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The sinuses are mucosa-lined cavities in the skull bones. Normally, their secretions drain into the nasal cavities through openings or ducts. These ducts also ensure their necessary ventilation. There are four sinuses on each side of the face, housed in the skull bones that carry the same names: the frontal sinuses are located above the eyes, the maxillary sinuses below the eyes, the ethmoid sinuses between the eyes, and the spheroid sinuses behind the eyes.
Sinusitis (or infection of the sinuses) may involve one or more of the sinuses, on one or both sides. When the drainage and ventilation of the sinuses are blocked, sinusitis usually sets in. The most common causes of blockage include nasal allergies; the common cold; or anatomic blockage related to large or deviated structures, such as a deviated septum, polyps, or other rare lesions. Sinusitis may be acute, chronic or recurrent.
Symptoms vary. They include pressure pains or discomfort over the involved sinuses, nasal discharge, post-nasal drip, nasal blockage, and even cough. A feeling of malaise may be present. Complicated cases may exhibit more severe or other symptoms.
The physician makes a diagnosis after taking a medical history, performing an examination of the area (usually using a small telescope inside the nose after applying an anesthetic spray), and reviewing the X-rays. Cultures are sometimes necessary.
Sinusitis is usually managed using drug therapy, which includes an antibiotic to combat the infection, an anti-allergic treatment if allergies are a suspected cause, decongestants, and pain killers, if necessary.
Most patients with sinusitis respond well to this medical management. When they fail to respond, if the infection keeps recurring, or when complications set in or are imminent, then surgery is considered.
When medical management fails, sinus surgery is recommended. There is more than one surgical option available, depending on the surgeon, the indications, and the sinuses affected. Some surgeries require external incisions, some require incisions under the upper lip and others involve work within the nasal cavities only.
The technique commonly used at present involves intranasal work with the help of fiberoptic telescopes. The telescopes allow better visualization thanks to modern lenses that permit angular vision and thus provide access to areas that were previously not accessible through the intranasal approach. The telescopes also allow the application of the increasingly popular Functional Endoscopic Sinus Surgery (FESS). This technique consists of removing obstructing tissue in a key area of the nose where the commonly involved sinuses drain. The removal of the abnormal tissue restores ventilation and drainage of the sinuses, and therefore their well-being.
Patients opting for a surgical intervention may expect the following:
Hospitalization: Surgery takes around one to two hours, using local or general anesthesia. An overnight hospital stay may be required, along with a nasal packing. Post-operative pain usually is not very bothersome.
Follow-up: Patients should plan on at least two post-operative visits at approximately weekly intervals. During these visits, a local anesthetic is sprayed inside the nose to allow proper cleaning. Plastic implants, if used, also are removed. Usually, patients may resume activities that do not involve physical strain in several days. Physical exercise should be deferred for a couple of weeks.
Possible Complications: As in all surgeries, complications may happen, but they rarely do. General complications include bleeding, fever, infection, pain, and possibly, failure to achieve the anticipated results. Specific complications due to the location of the sinuses may include smell disorders, eye disorders, and central nervous system complications. These complications are very rare and may be managed successfully when recognized early.
If you have further questions or would like to make an appointment, please call the Sinus Center at 617-573-4101.
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