Sinusitis and Endoscopic Sinus Surgery

Sinusitis and Endoscopic Sinus Surgery

Sinusitis and Endoscopic Sinus Surgery Endoscopes are devices that have light and optical lenses at one end so that when viewed from one end, the image at the other end can be seen directly. Depending on the placement of the lens at the end of the endoscope, there are 0º, 30º, 45º, 70º, angled endoscopes. Endoscopes allow us to see areas inside the nose that we cannot see directly. A camera is attached to the endoscopes so that the image can be transferred to the computer and monitor. Sinus surgery using endoscopes is called endoscopic sinus surgery. Endoscopes are used in the diagnosis and surgical treatment of numerous diseases affecting the nose, sinuses and surrounding areas. These are:

  • Chronic Sinusitis (which do not respond to drug therapy)
  • Nasal Polyp
  • Antrochoanal Polyp
  • Concha Reduction
  • Paranasal Sinus Mucoceles
  • Nasal and Sinus Tumors
  • Cerebrospinal Fluid Leaks
  • Dacryocystorhinostomy (Restoring the flow of tears)
  • Choanal Atresia Repair
  • Removal of Foreign Bodies in the Nose
  • Nosebleed Control
  • Endoscopic Septoplasty
  • Eustachian Tube Dysfunctions
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Thanks to endoscopes, surgeries can be performed entirely through the nostrils without the need for incisions in the nose and face. Moreover, the areas that we cannot reach or see well with classical methods can be reached much easier with endoscopes. It allows surgical intervention only on diseased tissue without damaging healthy tissue. Endoscopic surgery reduces the risk of complications and shortens recovery time. I prefer to perform endocospic sinus surgery under general anesthesia. Prior to surgery, a scan of the patient’s sinuses CT is obtained and the surgery is planned. During the operation, the endoscope is inserted through the nostril and the necessary procedures are performed under direct vision of the tissue using precision instruments developed for endoscopic surgery. The extent of the procedure to be performed varies depending on the disease and its prevalence. For example, in chronic sinusitis, blocked sinus passages are opened and diseased tissue is cleared without damaging healthy tissue. In the case of nasal polyps, all polyp tissues filling the inside of the nose and sinuses are cleaned without touching healthy mucosa. For tumors, it is removed along with the tumor tissue and some of the healthy tissue around it. The duration of the procedure varies depending on the extent. The operation can be assisted with various technical instruments. Microdebrider system: tissue is cut with blades and cleaned by suction. It is commonly used, especially for common nasal polyps, as it reduces both surgical time and bleeding. Balloon sinuplasty involves opening narrowed sinus passages with the use of a catheter. The balloon at the tip of the catheter is inserted into the sinus canal and inflated to widen the canal and empty the sinuses. It can be combined with traditional endoscopic sinus surgery techniques. It can be used for chronic sinusitis affecting the frontal, maxillary and sphenoid sinuses. I prefer to use it in my practice for frontal sinus surgery. Surgical Navigation ( Image Guided Surgery ): with the navigation system in endoscopic sinus surgery, we can see the position of the surgical instruments we use in the nose in three dimensions. In the surgical navigation system, a tomography of the patient’s sinuses is taken and uploaded to the system before surgery, and a special cap is placed on the patient’s head during surgery. In this way, we can see the position of our surgical instruments on the monitor during the operation. The main advantage of surgical navigation is that it cleans the diseased tissue near the base of the skull and brain, eye and optic nerve, and vessels, while reducing the risk of damage to these structures, thus avoiding serious complications. Surgical navigation is not required for routine endoscopic sinus surgery. I personally prefer surgical navigation in people with chronic sinusitis accompanied by nasal polyps who have already undergone surgery and have altered normal anatomical structures. After surgery, there may be mild pain, which can be easily relieved with simple painkillers. During endoscopic surgery, there is no change in the shape of the nose, no swelling or bruising. At the end of the surgery, self-dissolving tampons are placed on the surgical area, and the nostrils remain open. In the first 1-2 days after surgery, there may be bloody discharge from the nose, mucous discharge in the next few days, and then scabbing of the nose. Depending on the extent of the surgery, this may take 2-6 weeks. This scab can be cleared by softening it with normal saline and moisturizing drops. In this process, frequent checkups and intranasal dressings are very important for a healthy recovery. After surgery, if you are doing work that does not require exertion, you can start working after the 5th day. The results of endoscopic surgery vary depending on the disease. The success rate for chronic or recurrent sinusitis ranges from 80-90%. Nasal polyps tend to recur. The duration of recurrence varies from person to person. In addition to the disease, the surgeon’s experience plays a major role in the results.

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