non-toxic effect on the body
• does not impair breathing function, connection to a ventilator is not required
• comfortable awakening without side effects such as nausea, headache, chills
• sedative drugs are eliminated in 30-40 minutes , narcotic – 1-2 days
• can be used for patients with some allergic reactions
• suitable for people with nervous system disorders, panic attacks, epilepsy

Sedation is a rescue for hypertensive patients and heart patients who are able to bring themselves into a hypertensive crisis during the operation. Together with sedatives, a cocktail of drugs is selected that corrects blood pressure and heart function.

Options for extracting the root of a tooth

Depending on the complexity of the clinical picture and indications, the operation is performed according to one of four options. They differ in the way of forming access to the maxillary sinus.

Standards and technologies of our Center

We have done everything possible to ensure that surgical interventions are safe, less traumatic, without complications and relapses, and create conditions for patient comfort during surgery.

3D computer diagnostics – for reliable results

Ultra-precise SIRONA-SIEMENS tomograph with ENT settings provides a detailed study of odontogenic and ENT pathologies

• The most informative assessment of the condition of the sinuses
• Determining the location and size of the tooth root
• Identification of the extent of the inflammatory process

PiezoSurgery® – for gentle work

NSK VarioSurg 3 ultrasonic scalpel is used

• Provides accurate work with bone tissue
• Gently accessing the maxillary sinus
• Damage to nerves, vessels or sinus lining excluded

Dental microscope – for error-free work

The Seiler dental microscope increases the visibility of the working field

• Optical control of the surgeon’s actions
• Thorough revision of the maxillary sinus
• The risk of medical errors is reduced to zero

Sedation – for stress and pain free treatment

Treatment with comfort, without psycho-emotional and physical stress

• Ultrashort-acting preparations are absolutely safe
• No consequences of general anesthesia
• You can go home in half an hour

Rehabilitation period

After treatment in our Center, you will need only a couple of days to fully recover from surgery

Without hospitalization

Operations are performed by experienced maxillofacial surgeons using the PiezoSurgery gentle ultrasound protocol under the control of a dental microscope. This ensures the clarity, accuracy, safety and accuracy of the actions of doctors. The use of sedatives does not adversely affect the body. Therefore hospitalization for a week, which is mandatory in hospitals, you do not need .

For patients in need of special care, our Center has a day hospital ward. This is a postoperative support service for patients with cardiac diseases, hypertension . You will be observed by your attending physician, under the supervision of an anesthesiologist without mandatory hospitalization.

Accelerated Recovery Package

For a quick recovery, we offer an accelerated rehabilitation package with procedures that improve healing.

Microcurrent therapy

Microcurrents increase the synthesis of ATP, protein and lipids, accelerate tissue regeneration. Enhance lymph flow and blood flow, stimulate cellular respiration, increase tactile sensitivity. Helps to eliminate swelling and pain, muscle spasms.

Lymphatic drainage preparations

Preparations-biomodulators with lymphatic drainage action contain a complex of peptides and microelements. Improve blood circulation, postoperative wound healing. They relieve swelling, prevent hematomas, tighten the contour of the face.

PRP Plasma Therapy

Platelet-rich plasma injections regulate wound cleansing processes, reduce inflammation and quickly relieve pain. Improve the outflow of lymph, prevent the development of hematomas and swelling.

Home care

You will receive all the necessary drugs for treatment in the postoperative period at the Center. We value your personal time, so you do not have to run around pharmacies in search of the necessary medicine. You will receive painkillers, anti-inflammatory, antibacterial agents. Take them according to the instructions that are in the medicine package.

The post-surgery kit includes all the necessary medicines to improve well-being and prevent complications.

Also learn the rules of conduct and some restrictions on the healing period after surgery. Please do not ignore medical recommendations to avoid complications.

If you have any questions, please contact the post-operative service 24/7, our Center is open seven days a week and holidays. The number is on the recommendation brochure.

Frequently Asked Questions

Do I need to have an examination before the operation?

Your treatment always starts with a doctor’s consultation. If your history reveals systemic diseases of the body that need to be taken into account when using sedation, after a conversation, the doctor will prescribe the studies you need. Most often this is an ECG, blood tests.

Levin Dmitry Valerievich
Oral and Maxillofacial Surgeon, Head Physician of Center

How long does the operation take?

It all depends on the clinical situation and the treatment protocol used. If the case is simple, the operation is simple, lasting no more than an hour. If the inflammatory process in the sinus is large-scale, if the roots of the teeth have complex localization, a more serious operation is performed, which will take up to 4 hours.

Levin Dmitry Valerievich
Oral and maxillofacial surgeon, chief physician of the Center

How long does recovery take?

Thanks to the complex of accelerated rehabilitation, which is carried out directly on the day of the operation, you can return to normal life immediately. The pain syndrome will not bother you for more than three days. Complete healing of the wound takes two weeks.

Levin Dmitry Valerievich
Oral and maxillofacial surgeon, chief physician of the Center

I’m very afraid of anesthesia.