Sinus Surgery

Functional endoscopic sinus surgery (FESS) is a minimally invasive procedure that opens clogged sinus cavities and improves mucus flow.


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What is Sinus Surgery?

Sinus surgery is a minimally invasive procedure that improves the function of the paranasal sinuses, reduces sinus infections, and improves the symptoms from chronic sinusitis. Modern techniques are called functional endoscopic sinus surgery (FESS) as they aim to restore the natural clearance of mucus from the sinus cavities. While techniques in the 1970s and 1980s were painful and high risk, sinus surgery today has become a much safer outpatient operation and often remarkably little pain.

When is sinus surgery necessary?

Sinus surgery is necessary for those who suffer from chronic sinusitis or recurrent sinus infections when medications are not enough to fix the issues. This is a form of nasal surgery in which the sinus cavities are enlarged and cleaned out to correct the underlying problem.


Here are some of the common reasons why sinus surgery is recommended: 


  • To remove a blockage in a sinus cavity to allow it to drain freely. If the sinus is blocked, an infection can get into the sinus and cause a sinus infection. 


  • To relieve congestion from swelling in the sinus cavities. If you have sinus pressure, one of the causes is inflammation of the sinuses.


  • To remove a tumor in a sinus cavity. 



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What are the types of sinus surgery?

The types of sinus surgery include functional endoscopic sinus surgery, image-guidance sinus surgery, balloon sinuplasty, expanded endoscopic sinus surgeries, and open sinus surgery. 


Functional Endoscopic Sinus Surgery


In functional endoscopic sinus surgery, a tiny camera is placed in the nose and micro tools are used to remove, or excise, the blockage. The surgeon may work on one or more of 8 paranasal sinuses. A maxillary antrostomy is opening the maxillary sinus (or cheek sinus). An ethmoidectomy is performed by removing the ethmoid sinus cells from ethmoid sinusitis and sinus nasal polyps. In a sphenoidotomy, the surgeon opens the hole that connects the nose to the sphenoid sinuses. Finally, a frontal sinusotomy is the opening of the frontal outflow tract, the hourglass tunnel connecting the nose to the frontal sinus.


Image-Guided Sinus Surgery (or Navigated Sinus Surgery)

 

In image-guided sinus surgery (or navigated sinus surgery), the surgeon uses a special "heads-up display" to help guide the surgeon's tools. In some cases, innovative techniques, such as planning tools, virtual cameras, anatomic mapping, and artificial intelligence, are used to improve safety and outcomes.


Balloon Sinuplasty


Balloon sinuplasty is a procedure to dilate the sinus cavities without any cutting. It is can be performed in the office with no or minimal sedation. A tiny camera and a specialized sinus balloon catheter is guided into the sinus openings through your nostrils. The balloon is inflated, opening up pathways for drainage. Then, the balloon is deflated and withdrawn. The procedure can be performed in approximately 30 minutes. You will be able to return to your usual activities right away.


Endoscopic Medial Maxillectomy


Endoscopic medial maxillectomy is an advanced sinus surgery technique for refractory maxillary sinusitis. In this procedure, the wall of the cheek sinus is removed down to the floor of the nose. This allows the surgeon to access the bottom of the sinus cavity to remove sinus pus, polyps, cysts, or tumors. The main advantage of endoscopic medial maxillectomy is that it offers a full view of the sinus, making it easier to remove the full extent of the infection or polyp. This makes it more likely to remove all traces of disease, whether that is an infection, polyp, or cancerous cells in the sinus. Endoscopic medial maxillectomy has replaced many of the indications for which a Caldwell-Luc procedure, an open sinus surgery that accesses the maxillary sinus through an incision underneath the upper lip.


Frontal Sinus Surgery

 

Frontal sinus surgery is an advanced sinus surgery that requires the delicate removal of tissue between the forehead, eyes, and skull base. Because of the narrow tract leading up to the frontal sinus, the sinus is prone to scarring and closure after surgery. This can lead to a recurrence of sinus problems. Expanded endoscopic frontal sinus surgeries may be required to treat conditions such as extensive nasal polyps, mucoceles, osteomas, and tumors of the frontal sinus. Occasionally, a Draf 3 frontal sinus surgery is needed in which the two frontal sinuses are connected to each other using a tiny specialized angled surgical drill. 


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What are the benefits of sinus surgery?

If you experience chronic sinus pressure, congestion, or other symptoms, you may be a candidate for sinus surgery. Sinus surgery greatly relieves the symptoms of chronic sinusitis and has been shown to reduce or eliminate future sinus infections. It may also be used to improve nasal breathing, relieve smell loss, and reduce headaches caused by sinus congestion.



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What are the benefits of sinus surgery? | Functional endoscopic sinus surgery | Dr. Thomas Higgins, Expert Sinus Surgery in Louisville, Kentucky

What are the risks of sinus surgery?

Any surgery has risks and making sure the benefits outweigh the risks is important discussion to have with your surgeon.


Some of the potential risks of sinus surgery include:

  • Nosebleeds
  • Risks of anesthesia
  • Infection
  • Scarring
  • Loss of smell
  • Loss of taste
  • Injury to eyes or vision loss
  • Brain fluid leak


All surgeries have risks, but it is possible to minimize the risks by taking certain precautions and make sure that you are under the care of a qualified and experienced surgeon.



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Frequently Asked Questions

  • Who should I see for sinus infections?

    We recommend you see an otolaryngologist or ENT who has expertise in managing nose and sinus conditions. Dr. Thomas Higgins is a fellowship-trained rhinologist (sinus specialist) and advanced sinus surgeon in Louisville, Kentucky who is dedicated to relieving people's sinus issues. Contact us today to begin your journey back to health.

  • How can I tell if I need sinus surgery?

    The question of whether or not you need sinus surgery is a difficult one. You can't really tell if you need it until you know if the right treatment has been tried for the right symptoms. If you're feeling like you're constantly congested and can't seem to breathe, then you might need surgery. Dr. Thomas Higgins uses an innovative medical approach that takes your sinus symptoms and story in combination with his findings to come up with a highly effective, tailored sinus treatment plan that is right for you. 

  • Does health insurance pay for sinus surgery?

    Health insurance typically covers sinus surgery. If Dr. Thomas Higgins recommends sinus surgery, it is almost a certainty that the procedures will be covered. His dedicated staff reviews the medical necessity with your insurance company on your behalf and, occasionally, Dr. Higgins will even get on the phone with the health insurance doctor representative to aid in the approval process. Breathe easier with Dr. Thomas Higgins, a John Hopkins-trained sinus surgeon. (*Please note that insurance may require a portion of your individual contribution in the form of such items as deductibles, out-of-pocket expenses, and co-pays.)

  • Is sinus surgery painful?

    Many people wonder if sinus surgery is painful. We performed a multi-institutional study on pain after sinus surgery and found that people only had 2-3 pain levels on a scale of 0 to 10 in the first week after surgery. Dr. Thomas Higgins usually does not use nasal packing and the majority of patients report little to no pain. But he does like to tell his patients that everyone is different, some make experience more pain than others.


     Looking for a sinus surgeon in Louisville who does not pack the nose? Make an appointment with Dr. Thomas Higgins today.

  • How long does it take to recover from sinus surgery?

    Sinus surgery usually has a quick recovery. The first part of the healing process occurs over a few days to a week. You may have discomfort and some bleeding from the nose during this time. We ask our patients to avoid strenuous activity for 2 weeks and there are no restrictions after that. You will receive instructions for your care at home, which includes medications and when to call if there are any problems. You will typically have a post-operative appointment a week after surgery to make sure you are healing well from surgery. Please call our office if you have any concerns and our staff will be ready to assist you.

  • Is sinus surgery worth getting?

    People suffering from years of sinusitis will tell you that sinus surgery is definitely worth getting. Sinus surgery is a procedure to help people clear their nasal passages and breathe better. Complications are rare when the surgery is performed by an experienced surgeon. Make an appointment with Dr. Thomas Higgins today if you want to know more about sinusitis and if sinus surgery is worth it for you.