Pre Sinus Surgery Information

Chronic sinus problems are a very frequent condition in North Texas. It is important that all medical concerns have been addressed prior to pursuing a surgical option.

Imaging

Radiological imaging allows your physician to determine the extent of sinus disease prior to considering surgery. Computerized tomography (CT) is the best imaging technique to assess the anatomy of your child’s sinuses and to determine which sinuses are involved.Sinus x-rays or MRIs are not as useful to assess chronic sinus disease.

Adenoidectomy

Adenoidectomy involves surgical removal of the adenoids. Adenoids are lymph tissue that lies in the upper airway between the back of the nose and the throat. The procedure is considered the first line of surgical therapy for chronic sinus disease in young children.

Removal of the adenoids serves to eliminate a potential source of structural obstruction from the back of the nose and, perhaps more importantly, removes a source of chronic infection from the back of the nose known as a “biofilm”. Adenoidectomy may be indicated for the following symptoms:

• Nasal obstruction
• Chronic or recurrent sinus infections
• Snoring

This surgery takes about 20 minutes and is carried out under general anesthesia, usually in an outpatient setting.

Endoscopic Sinus Surgery/FESS

Functional Endoscopic Sinus Surgery (FESS) is a surgical procedure that involves the removal of small bits of bone and soft tissue from the nasal cavity to open the normal drainage pathways of the sinuses. FESS is used to treat:

• Chronic Sinusitis
• Recurrent Acute Sinusitis
• Nasal polyps
• Allergic Fungal Sinusitis
• FESS is a term that encompasses several different surgeries.

The severity of your child’s sinus disease will determine which of the FESS procedures is utilized. Each procedure addresses a different sinus:

 

• Maxillary antrostomy – involves the maxillary sinusthat is located in your child’s cheeks
• Ethmoidectomy – can be limited to the front part of these sinuses (anterior) or may involve both the front and the back of these sinuses (total) that are located between your child’s eyes
• Frontal sinusotomy – involves the frontal sinus that is located in your child’s forehead
• Sphenoid sinusotomy – involves the sphenoid sinus that is located in the very back of your child’s nose, almost in the middle of their head

Endoscopic sinus surgery takes between 1 to 3 hours and is performed with yourchild under general anesthesia. The procedure is performed entirely through a child’s nostrils with the aid of special instruments and nasal endoscopes (small cameras). Children who undergo the surgery are often discharged home the same day.

Balloon Sinuplasty

Balloon Sinuplasty is also called catheter-based dilation of the sinus ostia (the opening that connects the sinus to the nasal cavity) and is performed for the treatment of blocked sinuses. The procedure involves inserting a balloon catheter inside your child’s nose to open the blocked sinus. The balloon is inflated to remove any obstructions and improve drainage. The sinus contents can be cultured and the cavity is irrigated with salt water (saline) at the same time.

The procedure is effective in relieving symptoms of chronic sinusitis involving the maxillary or frontal sinuses. Balloon sinuplasty takes approximately 1 hour and is performed with your child under general anesthesia. The procedure is performed entirely through a child’s nostrils with the aid of nasal endoscopes (small cameras). Children who undergo the surgery are often discharged the same day.

Computer Guided Sinus Surgery

Computer Assisted Sinus Surgery involves a three-dimensional mapping system that facilitates the use of both surgical instruments and a high-speed computer during the procedure.

Your child’s ENT for Children surgeon begins the procedure by fitting a head frame on your child that link the surgical instruments to the computer and allows the surgeon to see real time where the instruments are within your child’s sinuses on the CT scan. The process works with a CT scan that is loaded into a computer prior to the surgery. Since the scan is displayed on a large screen in real time it allows your ENT for Children surgeon to navigate through complex sinus passages in a more precise manner. The locations of the instruments within a sinus cavity are displayed with cross hairs on the screen. The procedure is often utilized when a child has had previous endoscopy sinus procedures or when the chronic sinus condition has distorted the normal sinus anatomy.