Endoscopic Sinus Surgery

The four sinus cavities, frontal, maxillary, ethmoid, and sphenoid are lined with soft tissue called mucous membrane and covered with cilia. The lining and cilia protect the body from dust, pollen, germs, and other foreign bodies in the air, and humidifies the air entering in through the nose. However, such high exposure to environmental irritants can overwhelm the body’s natural defenses and makes many people susceptible to sinus infection or bacteria-nearly 37 million Americans are affected by sinus disorders annually.

Symptoms of sinus disorders vary widely. Infection from colds or sinusitis can result in facial pain and pressure, discolored mucous discharge, nasal obstruction, reduced smell and taste, headache and fatigue. Most people can be treated with antibiotics, nasal steroid sprays, oral steroids, antihistamines, and saline sprays, although surgery is an option if medical therapy proves to be ineffective. Other factors such as a deviated septum may necessitate surgical treatment.

Endoscopic sinus surgery, is a minimally invasive surgical procedure used to remove blockages in the sinuses for recurring or persistent sinus infections.

During the procedure, a thin lighted tube with a camera on the end is inserted into the nose to let the doctor visually examine the area. Tiny surgical instruments are then inserted to remove the obstructive tissues. Endoscopic sinus surgery does not require any incision, as the whole procedure is performed through the nostrils. Most procedures are performed on an outpatient basis and patients can go home the same day. Today we perform many of these procedures in the office.

Most patients experience a major relief in symptoms such as facial pain and swelling, difficulty breathing and headaches. Endoscopic sinus surgery is also effective in removing sinus polyps, tumors and in repair of CSF leaks and even in providing exposure for removal of brain tumors.

Endoscopic Tear Duct Surgery

Tears usually drain through small openings in the corners of the eyelids, known as puncta, and enter the nose through the nasolacrimal duct. When an obstruction exists, tears cannot properly drain from the eyes and may well up on the surface of the eye and overflow on the eyelashes and eyelids. The eyelids may also become red and swollen with yellow or green discharge.

If this blockage cannot be effectively treated through conservative methods, surgery will likely be recommended. A procedure known as dacryocystorhynostomy or dacryocystorhinostomy (DCR) will be performed to construct a new tear drain. This type of surgery is usually performed as an outpatient procedure, either using local anesthesia and sedation or general anesthesia.

No incision is necessary when undergoing an endoscopic DCR. With the traditional form of this surgery, the doctor would make an incision on the side of the nose, which would leave a scar. With the endoscopic approach, the surgeon uses an endoscope-a thin, flexible, lighted tube with a microscopic camera on the end. The camera helps the doctor guide other tiny instruments, used in the procedure, through the nasal opening to access the tear duct area.

A new tear drain opening is then created, providing a fresh route between the eyes and nose avoiding the obstruction. A tiny stent may be placed in the new tear drain and kept there for several months after the procedure ensuring the duct will remain open. In cases in which the tear drain blockage cannot be cleared, a small drain, known as a Guibor stent or Jones tube, may need to be inserted in the area. This offers a more permanent solution to keeping the tear duct clear.

A major advantage of having an endoscopic DCR is that no incision is made, meaning no scar will form on the face. It is also a less invasive method of surgery, so the recovery is generally both shorter in duration and more manageable.