My doctor has suggested that I consider sinus surgery. What does that involve?

Q.I’ve had bouts of sinusitis for several years. Although various medications seem to take care of these attacks, my doctor has suggested that I consider sinus surgery. What does that involve?

A.Sinusitis is an inflammation of the sinus cavities in the head.  And because these attacks keep happening, your doctor has suggested surgery. The goal is to enlarge the sinus cavities so that they can drain more effectively. With improved drainage, the damaged sinus lining can return to normal.

The first step is to pinpoint the problem area. That may involve a number of tests, including a CT scan. Previously, sinus surgery required that the sinuses be entered through the
cheek—a major procedure that left prominent scars. Today the surgery is much less invasive.

There are 3 basic options.

• One is functional endoscopic sinus surgery (FESS). An endoscope (a thin flexible viewing tube) is inserted through the nostrils so that the doctor can look closely at the sinus cavities and remove any obstructive tissue. The procedure can be performed on an outpatient basis. It leaves no scarring.
• Another approach is image-guided surgery, which combines CT scanning with infrared technology to monitor positioning of surgical instruments. This method may be indicated for severe cases of long-term sinusitis or when abnormal sinus anatomy makes FESS inappropriate.
• A third option is called the Caldwell-Luc operation. It focuses on improving drainage of the maxillary sinus. One such sinus is under each eye. The surgeon goes through the upper jaw to reach this sinus and then creates a “window” to connect the sinus to the nose.