The maxillary sinuses are air-filled cavities located within the cheekbones, representing the largest of the paranasal sinuses. Their primary function is to produce mucus that drains into the nasal cavity, helping to warm, moisten, and filter inhaled air. Maxillary sinus surgery is a procedure designed to address issues that obstruct this natural drainage system. The goal is to clear blockages and enlarge the sinus openings to improve ventilation and alleviate uncomfortable symptoms.
Medical Reasons for Surgery
The most common reason for recommending maxillary sinus surgery is chronic rhinosinusitis, a condition where the nasal passages and sinuses remain inflamed for more than 12 weeks, despite attempts at medical treatment. When medications such as nasal corticosteroids, antibiotics, and saline irrigation fail to provide lasting relief, surgery becomes a consideration. These persistent infections lead to symptoms like constant nasal congestion, thick, discolored discharge, facial pain, and pressure in the cheek area.
Another reason for surgery is the presence of physical obstructions within the nasal and sinus cavities. Nasal polyps, which are noncancerous growths, can develop and block the sinus drainage pathways. Structural problems, such as a deviated septum where the wall between the nostrils is off-center, can also impede airflow and mucus drainage. In these cases, surgery physically remodels the internal nasal architecture to restore normal function.
The decision to proceed with surgery is made after an evaluation by an otolaryngologist, a specialist in ear, nose, and throat conditions. A computed tomography (CT) scan is typically ordered to get a detailed view of the sinus anatomy. This imaging helps the surgeon identify the extent of inflammation and the precise location of any blockages, which informs the surgical plan.
The Surgical Procedure
The most prevalent surgical technique for addressing issues within the maxillary sinus is Functional Endoscopic Sinus Surgery (FESS). This minimally invasive procedure is performed entirely through the nostrils, avoiding any external incisions on the face. The surgeon uses an endoscope, a thin, rigid tube equipped with a light and a camera, to visualize the internal structures of the nose and sinuses on a video monitor. This high-definition view allows for precise surgical maneuvers in a confined space.
With the aid of the endoscope, the surgeon introduces micro-instruments into the nostril to access the maxillary sinus. The main objective is to widen the natural opening of the maxillary sinus, known as the ostium. This may involve removing small pieces of bone or diseased tissue that are causing the blockage. For instance, the surgeon might remove the uncinate process, a small bone, to enlarge the sinus opening. If nasal polyps are present, they are also removed during this process.
The surgery is typically performed while the patient is under general anesthesia. The procedure can last from one to three hours, depending on the complexity of the case and whether both maxillary sinuses are being operated on. In some instances, a septoplasty to correct a deviated septum may be performed at the same time to ensure the nasal passages are clear.
A less invasive alternative for some patients is balloon sinuplasty. In this technique, a flexible guide wire and a small balloon catheter are threaded through the nostril into the blocked sinus opening. The balloon is then gently inflated, which pushes back the surrounding tissue and bone to widen the sinus pathway. After the opening is expanded, the balloon is deflated and removed, and the sinus may be flushed with a saline solution to clear out trapped mucus and pus.
Post-Operative Care and Recovery
Immediately following surgery, patients are monitored in a recovery area as the anesthesia wears off. It is normal to experience some nasal congestion, mild discomfort, and bloody drainage for the first week. Gauze may be placed under the nose to catch this drainage. The surgeon may prescribe pain medication and antibiotics to prevent infection, and patients are typically able to return home the same day.
Patients are instructed to perform regular nasal saline rinses. This practice is important for recovery, as it keeps the nasal passages moist, washes away blood and crusts, and helps prevent the formation of scar tissue. It is also important to sleep with the head elevated and to drink plenty of fluids.
To prevent complications, certain activities must be avoided in the initial recovery period. Patients are advised to refrain from strenuous activities, such as heavy lifting or intense exercise, for at least the first week. It is also important to avoid blowing the nose forcefully, as this can interfere with the healing of the delicate sinus tissues.
During follow-up appointments, the surgeon will examine the sinuses to monitor the healing process. The surgeon may also perform a procedure called debridement, which involves cleaning the sinus cavities to remove any remaining crusts or blood clots. While most people can resume normal activities within a week or two, complete healing of the sinus tissues can take one to two months.